Overview
Based on the individual circumstances of each patient who is diagnosed with head and neck cancer, a treatment plan will be devised that may involve one or more of the following:
Unfortunately, pain is a common side effect of head and neck cancer treatment. Many patients experience pain after surgery, as well as during and after radiation and chemotherapy. Because of the many anatomical structures located in the head and neck, the pain can be nociceptive (meaning that it stems from damage to local tissues and subsequent activation of pain receptors), or neuropathic (meaning that it originates from damage directly to branches of the nervous system).
Types of Pain Medications
Most head and neck cancer patients will require pain medication at some point during their recovery. There are several different types of pain medications that doctors may prescribe.
Oral Pain Medications
- Non-steroidal anti-inflammatory drugs (NSAIDs)
In addition to reducing pain, these drugs also reduce fever and prevent blood clots. NSAIDs relieve pain by lowering inflammation, thereby decreasing any heat, swelling, and/or nerve stimulation. These medications are generally used to treat mild to moderate pain. Examples include ibuprofen, aspirin and naproxen. Side effects include stomach pain, heartburn, stomach ulcers, increased bleeding, and allergic reactions in rare cases. In high doses, these drugs can cause severe gastrointestinal bleeding. Additionally, in people over the age of 60, NSAIDs may worsen high blood pressure and could cause kidney damage. - Acetaminophen
Also known as Paracetamol, acetaminophen is used to treat both pain and fever. It is considered to be safe, and is used to treat mild to moderate pain. This type of medication is generally taken orally. The most common example is Tylenol. Side effects are rare, but may include stomach upset, nausea, and allergic reaction in rare cases. In high doses, acetaminophen can cause liver and kidney damage. - Corticosteroids
These drugs relieve inflammation by decreasing swelling, itching, and redness. They are usually given in the form of a pill or targeted injection. Examples include hydrocortisone, prednisone, and methylprednisolone. Side effects include fluid retention, swelling, and muscle weakness. When taken for an extended period of time, these drugs can lead to high blood pressure, osteoporosis (fragile bones), muscle weakness, and immunosuppression. - Narcotics
Also known as opioids, these drugs block the sensation of pain in the nervous system and are used to control moderate to severe pain. Examples of narcotics include codeine, morphine and oxycodone. These drugs may be delivered through an oral or transdermal approach, as described in further detail below. Narcotics are highly addictive and should be used with caution. Side effects include constipation, fatigue, nausea, vomiting, constipation, sedation, and altered cognition. When taken in high doses, these drugs can be fatal. These drugs are usually only given for a finite period of time, after which patients are slowly weaned off of the medication.
All of these methods of oral pain management are safe at the prescribed doses. Taking more than the prescribed dose of any medication is dangerous.
Narcotics Carry Serious Risks
The group of drugs labeled narcotics alter the way the brain functions. This can lead to drowsiness, sedation, impaired judgement, altered cognition, and a change in behavior. These drugs may make it difficult for patients to concentrate and function in the workplace. Additionally, patients should never drive or operate machinery while taking narcotics.
Narcotics offer positive feelings of pleasure and relief, and sometimes, patients begin to crave and strongly rely on these feelings. They may feel as though they need the medication to live a normal life. This feeling of not being able to function without taking a drug is called dependence.
Additionally, with continued use, patients will stop responding to the drug in the same way that they did at first. They will begin to feel less pain relief with the same dose of the drug, and will therefore require increased doses. This decreased response to a drug over time is called tolerance.
In combination, dependence and tolerance often lead to addiction. Addiction is a disease in which a patient continuously feels as though they need to take a drug, even when the drugs are no longer medically necessary and even when they may do the patient harm. Addiction can cause many medical, social and economic problems in a patient’s life.
To prevent these risks, patients should only take narcotics if they are prescribed by their doctor, and they should strictly follow the prescribed doses. Patients should talk to their doctor before they begin taking these medications and they should consider seeking the help of a pain specialist. Multidisciplinary pain management programs may also be helpful in showing patients how to safely manage their pain, while avoiding addiction.
Topical Pain Medications
Topical pain relievers are ones that can be applied directly to the skin and to the mucous membranes in the mouth and throat. They exist as liquids, gels, creams, mouthwashes and lozenges.
Some topical pain relievers are anesthetics, meaning that they numb the body by blocking pain nerve impulses. Oral cavity pain, such as that caused by mucositis, may be alleviated by topical anesthetics, such as lidocaine and benzocaine, or by new oral lozenges (some of which contain bupivacaine, another anesthetic). Examples include Orajel (benzocaine), Blistex (benzocaine), Marcaine (bupivacaine), Sensorcaine (bupivacaine), xylocaine (lidocaine), and lidoderm (lidocaine), among many others. These topical pain relievers typically last for a few hours.
Additionally, some of the oral pain medications mentioned above may be administered through patches that can be stuck onto the skin. This method is called transdermal administration, meaning that the medication is absorbed through the skin and can then circulate to affect parts of the body distant from the site of application. This is in contrast to topical administration, in which the medication only affects the site of application. The transdermal approach can be useful in patients who are unable to swallow medications (oral administration) or for drugs that could negatively impact the liver. Transdermal administration of narcotics results in a lower risk of addiction, as compared to oral administration. Additionally, transdermal administration offers slow and continuous drug delivery, reduced drug-drug interactions, and fewer side effects. Depending on the type of medication delivered in the patch, the effects may last from several hours up to several days.
Pain Management Specialists
For short durations of pain management, a patient’s doctor may elect to prescribe pain medication, as listed above. However, if pain persists for an extended period of time, it is often advantageous to seek care from a pain management specialist. These specialists are doctors with specific training in evaluating, diagnosing, and treating different types of pain. They may include anesthesiologists, neurologists, and physiatrists. Pain management specialists have an in-depth knowledge of the various causes of pain, the tests that can be used to evaluate pain and discover its source, and the medications that may help alleviate pain.
Alternative Options
In addition to drugs and medications, patients can explore several beneficial, alternative pain management techniques.
Acupuncture
This technique originates from traditional Chinese medicine practices and involves the stimulation of specific points on the body with small needles, heat, pressure or electricity. Acupuncture has been used to help with a variety of conditions and symptoms, such as pain, anxiety, depression and fatigue. This technique has been shown to be successful in reducing some of the pain caused by head and neck cancer treatments. In particular, studies have found that acupuncture may help patients suffering from xerostomia, as well as some of the pain and limited mobility commonly encountered following head and neck surgical procedures.
Nerve Blocks
A nerve block is a method of pain control that involves injecting a medication around a specific nerve to prevent that nerve from sending signals to the central nervous system. This eliminates all sensation around the nerve, creating a feeling of numbness or tingling, and stopping any feelings of pain. Nerve blocks generally last between 12 and 36 hours. The medications commonly used in nerve blocks include lidocaine and bupivacaine, among several others.
Surgery for head and neck cancer may lead to neuropathic (nerve) pain due to the high number of nerves concentrated in the region, as well as the constant movement involved in chewing, swallowing and talking. Nerve blocks are only used in patients suffering from neuropathic pain that has not responded to traditional pain management strategies (such as those discussed above).
