It is simply not acceptable that any patient be left in chronic pain – especially cancer patients. It is also not necessary, as cancer pain, like other pain, can be very effectively treated! The treatments discussed in my earlier columns and book Pain Free 1-2-3 (McGraw Hill) can be very helpful in eliminating cancer pain. To do so effectively, though, it helps to determine where the pain is localized.
Muscle/Myofascial Pain: We often forget that having cancer can throw muscles into spasm for many reasons. Muscle pain often feels like deep organ pain, and we miss the opportunity to treat this simple yet uncomfortable problem. Many treatments can help:
structural/manipulation therapies, which include many hands-on techniques such as chiropractic and osteopathic manipulation, massage, etc. Acupuncture and trigger point therapies can also be very helpful; treating underlying metabolic problems that are throwing the muscles into spasm/shortening; the SHINE Protocol, which often supplies dramatic relief (it is discussed in more detail in my books). In short, it means:
• Sleep: Making sure the patient gets 8 hours of sleep a night is critical. Ask your patients how much deep sleep a night they are getting. Offer natural and even prescription therapies to make sure they get the sleep they need for both growth hormone release and tissue repair. Excellent natural options include herbal mixes (my favorite is the Revitalizing Sleep Formula by Integrative therapeutics), melatonin, and magnesium (a sustained-release magnesium can eliminate diarrhea concerns). The medications Ambien, Neurontin, and even Klonopin can help promote sleep in cancer patients. And don't forget the benefits of a hot bath before bedtime.
• Hormonal support: Especially important in cancer patients is adrenal support.
• Infections, Inflammation, and Impingement: Yeast overgrowth is especially important to consider, and is suggested if the patient has chronic sinusitis or spastic colon. Natural anti-inflammatory herbs can be very helpful. These include willow bark, Boswellia, and Cherry (all three are present in the Pain Formula by Integrative Therapeutics). Some pain presumed to be impingement by cancer is actually caused by secondary muscle spasm as well.
• Nutritional support: This can offer a major benefit, especially as cancer patients are often malnourished. How much this contributes to pain and debilitation is often forgotten. I do not recommend handfuls of pills each day, but rather prefer vitamin powders where a single drink gives excellent overall nutritional support. My favorite is Energy Revitalization System vitamin powder (Integrative Therapeutics), which is outstanding for almost everyone for overall nutritional support. This supplies strong nutrition; advise the patient to take less than the recommended 1 scoop a day if he/she gets diarrhea. Eating three or four servings of fish a day can also have an anti-inflammatory effect.
• Exercise as able: Walking is excellent and keeps the muscles stretched. If the patient is too debilitated, walking in a pool (heated if available) or even doing stretches in a warm-to-hot bathtub can help keep the muscles from locking in a shortened position.
Neuropathic Pain: Characterized by burning or shocklike sensations, nerve pain can occur from both the cancer and the chemotherapy used for treatment. Although mildly relieved by narcotics, nerve pain responds better to medications that alter neurotransmitters such as GABA, serotonin, and norepinephrine. These medications include Neurontin (100 hs to over 3600 mg daily), Lyrica (150–300 mg b.i.d.), Cymbalta (20–60 mg a day), Elavil (10–25 mg HS), and Effexor. Namenda, which I consider to be a waste of money in Alzheimer's (its primary indication), can be very effective for nerve pain and allodynia (where normal touch is painful) when other medications are ineffective.
Natural therapies can be as or more helpful, but may take weeks or months to be fully effective. Be sure that the patient has at least 50 mg of the B vitamins (and B12 at least 500 mcg) daily plus magnesium and inositol (all present in Energy Revitalization System vitamin powder). Also add acetyl-l-carnitine 2000 mg a day (which has been shown to decrease chemotherapy induced neuropathy) and lipoic acid 300 mg twice a day.
