October 3, 2016 | by City of Hope
As cancer survival rates in the United States increase due to improving detection and treatment protocols, a growing number of patients are faced with a new and difficult challenge - living with chronic pain. For Christine Chang, M.D., assistant clinical professor in the Department of Supportive Care Medicine and director of the Interventional Pain Management Program at City of Hope, helping those patients achieve the best quality of life possible is a priority.
“A lot of patients will suffer in silence and just try to get through their treatments the best that they can,” said Chang, an expert in interventional pain management who is board-certified in neurology and psychiatry. “But with the Interventional Pain Management program at City of Hope we are able to offer our patients help for their physical pain, and provide them with emotional support as well.”
Studies show that approximately 100 million Americans suffer from chronic pain. Among cancer patients, more than half report experiencing uncontrolled pain during and after treatment. The majority of those say they also have significant anxiety, suffer from depression, experience insomnia and are unhappy with their quality of life.
Interventional pain medicine, a new specialty that draws from several branches of medicine, can provide relief to patients suffering from chronic pain, Chang said.
We are able to offer our patients help for their physical pain and provide them emotional support as well.”
“What we want our patients to know is that we take their pain seriously and will work with them to find the best outcome for their particular case,” she said. “That means we will focus on wellness for patients who are in active cancer treatment, as well as those who are cancer survivors and require ongoing help with long-term pain.”
In addition to medication, interventional treatments include a variety of nerve blocks and plexus blocks that are effective in alleviating abdominal, pelvic, rectal and nerve pain, the targeted delivery of small but potent doses of anesthetic directly to the spinal fluid via intrathecal pain pumps, spinal cord stimulation and peripheral nerve field stimulation. These interventions also address chronic pain that results from trauma, degenerative joint disease or ongoing postsurgical pain.
Additional challenges that stem from cancer treatment frequently include severe fatigue, changes in memory, altered physical appearance and emotional distress, Chang said.
“Even when a patient’s treatment has been successful and has ended, they may experience a new kind of pain and then are fearful that the cancer has come back,” she said. “The emotional side of cancer treatment can be equally challenging to deal with for the patient as is the physical.”
Chang’s focus is a patient-centric program. It offers multidisciplinary supportive care that draws from specialties including anesthesiology, neurology, psychiatry and rehabilitative medicine. Looking forward, Chang sees great promise in the growing field of research into the gut microbiome.
“We have to have more research into the mechanics behind chronic pain,” Chang said. “We want to look at it epidemiologically and also on a molecular level to see how it may be linked to the gut microbiome.”
Chang hopes that as the Interventional Pain Management program at City of Hope grows and expands to include specialists from additional departments and disciplines, more funding will be made available for studies and clinical trials. This includes looking into a multidisciplinary treatment approach that includes cognitive behavioral therapy, group therapy, and treatments such as hypnosis and acupuncture.
“Neuropathy, anxiety, nausea, all of which are so common in our patient population, may addressed by means other than the use of heavy medications,” Chang said. “I see the future of this field having more of an emphasis on complementary approaches to pain management, and for that we need more collaboration and ongoing research.”