Cancer Pain

Background

Cancer pain can have a variety of causes, and it is common to occur at the site of a tumor and also in remote locations where metastatic disease has occurred. The World Health Organization estimates that most patients with advanced cancer experience pain, and 60% of patients with any stage disease experience pain. They also estimate that 25% of the patients die with unrelieved pain.1 Focused ultrasound has been primarily used been to treat the malignancy. However, pain improvement has also been observed, in some cases with lasting results.

It is important to determine the source of the pain. Tumor growth is a likely choice, but in some situations the mass of the tumor can impact adjacent organs and produce pain from impingement. Antineoplastic therapy can also produce pain. Psychological factors can also be a part, and pseudo-addiction can result from chronic failure to adequately treat a painful condition. Additionally, pain from nonmalignant sources must also be considered. Thorough evaluation is often needed to differentiate cancer-related pain from noncancer-related pain.

Current Treatment

Standard treatment of pain can include analgesics, which can include nonsteroidal anti-inflammatory drugs, patches, local anesthetics, narcotics, other agents and combinations. Part of the challenge in treatment is the development of tolerance to the agents which can result in significant increases in dosing requirements to achieve effective analgesia. The issue of side effects may also be of concern, particularly with the respiratory depression that occurs with large doses of narcotics. In certain situations nerve blocks, radiation, surgery or other invasive procedures may be needed to help control the pain.

Focused Ultrasound Treatment

The focused ultrasound technology is approved to relieve the several types of pain. An FDA approved example is treatment of bone metastases. Arthritis pain and back pain (originating from facet arthritis) are other examples that are approved in Europe but not yet in the United States. For these situations, the mechanism of pain improvement is that focused ultrasound non-invasively ablates the nerves that serve the affected area. 

At the current state, the improvement of a patient’s cancer pain has been observed while looking for other malignancy improvements, such as change in tumor size. In a study of 10 pancreatic cancer patients who received focused ultrasound, the patients’ narcotic use was cut in half following focused ultrasound treatment, and in two patients it was completely eliminated. This reduction was sustained in the three month follow up, and prompted the author to suggest that a larger study on the analgesic effect should be considered. (Strunk, et. al.)

Early reports of pain improvement such as the one cited above may promote additional studies looking for improvements in pain and other quality of life factors. While more work is needed in this area, these reports suggest that focused ultrasound yields a significant relief of pain and that it can last for several months.

Learn More about focused ultrasound for other painful conditions:

ClinicalStage 35Back PainDC key
ClinicalStage 35Bone Metastases
ClinicalStage 35Osteoarthritis
ClinicalStage 35Osteoid Osteoma
EarlyStages 35Disc Degeneration
EarlyStages 35Muscle Atrophy
EarlyStages 35Sacroiliitis
EarlyStages 35Spinal Cord Injury
EarlyStages 35Spinal Tumors

 

Notable Papers

Marinova M, Strunk HM, Rauch M, Henseler J, Clarens T, Brüx L, Dolscheid-Pommerich R, Conrad R, Cuhls H, Radbruch L, Schild HH, Mücke M. [High-intensity focused ultrasound (HIFU) for tumor pain relief in inoperable pancreatic cancer : Evaluation with the pain sensation scale (SES)]. Schmerz. 2016 Jul 11. [Epub ahead of print] German.

Strunk HM, Henseler J, Rauch M, Mücke M, Kukuk G, Cuhls H, Radbruch L, Zhang L, Schild HH, Marinova M. Clinical Use of High-Intensity Focused Ultrasound (HIFU) for Tumor and Pain Reduction in Advanced Pancreatic Cancer. Rofo. 2016 Jul;188(7):662-70. doi: 10.1055/s-0042-105517.

Anzidei M, Marincola BC, Bezzi M, Brachetti G, Nudo F, Cortesi E, Berloco P, Catalano C, Napoli A. Magnetic resonance-guided high-intensity focused ultrasound treatment of locally advanced pancreatic adenocarcinoma: preliminary experience for pain palliation and local tumor control. Invest Radiol. 2014 Dec;49(12):759-65. doi: 10.1097/RLI.0000000000000080.

Huisman M, Lam MK, Bartels LW, Nijenhuis RJ, Moonen CT, Knuttel FM, Verkooijen HM, van Vulpen M, van den Bosch MA. Feasibility of volumetric MRI-guided high intensity focused ultrasound (MR-HIFU) for painful bone metastases. J Ther Ultrasound. 2014 Oct 10;2:16. doi: 10.1186/2050-5736-2-16.

Orsi F, Arnone P, Chen W, Zhang L. High intensity focused ultrasound ablation: a new therapeutic option for solid tumors. J Cancer Res Ther. 2010 Oct-Dec;6(4):414-20. doi: 10.4103/0973-1482.77064.

 

 

     

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