Role Of Pain Management Solutions In Oncology

As we observe Pain Management Month with this year’s theme, ‘Let’s Solve Pain Together,’ it is an opportune time to reflect on the importance of comprehensive pain management, particularly in oncology. In India, where the cancer burden is rapidly increasing, pain remains a significant and often under-treated challenge for many people battling cancer. According to the Indian Council of Medical Research (ICMR), there will be an estimated 1.5 million new cancer cases by 2025.The need for effective pain management has never been more pressing as the need for better cancer treatments improves. 

It is estimated that less than 3 per cent of India's cancer patients have access to adequate pain relief. Pain affects a significant number of cancer patients across India, particularly in the advanced stages of the disease. As per research, about 53 per cent of patients suffer pain at all stages of cancer. Meanwhile, 59  per cent of patients suffer pain during the active therapy phase, and 65 per cent suffer during the advanced stages. 30 per cent are not relieved by medicine treatment alone, so they require interventional pain management. Staggeringly, forty per cent die of severe pain.

These statistics underscore a significant gap in pain management services in India, where issues such as limited access to opioids, a lack of trained palliative care professionals, and socio-cultural stigmas about pain management contribute to inadequate care. As a result, many patients endure unnecessary suffering, leading to diminished quality of life and exacerbated emotional and psychological distress.

The call for a multidimensional approach

This year’s theme, ‘Let’s Solve Pain Together,’ highlights the need for a collaborative, patient-centred approach to pain management, especially in India, where the healthcare system is still evolving to meet the needs of cancer patients.

In India, many cancer patients face additional socio-economic challenges that complicate pain management. Access to palliative care services, particularly in rural areas, remains limited. A study by the Indian Journal of Palliative Care highlighted that over 70 per cent of patients in India seek medical care only at the advanced stages of the disease when pain is often more severe and difficult to manage.This makes it critical for healthcare providers to not only focus on medical treatment but to understand the broader context of each patient’s lived experience, which includes financial hardships, social stigma, and lack of support systems.

Need for a collaborative effort by healthcare providers

Healthcare providers in India face significant challenges in delivering effective pain management, particularly due to the lack of awareness and formal training in palliative care. According, less than 2 per cent of India’s population has access to palliative care services, highlighting a crucial need for more specialised professionals. However, as palliative care awareness grows, efforts are being made to integrate oncology and pain management teams to ensure patients receive holistic care.

Introducing policies such as the National Program for Palliative Care (NPPC) and the efforts of organisations like the Pain and Palliative Care Society in Kerala have been instrumental in driving change. Nonetheless, more needs to be done, particularly in training healthcare providers to recognise and address cancer-related pain at all stages of the disease.

Importance of updated and reliable data

In India, there is a growing recognition of the importance of data in informing healthcare decisions. However, reliable statistics on cancer-related pain remain limited. The ICMR and other research bodies are working to address this gap, collecting data on cancer outcomes, treatment efficacy, and patient-reported pain levels. Leveraging such data can help healthcare providers make more informed decisions and improve treatment protocols.

In addition, innovative solutions like mobile health (mHealth) platforms are gaining traction in India. These platforms offer the potential to collect real-time patient data and monitor treatment effectiveness, particularly in remote areas where follow-up visits are challenging.

The urgent need for more pain research

Despite the prevalence of cancer-related pain in India, research in this area remains insufficient. According to the Indian Society for Study of Pain (ISSP), pain research is critically underfunded, and more needs to be done to explore alternative pain management strategies, particularly in the context of India's diverse patient population. Region-specific guidelines for pain management, tailored to the unique socio-economic and healthcare challenges faced by Indian patients, are also needed.

A Lancet Oncology Commission report in 2020 noted that while India has made progress in palliative care, significant gaps remain in funding, research, and policy implementation. This report calls for more government and private sector collaboration to ensure that every cancer patient in India receives the pain relief they deserve.

Innovations in pain management solutions

India has seen several innovative approaches to pain management in recent years. For example, the use of low-cost, patient-controlled analgesia (PCA) devices and regional anaesthesia techniques, like epidural infusions, have provided effective relief for many patients. Non-opioid alternatives are also being increasingly used to manage pain without the risks associated with opioid dependency. 

The theme ‘Let’s Solve Pain Together’ is particularly relevant to the Indian healthcare landscape, where innovation and collaboration are needed to overcome the barriers to effective pain management. With ongoing improvements in awareness, access, and treatment options, there is hope that we can significantly reduce the burden of pain for cancer patients in India and offer them a better quality of life.

Dr Kinnar C Shah

Guest Author Director - Department of Surgical Oncology, Krishna Hospital, Ahmedabad