Going beyond opioids for managing cancer pain; raising awareness of the intrathecal pump

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Monday, July 3, 2023
Going beyond opioids for managing cancer pain
While oral medications are the cornerstone for managing cancer pain, doctors say intrathecal pumps or surgical interventions are being underused.

PHILADELPHIA (WPVI) -- Pain is one of the most common problems for cancer patients.

They often struggle to find relief or with side effects from the powerful narcotics often used for pain.

There's an underused tool and a joint initiative, which can help dial down the pain.

"I actually thought I had hemorrhoids," remembers Kim McCrane of Port Richmond.

But McCrane learned she actually had a tumor due to anal cancer.

Intense chemotherapy seemed to wipe it out, but it came back larger, and pressing on nerves in her left buttock.

"I couldn't do anything but lay down, and even laying down was painful. So I couldn't sit up in the car. So I couldn't sit up to eat. I had to lie down," McCrane says.

"About half of all patients undergoing treatment for cancer have pain. And about two-thirds have pain with advanced disease," says Dr. Marcin Chwistek, director of palliative care at Fox Chase Cancer Center.

He says oral opioids work for many people.

But as more people live longer with cancer and the risk of mounting side effects from oral painkillers, there's more need for other solutions.

Dr. Chwistek says his team first defines a patient's goals:

Do they want to sleep through the night? Be mentally sharp for a job? Care for children or a family member?

He says Fox Chase can work jointly with Temple Health to seek solutions.

"A surgeon gets involved when medical treatments for pain are not enough," notes Temple neurosurgeon Willard Kasoff.

They offer a variety of procedures, including the intrathecal pump.

"It looks like this - It's about the size of a hockey puck," says Dr. Kasoff holding up the pump reservoir.

The pump is implanted in the abdomen, and through a tiny tube, it delivers the same medication people take orally.

"But it delivers it directly to the spinal cord," says Dr. Kasoff.

"You can use much smaller volumes of them, and typically, patients have less side effects," notes Dr. Chwistek.

Dr. Kasoff says the pump is "wildly underused," because patients and even doctors don't know about it.

"There are countless patients out there suffering who could be suffering a lot less by having an intrathecal pump," he adds.

McCrane says the pump turned her life around. She sat comfortably in her car during her interview with 6abc.

And she and her teenage daughter can walk the dog together.

"I'm in my daughter's life again. You know, I'm active in my daughter's school," she says with pride.

The pump reservoir must be refilled periodically, but McCrane says that takes about five minutes.

She's also in trials for immunotherapy that has stopped the growth of the tumor.