Cancer Pain Management and Compassionate Care

Restoring Quality of Life

From Yale New Haven Health-Greenwich Hospital Health Extensions

Greenwich, CT (May 15, 2016) – After years of enduring excruciating cancer-related pain, Janet Torres can finally embrace the life she envisioned, thanks to the holistic approach of the cancer pain management and palliative care specialists at Greenwich Hospital.

With a history of recurrent cancer, Janet had grown accustomed to living with the discomforts of the disease. In 2012, a tumor on her collarbone was pressing on nerves, sending sensations that felt like daggers down her arm, pushing her to tears.

“I was told by my doctors in Stamford that the cancer was stage 4 and very invasive,” said the Norwalk resident.

“They said there wasn’t much that could be done,” Janet added. “But I’m still here, thanks to my love in God, my faith, and the prayers of my family and friends.”

Over the next three years, Janet underwent chemotherapy to shrink the tumor and radiation treatments to control the growth.

The medications to manage her discomfort grew stronger as the pain, which now extended down to her fingers, worsened. “I looked like a druggie,” she said. “I was so doped up I couldn’t remember words or pronounce them. From the minute I woke up, I cried because the pain was so bad until I took those pills.”

Janet didn’t think she could live a pain-free existence – until she found Greenwich Hospital’s Joseph Andrews, MD, a board-certified palliative care physician, and anesthesiologist Julie H. Huang, MD, a board-certified interventional and cancer pain management specialist who is spearheading the development of the Cancer Pain Management Program, part of the hospital’s Sackler Center for Pain Management.

With a referral from her oncologist, Janet was admitted to the hospital to begin a 14-day intervention that dramatically changed her life.

Improving quality of life

“The goal was to address Ms. Torres as a whole person by getting her pain under control and then lifting her spirits. We can talk about how to treat the actual illness once we have control of the symptoms, such as the pain, depression and anxiety that often accompany a chronic disease,” said Dr. Andrews. “Contrary to common belief, palliative care is not synonymous with end- of-life care. Palliative care is about restoring quality of life, and that’s exactly what Ms. Torres needed.”
Janet is not alone. “Half of all cancer patients have pain at the time of diagnosis and another third can experience pain while undergoing therapy. Sixty percent to 90 percent of people with advanced cancer will report having some form of pain,” said Dr. Huang.

Advances in image-guided pain interventions, such as nerve blocks, can target cancer-related pain at its source.

“Decreasing the level of pain leads to increased comfort and reduced stress, which lessens the psychological impact of the disease.
“Proper pain management has been shown to boost an individual’s immune system, ward off infection, and potentially limit cancer progression while reducing the need for narcotic pain medication.” – Julie H. Huang, MD

Given that Janet’s pain required increasing doses of medications, Dr. Huang recommended she undergo a series of interventional pain treatments to target the area of her pain while increasing circulation to the affected arm, with the goal of improving mobility. “Advances in technology and the use of imaging allow us to creatively target complex cases of cancer related pain, as well as chronic pain,” she said.

After a series of nerve blocks, Janet experienced improved circulation and mobility, less pain and decreased swelling in her arm. An epidural-based intervention to relieve other aspects of her pain further enhanced her progress. Meantime, Dr. Andrews helped prescribe different medications, including one drug that was administered through a time- release skin patch.

The combination of new medications and nerve blocks allowed Janet to cut back her dosages of opiates, which cleared her head and made her feel better. As a result of the intervention, Janet reached a level of comfort she hadn’t felt in years and began physical therapy to address the mobility problems in her arm and hand.

One day at a time

Today, Janet wears an arm brace to help control lymphedema, a swelling condition that followed the removal of lymph nodes during cancer treatment. The brace also signals people not to touch her hand or arm, which remain sensitive. Even so, she’s no longer consumed by pain. She can now undertake important matters, such as planning a trip to her native Colombia to visit family and friends.

“I have a lot of gratitude toward the nurses, doctors and everyone at Greenwich Hospital,” said Janet. “They helped me when I needed it most.”

Cancer Pain Management Program

The development of new targeted cancer treatments has led to increased longevity and the need for physicians to address quality of life issues, including the presence of pain.

Cancer pain is complex and can occur at any stage of disease. “Once patients reach advanced stages, cancer pain benefits from multi- disciplinary and often novel approaches to treatment,” said Julie H. Huang, MD.

Dr. Huang works closely with oncologists and palliative care physicians to address the diverse needs of cancer patients. Integral to her practice are state- of-the-art, minimally invasive fluoroscopic and ultrasound-guided pain treatments for a broad range of cancers, including head and neck, breast, prostate, pancreatic, pelvic, uterine, gastrointestinal, and genitourinary among others. “Advances in interventional cancer pain management can tackle pain at its source with the use of imaging,” she said.

In addition to treating cancer-related pain, the Sackler Center for Pain Management offers a variety of therapies to provide relief for back pain, sports injuries, arthritis and other conditions caused by surgery, accident or illness. The Sackler Center medical team consists of Dr. Huang, Christian Whitney, DO (an interventional pain management specialist who has been with Greenwich Hospital for seven years), radiology technicians and nurses.

Treatment options range from nerve blocks (medication or numbing agents injected directly into the source of pain) and infusion pumps (for continuous delivery of medication to relieve pain or muscle spasms) to spinal cord stimulators (using electrical current to release natural pain-relieving hormones) and neurolytic procedures or radiofrequency ablation (to selectively destroy nerve cells that carry pain signals).

Decreasing pain levels can improve a cancer patient’s physical and emotional well-being. Studies show pain management can boost the immune system, potentially increasing the body’s innate defense against tumor progression. Controlling pain can also decrease the side effects, including cognitive impairment, associated with using opioids.

“Most important, controlling pain allows patients to continue a treatment plan – whether it’s radiation, chemotherapy or surgery – while restoring and maintaining quality of life,” said Dr. Huang.