Name of Lecture: …Management of Pain With Cancer Patients

Name of Speaker: …Dr Sunil Saini, Professor of Surgery, Head of Oncology HIHT, Rishikesh, India

Program Time: …3:00-4:00pm

Name of Reporter: …Peter Fabian

Main Points of the Lecture: ....

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The management of Pain is simple.  There is allopathic and common man control.  Drugs and injections are not enough.  We need other options other than surgery and drugs.  Many cancer patients with cancer in India are not diagnosed until 3^rd and 4^th stages, near the end of their disease.

By Dr. Parul, MD

Childs definition of pain: it hurts

Problems with persisting pain include: suffering, dependence, drug abuse, financial loss and domestic disruption.  Doctors sometimes withhold using drugs for a variety of fears to include: drug dependence, masking symptoms, respiratory compromise, hemodynamic imbalance, and societal stigma.

We need to treat pain because it affects multiple systems in the body to include: Respiratory System-poor secretion clearing, Cardiac System, GI system with problems of constipation and urinary retention, Musculoskeletal System, Psychological System, Neuro-endocrine System.

We need to treat both the chronic pain and break through pain (periodic episodes of marked increased pain).  We must assess the patient and educate the doctor and staff.  One formula would include: Ask, Believe the patients report, Choose an appropriate type and amount and Deliver it effectively and timely.  There are many routes to administer drugs for pain from oral to rectal and in-between.  Injections can target Plexi, ganglions and the spinal cord.  There is also surgical remediation of nerves and cord (transecting the Trigeminal nerve of dorsal rhizotomies).  Also complimentary therapies can be added pertaining to patient’s interests and hobbies which helps ameliorate the symptoms.

By Dr Saini

There are three types of pain: Physical, Mental and Spiritual.  Pain is the most common symptom of a patient with cancer.  Treatments include: Analgesics and Pain Clinic approaches.  One must evaluate four types of pains that vary for each individual.  These include: Threshold of Pain; Tolerance of Pain; Response to Pain; and Recovery to Pain.

One must deal with pain of course.  Also we must consider various fears and the fear of death.

He then outlined four case studies from a very humanistic viewpoint. 

#1—a woman with a massive belly tumor for many years was successfully operated on by him.  The removal of the tumor allowed her to function more normally.  She was supported at different stages of her life.  She later married and gave birth to a child.  She still had metastatic disease to her liver but was able to return to a more normal lifestyle because of her medical and surgical support.

#2—an illiterate man living in a village had pancreatic cancer in 2002.  He had proper medical and surgical intervention.  Proper education helped.  This simple man had great discipline and great faith.  He survived into 2008 when he was diagnosed with metastatic disease to his lymph nodes.

#3—A Courageous German woman was dying of a tumor in her belly.  (2 years before, she was treated for tumor resection and reconstruction of the chest wall.)  Her second cancer was inoperable and treatment was only for symptoms.  She died with Dr Saini holding her hands.  She had lived life for two months by noticing the beauty of the life she had lived and was still living.  (Quoting the German theologian, philosopher and mystic, Meister Eckhart: He who could be—What he had to be—Must finish to be—What he is.)

#4—A patient that was just seen and operated by Dr Saini the day before.  He underwent 8 hours of excision and reconstruction of a laryngeal tumor.  He was sitting up in his bed after surgery.  Demonstrating such strong faith, conviction and discipline.

Dr Saini’s overall message was to follow modern science and to learn to see much more in life that that which one reads in scientific journals.  He founded a successful and active cancer support group to help the patients and their families with managing and coping with cancer and its effects.