MD Anderson pain doctor: Only aggressive forms of cancer need opioids

Many people who live with cancer and chronic pain and who come to the world-renowned MD Anderson have already seen lots of doctors and tried many different treatments. Sometimes, MD Anderson is their last hope.  Dr. Bruel makes sure they know there is always hope…

Dr. Bruel recalls that there was a time—during his medical school and residency days—when future doctors were taught that the best treatment for managing chronic, debilitating pain was to prescribe opioids. That used to be the standard … before doctors knew better.  “Then, we saw the ugly part of opioids,” Dr. Bruel says…

“In the past decade, managing chronic pain using neuromodulation has also taken off,” Dr. Bruel says of the technological advance…

Cancer pain is one of Dr. Bruel’s specialties. “With cancer pain, we may offer certain modalities a little quicker than we would with other types of pain.” One such modality is opioids.

Particularly with aggressive forms of cancer—pancreatic cancer, for instance—doctors can be a little more liberal with pain meds. “In some cases, we tend to think that it may be okay to give high-dose opioids to get them comfortable,” he says…

So Dr. Bruel encourages health care professionals and pain management specialists to think in terms of what happens when the cancer is in remission. “You can be cancer free, but not pain free,” he explains. “Chemo and radiation can cause long-term pain.” …

More doctors are adopting this innovative way of thinking—thinking beyond getting the cancer into remission. In many cases, they know they can do that. But a cancer-free patient who still lives with pain, or one who is addicted to pain medication, isn’t Dr. Bruel’s definition of success

Spinal cord stimulation (also known as neurostimulation therapy) is delivered with a neurostimulator and lead(s) implanted under the skin and adjusted with a clinician and a patient programmer…

Neuromodulation involves direct stimulation of the nervous system with electrical signals. It is used as a treatment for unmanageable chronic pain and/or movement disorders…

(2011) Results of neuromodulation for the management of chronic pain.

Conclusions : A good indication for spinal cord stimulation is FBSS and angina pectoris. Motor cortex stimulation is helpful in the treatment of chronic central neuropathic pain. Further observations and a larger group of patients are necessary for a reliable assessment of the effectiveness of neuromodulative treatment of chronic pain in our clinic.

Risks and Potential Complications of Spinal Cord Stimulation

  • Allergic reaction to the implanted materials
  • Bleeding
  • Infection
  • Pain at the incision site (usually resolves in a few weeks)
  • Weakness, numbness, clumsiness, paralysis
  • Battery failure and/or battery leakage requiring a surgical incision to remove and replace the battery
  • Fluid leak from the spinal cord, causing headache
  • Undesirable changes in stimulation may occur over time due to scar tissue forming around the leads, or movement of the lead position
  • Undesirable or unpleasant stimulation of the chest or rib area as a result of nerve root involvement
  • Migration of the electrode may occur, resulting in a loss or change of stimulation
  • Skin breakdown over the generator or electrode site
  • Stimulation may work for a period of time and then lose effectiveness after 1-2 years

“It helped for a while, and you have to constantly get them adjusted for the scar tissue and what not, and after a while it just, they couldn’t get the programming to function properly,” Paul said. “I couldn’t be very active. I could to an extent, but it was always in the back of my mind, you had to be careful because I could actually feel the stimulation changing as my body position changes.”

The outpatient procedure takes about an hour. A small amount of bone is removed from the middle of the spine. The electrodes are put in. The battery pack goes in the buttocks…

“For patients with routine problems, say a disc herniation or spinal stenosis, traditional back surgery still works better,” Dr. Bonaroti said. “We have some patients that have cancer. They need a routine MRI scan to screen for recurrences of their cancer. They can’t have an implant unless we use the MRI compatible version.” …

4 thoughts on “MD Anderson pain doctor: Only aggressive forms of cancer need opioids

    • As a 30-year intractable pain patient who doesn’t suffer from cancer (yet), I have been discriminated against just because of that, as have millions of other pain patients. But the link to the article is there for anyone who’s interested in looking further, along with excerpts directly from the article.

      If you like, I can change the title of this post… but maybe I’m too biased. Why don’t you pick a title?


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