Tissue Invasion: Although we tend to presume that this is source of the pain in cancer, this presumption is often wrong. In some cases, the cancer may be triggering localized nerve and muscle pain as the mechanism for "tissue invasion" pain. The medications discussed above under neuropathic pain may be more effective than narcotics and can be added to narcotic pain medications. Interestingly, IV magnesium (which has been shown to be helpful in pancreatic cancer pain) and IV lidocaine (at a dose of 2–2.5 mg per minute for one to three hours given as needed – effects after 2 to 4 doses often persist for weeks), which a Cochrane review found to be effective for neuropathic pain, can be very helpful.
For bone metastases, treatments that improve bone density may decrease bone pain as well. In one study of patients with bone metastases from breast or prostate cancer, strontium gluconate (the healthy form – not the radioactive one), 274 mg daily, increased bone regrowth in areas of tumor, and often resulted in patients' feeling better and gaining weight. I would use the 680 mg daily dose of strontium plus 200–600 mg of magnesium a day (Jigsaw Health makes a sustained-release magnesium that does not cause diarrhea). If calcium blood levels are not elevated, I would add calcium (600–1200 mg a day) and vitamin D (2000– 4000 units daily).
As an aside, there are many treatments that can help which cancer oncologists may not be aware of (usually because they are too inexpensive). I recommend that any patients with significant cancer order a search of medical studies done on their specific types and stages of cancer from Health Resources, which does a spectacular job (call Jan Guthrie at 800-949-0090 for more information). This report routinely turns up valuable treatment options that most doctors are not aware of. I have seen "incurable" cancers go away when the patient combines the best of the standard and complementary therapies that are found in the printout's studies. As an example, my earlier research associate has now been cancer free for over 15 years despite having had an ovarian cancer metastatic to her neck!
Further Thoughts on Treating Cancer Discomfort
For uncontrollable nausea, apply ABHR (Ativan/Benadryl/Haldol/Reglan) cream to an area of soft skin, such as the wrist. This prescription cream can be made by compounding pharmacists (such as Cape Apothecary; 410-757-3522. Tom, their excellent pharmacist, can also guide you in its proper use). Nausea often settles within 15 to 30 minutes after applying the medication. The cream can be reapplied every 6 hours as needed. Promethazine 25 mg per ½ cc of cream is also helpful for nausea.
A study by Dr. Neoh Choo Aun, a wonderful acupuncturist and friend in Taiwan, showed that using acupuncture to treat the trigger points in cancer patients was very beneficial.
In one study of 12 patients with very severe neuropathic pain, IV magnesium was given. Half the patients received 500 mg and the other half 1000 mg given over 10 minutes. Aside from producing a mild feeling of warmth at the time of the injection, the IV was well tolerated. 10 of the 12 patients experienced significant relief that lasted approximately four hours. I would give 2 g magnesium over 30 to 60 minutes. Most patients with neuropathic pain will not need this – although it can easily be given if they have an IV in place – if they simply use the medications we discuss for neuropathies.
It takes much less medication to prevent pain than to make it go away once it occurs. Because of this, recommend that patients with chronic pain take their pain medication before they expect the pain to occur, or at the first sign of it coming back, instead of waiting for it to be severe. By doing so, they will need less medicine and have fewer side effects. If narcotic side effects are problematic, use the other pain medications discussed above (and there are dozens of other natural prescription therapies discussed in Pain Free 1-2-3) so that you can find a combination that is more comfortable for the patient.
When giving narcotics combined with acetaminophen, the risk of acetaminophen overdose may be much greater than the risk of the narcotic itself. Try to keep the total acetaminophen dose to under 2000–3000 mg a day and certainly at no higher than 4000 mg a day. Be sure that the patient does not add other over-the-counter medications which may also contain acetaminophen, putting them over 4000 mg/day total.
In my 30 years of treating chronic pain, I can count on my fingers the number of patients who could not get adequate relief. This has also been the experience of other physicians who use the best of natural and prescription therapies for pain relief and who treat underlying causes. More information can be found on my website, www.vitality101.com, in the "health topics A–Z" section.