Managing Cancer Pain; Are Better Approaches on the Horizon?

The National Cancer Institute (NCI) of the National Institutes of Health (NIH) publishes an e mail blog entitited Current Contents to which one can subscribe. On January 23rd, their blog focused on non-opiod methods of managing cancer pain (see below).  Pain is a common and much-feared symptom among people being treated for cancer and long-term survivors. Cancer pain can be caused by the disease itself, its treatments, or a combination of the two. It may be short-lived or chronic, and for some people it can persist long after treatment ends.

The most common cancer types, such as breast, lung, prostate, and colon cancer, rarely cause pain at the site where they originate. One of the most common types of cancer pain is bone pain. Cancer-induced bone pain occurs when metastatic tumors of cancers that start in other parts of the body grow in the bone marrow, the sponge-like tissue in the center of most bones. In fact, bone pain may be the first symptom of several forms of cancer, including prostate and lung cancer.

Researchers have found that “tumors in bone stimulate the sprouting of pain-transmitting nerve fibers near the tumor. Once tumor cells are established in the bone marrow, they hijack the molecules that regulate cells involved in breaking down bone, called osteoclasts. As a result, the osteoclasts get bigger and then they avidly digest bone. To digest bone, osteoclasts create an acidic environment that is almost like pouring battery acid on bone. The causes of bone cancer pain are twofold. First, sensory neurons, or nerve fibers, in bone “detect the acidic environment and signal it as pain. Second, excess osteoclast activity results in microfractures or full fractures of bone that can cause extreme pain.”

Denosumab (Prolia) and bisphosphonates like alendronate (Fosamax), are both first-line therapies for cancer-induced bone pain caused by metastatic cancer. Both denosumab and bisphosphonates, which were originally developed to treat osteoporosis, help maintain bone integrity by reining in osteoclast activity. A potential new treatment for bone pain due to metastatic cancer is an antibody called tanezumab, which blocks the activity of a pain-signaling molecule called nerve growth factor (NGF). Researchers found that in mice, tanezumab blocks nerve-sprouting in bone and reduces the development of late-stage cancer pain. Tanezumab is now being tested in phase 3 clinical trials for cancer-induced bone pain. A related approach seeks to block the actions of NGF by blocking its receptor, known as TrkA (tropomyosin receptor kinase A), on sensory nerve fibers. There is also keen interest in using cannabinoids,  chemicals found in marijuana, to treat cancer-induced and other types of bone pain but this research is still in the stage of animal testing.

The NCI article below also describes chemotherapy-induced peripheral neuropathy (CIPN), often an undesirable side effect of chemotherapy. This is often the reason that patients must reduce their chemotherapy dose or stop treatment prematurely. Other sections in the NCI blog include non-drug approaches to relieving pain and other challenges to pain management.

The entire NCI blog can be found at the following link.


Excellent Informative Prostate Cancer Videos on Several Subjects

The Prostate Cancer Research Institute (PCRI) has produced several short videos covering many aspects of the disease including, imunotherapy, brachytherapy, intensity-modulated radiation therapy (IMRT), sexual disfunction, testosterone levels, and more. The speakers include Dr. Mark Moyad, Dr. Eugene Kwon from the Mayo Clinic and others. It is my understanding that such videos will become available on an on-going basis. One can obtain these videos by subscribing to Google below.


Mind Boggling New Year Promises

“If you want to feel small, just imagine moving at 34 thousand miles per hour for forty years and getting—astronomically speaking—nowhere. Late last year, the Voyager 2 space probe became the second craft to ever leave our solar system. Now 11 billion miles from earth, it is one of the farthest-flung man-made objects in existence. And it was launched in 1977.

Because there are different ways of defining the solar system, we should be precise. The American Geophysical Union in Washington reports that Voyager 2’s sensors recently detected a sudden dip in radiation and magnetism, which marks the boundary of what astronomers call the “heliosphere,” our sun’s protective bubble of particles and magnetism. In other words, the probe is now beyond our star’s most significant influences and is hurtling into interstellar space—literally “the space between the stars”—at 34 thousand miles per hour. Its departure from the heliosphere is big news because, unlike its twin, Voyager 1, Voyager 2 is still transmitting data back to us here on earth, providing “first-of-its-kind” observations of the nature of this unexplored space. Voyager 2 was originally designed to observe the gas giants Jupiter, Saturn, Uranus, and Neptune—a mission it completed back in 1989. But scientists now think the aging probe might hold together as late as 2027, depending on how long its plutonium fuel source provides power.

The accomplishment of both Voyager probes is unparalleled. Still, astronomically speaking, they’ve only just stepped outside our front door, and barely entered the larger stellar neighborhood. It will take Voyager 2 another 40 thousand years to approach the nearest star to our sun—which together occupy only a fraction of the Orion Arm of the Milky Way galaxy. The Milky Way, in turn, is just one of at least 100 billion galaxies in the visible universe.” Makes one feel small doesn’t it.

“In the distant reaches of space, there are stars so much bigger than our sun they defy description. The longtime record-holder for largest known star is VY Canis Majoris, a red hypergiant over two thousand times the size of our sun. To give you an idea of the scale we’re talking about, if VY Canis Majoris replaced our sun, it would engulf most of the inner planets of the solar system, including Earth.

Voyager 2’s journey is a constant reminder to us of the enormity of the universe. I don’t know about you, but the distances and objects visible in the night sky make me dizzy; they confront me with the realization of how little I seem to matter by comparison… which is exactly the reaction God wanted us to have. Our own wonder ought to echo the Psalmist, who sung: “When I look at your heavens, the work of your fingers, the moon and the stars, which you have set in place, what is man that you are mindful of him, and the son of man that you care for him?”

God—the Creator of VY Canis Majoris—answered that question, but not ultimately in words. Instead, He came to dwell with His people, first through the Ark in the Tabernacle in the Old Testament, and ultimately in the Incarnation of Jesus Christ, whose name means “Immanuel, God with us.” Though it boggles the mind, the maker of the Milky Way chose this little planet to reveal Himself most fully and personally. By doing this, He bridged a gulf that makes the space between our stars seem small—the separation between an infinitely holy God and sinners like us who are doomed to death.

Against this backdrop of our cosmic insignificance, we can better appreciate God’s love—which He demonstrated by ‘coming to our neighborhood.’ Thank God, since we can’t even build a probe able to leave our interstellar neighborhood.”

As stated above, this enormous Creator God can be known in an intimate personal way through Jesus Christ, appropriately named Immanuel, meaning God with us. He is interested in every aspect of our lives including our medical situations. To substantiate this, God gave us hundreds of specific promises in writing, His Word. For example, Deuteronomy 31:8 states “And the Lord is the one who goes ahead of you; He will be with you. He will not fail you or forsake you. Do not fear or be dismayed.” For many others, see this website section entitled Scriptural Medicines. To enter into such a personal relationship with God, see the following.

The Voyager 2 essay was published online from “Breakpoint Daily from the Colson Center“, January 8th, 2019  to which I enthusiastically suggest a subscription.