Identification, assessment and treatment of pancreatic cancer pain is vital to quality of life. Each person’s response to pain is unique and dependent on different physical and psychological factors. It is important for the pancreatic cancer patient to discuss their treatment options, for pain management, with their healthcare team. A referral for a pain management specialist is strongly suggested.
Remember: Successful treatment of pain in pancreatic cancer patients is achievable.
Tumours often grow rapidly and can cause swelling and inflammation within the body. These rapidly growing tumours can cause tumour-obstructing flow (of bile or pancreas enzymes or the bowel contents) or by invading nearby nerves or other structures.
Pain can also be caused by side effects from chemotherapy, radiation, surgery or other treatments.
Often abdominal pain is the first symptom of pancreatic cancer. This mid-abdominal pain often radiates to the back area. When pain is not treated properly it can have significant negative effects on the patient and can lead to anxiety and depression.
When considering pain management, it is important to take a thorough look at the individual and assess all areas of that patient's life, while considering all options of pain management. One can do this by considering the “Four P’s":
• Physical Treatment - heat, ice, rest, TENS (Transcutaneous electrical nerve stimulation is a method of pain relief involving the use of a mild electrical current), acupuncture, diet
• Psychology Treatment - meditation, mindfulness, Qi Gong, Yoga and Cognitive Behaviour Therapy (CBT)
• Pharmaceutical - Medications
• Pins (Needles) - Injections and Coeliac Plexus Block
"Over the Counter Drugs"
First Line Prescription Medications
(These medications can take 3-6 weeks to work)
When used responsibly, opioids are often have positive results. They are fast acting and effective for most cancer patients, however they can cause constipation and drowsiness.
There are medical prescriptions called Sativex Spray (50:50 THC: CBD) and Nabilone (Synthetic THC).
Non prescriptions include medical access programs in Canada, or provincial distributors.
Coeliac Plexus Block
A Coeliac Plexus Block can be used when patients experience belly and back pain. A needle is placed in the mid back to the nerves from the pancreas. It can be done by a pain specialist or a radiologist.
This is a permanent nerve block which usually lasts around six months. It can be repeated if it wears off. A rare but serious risk of the procedure is accidental flow of the medicine into the spinal cord causing paralysis.
The Coeliac Plexus Block is roughly 80% effective in relieving pain and works for 80% of patients.
1. Placement of a Stent - Some pain may be relieved by repairing the obstruction in the bowel or a bile duct. A stent can be placed in the bowel or bile duct. It will relieve jaundice and/or vomiting.
2. Radiation and Steroids- Tumours can cause swelling and grow very rapidly causing inflammation and swelling around the site. Steroids and/or radiation may be used to reduce the tumour, swelling and discomfort.
3. Palliative Surgery - Patients who are not curable may be offered palliative surgery which removes part of the pancreas and connects the bowel around the obstruction. Additionally, some of the tumour will be removed, to relieve some pain and discomfort.
4. Radiation and Steroids
Remember that Pancreatic Cancer Pain Can Be Managed
Remember, patients have the right to receive the best pain control treatment options available. Good pain control allows you to focus on your life and do the things you want to be able to do. Make sure that your health care team listens to you and takes your concerns seriously.
Content coming soon.
Nutritional care, including supplemental pancreatic enzymes, improves pancreatic cancer patient outcomes and is critical for quality of life.
The World Pancreatic Cancer Coalition recommends that everyone diagnosed with pancreatic cancer has their nutritional needs assessed by someone with nutritional expertise, is offered information about diet and nutrition, and has access to pancreatic enzymes.
Individuals living with pancreatic cancer often struggle with maintaining a healthy appetite and weight, as a result of their pancreas being compromised by a cancer diagnosis. This is called Pancreatic Exocrine Insufficiency (PEI). PEI means that the pancreas is not:
Because the pancreas is struggling to provide the enzymes required to breakdown food and to regulate sugars, patients struggle with:
Medications, pain, depression and anxiety can also impact appetite and proper nutrition. Because of this, it is imperative that patients are referred to specialists trained in working with pancreatic cancer patients. These specialists should include:
Purchasing, preparing, eating food and personal lifestyle may look very different, once diagnosed with pancreatic cancer. The good news? With adjustments to your food and lifestyle, patients should start to feel better.
Eat multiple, small meals per day (6 - 8 meals)
Patients are encouraged to eat several small meals a day for a variety of reasons, some of which are:
When patients chew slowly they are ensuring that their body:
Drink at least 6-8 cups (1500-2000ml) of water a day. Patients are encouraged to avoid caffeinated products as they can cause dehydration.
Avoid (or limit) Fatty Foods
Fatty foods include:
Use Healthy Fats.
Although it is important to consume fat to absorb important vitamins, patients should understand that there are bad fats and good fats. Patients should avoid processed foods and red meats. However, good fats need to be consumed, such as:
Use Less Fibre
Fibre is part of a healthy diet, however, patients diagnosed with pancreatic cancer may find that foods high in fibre can make food move through the intestine more quickly, therefore the intake of whole grain breads, raw vegetables and nuts should be limited.
Easy fibre foods to digest include:
Avoid Gassy Foods
There are several types of foods which can cause gas and discomfort as a result. Vegetables in the cabbage and onion family, beans, corn, pop corn, carbonated drinks and even gum can cause gas.
These foods can help patients with weight gain and provide energy.
Patients are encouraged to engage in some form of physical activity daily.
Avoid Alcohol and Drugs
Avoid these as much as possible.
Doctors may also prescribe vitamin replacements for vitamins A, D, K and E.
Anti nausea, anti diarrhea medication
Patients must talk to their physician, who is a part of their treatment team.
Pancreatic Enzyme Replacement Therapy (PERT)
This is an effective treatment using mediation called pancrelipase (Cotazym®, Creon®, Pancrease® MT) medications. These medications help patients break down their food, digest their food and absorb the nutrients in their food. These enzymes are taken during meals or snacks. They travel with food, past the stomach until they reach the small intestine.
Here they will release digestive enzymes which will aid in the absorption of important nutrients. Some important points to note:
Changes in grocery lists, food preparation and consumption can be challenging and intimidating for many. The following cook book was developed by Celgene, in consultation with Pancreatic Cancer Action Network to assist patients and families in meal planning.
CLICK HERE for a downloadable recipe book called Cooking. Comfort. Care. to assist in menu planning.