PAIN MANAGEMENT AND IMPROVING QUALITY OF LIFE
IN TERMINALLY ILL CANCER PATIENTS
ALBERT GRAZIA, Ph.D.
One morning the mother of a terminally ill cancer patient called my office. Her son had renal cell carcinoma (kidney
cancer) which had spread to his liver and lungs. He was recently discharged from the hospital and was given a very poor prognosis
(two to three weeks to live). She explained that since medical treatment failed to control his disease, he was advised to
seek hospice care. She realized it was a hopeless situation, but still wondered if there was anything we could do to help
her son. When I entered the home, I observed a very pale young who was suffering from cachexia, the wasting syndrome commonly
associated with advanced cancers. He was nauseous and kept a bucket nearby because he was constantly vomiting. His appetite
was almost non-existent. I noticed his abdomen was swollen, often caused by a build up of fluid called ascites. This is generally
regarded as a sign of liver failure, from protein malnutrition, and usually correlated with a low serum albumin level. He
had also been constipated for some time. However, the most distressing symptom of his disease was the intense pain that even
morphine taken every four hours could not alleviate. As a clinical nutritionist, I am often called to help terminally ill
cancer patients. At this point, my focus is directed toward improving the quality of remaining life.
Most would agree that few diseases cause such excruciating pain as that experienced by many cancer patients. This
added suffering contributes to increased stress to both the patient as well as family members. Sometimes death is almost welcomed
as the final relief to such an unimaginable degree of suffering. Family and friends console themselves with thoughts that
their loved one is finally at peace.
Cancer pain syndrome is classified according to the structures involved such as somatic, visceral and neuropathic. Somatic
pain can be experienced throughout the body, while visceral pain tends to be localized to the internal organs in the abdominal
cavity. Neuropathic pain is more frequently felt in the extremities such as the hands and feet. Associated pain can range
from acute, to chronic, with the final stage known as intractable. Pain may result from tumor impingement on other organs
or nerve endings. Side effects of some chemo-therapeutic drugs known as platinum analogs, may contribute to pain. This is
evident due to the potential for damage to the peripheral nervous system, leading to neuropathic pain. Damage to nerve cells
can leave a patient with chronic pain in the hands and feet.
At the end stage of disease, all that remains is to provide some type of pain relief. Currently, the most common form
of pain management involves the use of opioids (narcotics) such as morphine. Unfortunately, this is often not entirely effective
in eliminating pain and often merely results in drowsiness. For this reason, methadone, is sometimes substituted for morphine.
However, since it can remain in the body for up to two days, repeated doses of methadone can accumulate in the blood to toxic
Pain may also be a result of accumulation of lactic acid in cancer patients. Studying the metabolism of cancer at the
cellular level, Otto Warburg, a Nobel Prize winning biochemist, demonstrated in 1930 that tumor cells prefer a particular
form of metabolism known as anaerobic (non-oxygen) glycolysis. The main by-product of this inefficient metabolism is a chemical
called lactic acid. This is the same lactic acid secreted by your muscles during a strenuous workout. When oxygen stores are
depleted, muscle cells revert to an anaerobic metabolism and release lactic acid. This is the substance responsible for the
localized pain experienced the day following the workout. Through the Cori cycle, lactic acid is metabolized by the liver
back into glucose. This process requires extra energy and can place a strain on the liver. Lactic acid secreted by tumor cells
accumulates in cancer patients, particularly when the liver is too weak to eliminate it. This can be responsible for the intense
chronic pain plaguing cancer patients. If you recall those muscle aches the day after a workout, multiply the pain a hundred
fold and you can better imagine the suffering that many terminally ill cancer patients endure. That explains why powerful
narcotics are often prescribed at this stage of the illness.
Although with end stage cancer we are focusing on quality of life, the process still begins with nutrition. With advanced
stage of disease, the body is either depleted of digestive enzymes, or lacks the energy and raw materials to produce them
in sufficient quantities to permit the proper breakdown and absorption of nutrients. So the key to nourishment in the terminal
patient is to start juicing. Fresh raw, (preferable organic) fruit and vegetable juices contain enough enzymes to allow them
to pass through the stomach and enter the intestines where they are quickly and easily assimilated. Fresh juices are concentrated
nutrition and are even more potent when we add a whole food supplement containing the naturally occurring phyto-chemicals
that are abundantly found in organic spirulina, wheat grass, barley grass and alfalfa. Sometimes a terminally ill patient
will have to start slowly, drinking half a glass at time, diluted with water, and then increasing to as much as tolerated.
In addition, flax seed oil or fish oil is suggested as an important source of alpha linolenic acid. This omega three essential
fatty acid is noted for its anti-inflammatory effects.
Due to the nature of their disease, cancer patients are very toxic. In addition to the toxicity received from cancer
treatments, tumor cells are very active metabolically and release many waste products. Even if cancer drugs were successful
in killing off tumor cells, the dead tumor cells will often remain to further poison the body. To make matters worse, one
of the more common side effects of narcotic pain medications such as morphine is constipation. An impacted colon places pressure
on an already crowded abdominal area and can press on nerve endings contributing to more discomfort. To assist the body in
its detoxification efforts, proper colon function must be restored as quickly as possible. I normally begin with an intestinal
corrective herbal formula containing cascara, senna, and aloe. However, in severe cases, I suggest dissolving the herbs in
water and adding them to an enema bag. Once bowel function is normalized, most cancer patients begin to feel less discomfort,
pressure and pain.
Many cancer patients have found that hot castor oil packs can also help relive pain. This is done by saturating a cotton
cloth in castor oil and then placing it directly on the skin over the tumor area. The cloth is then covered with plastic wrap
and a hot water bottle or hot pack is placed on top. The castor oil pack should be left on for at least an hour or more and
can be repeated as often as necessary. This permits ricinoleic acid, one of the healing components of castor oil, to be absorbed
directly into body tissues.
Another important consideration when it comes to pain management is to insure that the body is properly hydrated. Many
cancer patients do not drink enough water, or they may consume beverages containing caffeine or alcohol which produce diuretic
effects resulting in further loss of water. A dehydrated body will release histamine along with prostaglandins and kinins.
These are all substances that can contribute to pain directly when they come in contact with the pain-sensing nerves in the
body, or indirectly by increasing inflammation. A minimum of ten to twelve glasses of water per day is necessary to maintain
proper hydration and to assist the kidneys in eliminating toxins from the body.
Other measures to help decrease pain and improve quality of life are massage and acupuncture. Massaging the cancer patient
with extra virgin olive oil or castor oil is soothing to dry skin and the oils are quickly absorbed. Most patients also find
massage to be very relaxing as well as providing pain relief. Massaging towards the heart helps moves lymphatic fluid and
assists the body in removing accumulated toxins. Acupuncture has been documented to reduce pain by stimulating the release
of endorphins and enkephalins which are the body's own natural pain killing chemicals.
Returning to the case study described above, this young man immediately began drinking fresh raw juices and started cleansing
his colon. He also applied the castor oil pack on his abdomen over his liver area because that was the source of much of his
intense pain. His family also massaged him with extra virgin olive oil, alternating with castor oil. After four weeks, he
was not only still alive, but he was no longer vomiting, his color returned, and the swelling in his abdomen decreased considerably.
But more importantly he was completely free of pain. In fact he had been able to wean entirely off his morphine. He remained
pain-free and no longer required any type of pain medication. This was a dramatic improvement in quality of life both for
him and his family, who were no longer watching him suffer. His life was extended by several pain-free months. One afternoon
his mother called to thank me for helping her son, and to inform me that he died peacefully in his sleep with his family at