Врачи призывают внедрить междисциплинарные программы для борьбы с болью у онкобольных

“Pain remains a very common issue among cancer patients; its prevalence continues to be very high,” lamented María Luz Cánovas Martínez, head of the pain unit and the Department of Anesthesiology and Resuscitation at the Ourense University Hospital Complex, Ourense, Spain, in statements to El Médico Interactivo, part of the Medscape Professional Network. As coordinator of the Spanish Pain Society (SED)’s cancer pain working group, Martínez highlighted the impact that proper management of this symptom has on patients’ lives. “Seeing the satisfaction in the eyes of cancer patients when you’ve managed to relieve their pain and improve their quality of life brings indescribable satisfaction,” she said. This view is shared by French anesthesiologist Denis Dupoiron, MD, an international leader in the treatment of cancer-related pain and a specialist at the Institut de Cancérologie de l’Ouest, one of France’s leading cancer centers, located in Angers. Both agree that pain management must be individualized, tailored to each patient’s needs, and based on the early identification of factors that may interfere with pain control. “The classic stepwise model must evolve toward an integrated approach, in which supportive care — and, especially, pain treatments — are part of cancer care from diagnosis through survival,” noted Dupoiron, an expert in intrathecal techniques, one of the most advanced options for managing refractory pain. Early Detection and Treatment When asked about the current state of cancer pain, Dupoiron is blunt: its prevalence remains very high. Still, he cautioned that the quality of care patients receive depends in large part on how each center is organized and on whether multidisciplinary care pathways are in place. “Hospitals that have effective coordination between medical oncology, radiation oncology, medical and surgical specialties, and pain management units enable earlier and more effective intervention,” he explained. Martínez emphasized that early pain management not only reduces suffering but also improves quality of life, promotes adherence to and tolerance of cancer treatments, and can positively influence survival. When patients feel better, they can maintain an adequate diet, engage in physical activity, and cope better with treatment. However, both specialists warned of significant variability among hospitals. While some centers have well-established care pathways, others experience delays due to the lack of specific protocols, multidisciplinary structures, or insufficient referrals to pain management units. According to Martínez, the care paradigm has changed significantly in recent years. Traditionally, the main goal was to combat cancer. Today we know that pain management is essential for patients to tolerate treatments and maintain a better quality of life. Interventional Techniques Interventional techniques have undergone significant advancements and are becoming an increasingly important alternative when conventional analgesics prove insufficient or cause significant adverse effects. This is explained by anesthesiologist Alfonso Carregal Raño, a specialist in pain management units, who emphasized the need for specific training to identify the appropriate time to perform these procedures and optimize the management of patients in advanced stages of the disease. Notable among the available techniques are nerve and sympathetic blocks, chemical or radiofrequency neurolysis, intrathecal systems for administering medications near the spinal cord, implantable devices for pain control, and other advanced procedures developed in pain management units. Dyspnea and Pain Martínez and physical therapist Ane Arbillaga Etxarri, a member of the coordinator of the SED-related working group, emphasized the close relationship between pain and dyspnea. “Dyspnea is one of the most significant symptoms in these patients,” they noted. Etxarri explained that the sensation of shortness of breath should not be understood solely as a respiratory problem. It is a complex cerebral experience, very similar to pain. Both are subjective symptoms constructed from bodily signals, emotions, expectations, and contextual factors. For this reason, specialists advocate a joint approach to managing both symptoms. Alongside pharmacologic treatments such as opioids, nonpharmacologic interventions aimed at reducing the perception of shortness of breath and improving the patient’s functional ability are increasingly being incorporated. In the advanced stages of the disease, dyspnea ranks among the most feared symptoms alongside pain, due to the intense physical and emotional burden it entails. “It is associated with anxiety, fear, and a sense of life-threatening danger, so it requires a multidisciplinary approach that includes medicine, physical therapy, nursing, and psychological support,” Etxarri emphasized. In Cancer Survivors Specialists point out that the problem is not limited to patients with active disease. A significant percentage of long-term survivors continue to experience pain even after completing cancer treatments. It is estimated that about 35% of patients treated with chemotherapy develop persistent pain syndromes, particularly peripheral neuropathies affecting the hands and feet, which significantly affect their quality of life. Given this reality, experts advocated for the implementation of multidisciplinary care pathways that enable comprehensive care, with the coordinated participation of pain specialists, oncologists, nurses, physical therapists, and mental health professionals. “Informing the patient and their family is essential. They must be aware of the available treatment options, including interventional techniques, as well as the possible symptoms associated with the disease and its treatments,” they noted. The Experience With These Care Pathways For his part, Martínez highlighted that the Ourense University Hospital Complex has had a specific referral pathway for oncology patients to the pain management unit for years. “A significant percentage of patients develop persistent neuropathic pain following chemotherapy or radiation therapy. An interdisciplinary approach allows for the early implementation of interventional treatments that alleviate suffering and improve quality of life, even in patients with advanced disease,” she explained. For the specialist, the success of these programs depends on the coordinated involvement of all healthcare professionals. “Physicians, nurses, clinical psychologists, and physical therapists play a fundamental role. Experience shows that multidisciplinary care pathways significantly improve patients’ quality of life and should be implemented in all hospitals,” she concluded. The specialists disclosed having no relevant financial relationships. This story was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.