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Pain Management and Improving Quality of Life in Terminally Ill Cancer Patients

By: Albert Grazia, MS, ND

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). Since conventional medical treatment failed to control his disease, he was advised to seek hospice care. She realized it was a hopeless situation, but still wanted to know if it was too late to do anything to help her son. I reassured her that it's only too late if you never start. When I entered the home, I observed a young man, who was very pale and suffering from cachexia, the wasting syndrome commonly associated with advanced cancers. (In fact, it is estimated that 40 percent of all cancer patients actually die of malnutrition.) He was nauseous and kept a bucket nearby because he was constantly vomiting. His appetite was almost nonexistent. I noticed his abdomen was swollen, often caused by a buildup of fluid called ascites. This is generally regarded as a sign of liver failure from protein malnutrition and correlated on blood tests with a low serum albumin level. In addition, his bowels had almost ceased to function. However, the most distressing symptom of his disease was the intense pain that even morphine taken every four hours could not alleviate. As a naturopath, I am often called to help terminally ill cancer patients. At this point, my focus is directed toward improving the quality of remaining life. This is where natural healing can provide dramatic results.

Most would agree that few diseases cause such excruciating pain as that experienced by many terminally ill 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. Unfortunately, those suffering from advanced cancers find that not only has conventional medicine failed to cure them, but it also offers them few options other than to spend their last days in agonizing pain only partly relieved by strong and toxic drugs.

Cancer Pain
Traditionally, 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. To complicate matters, side effects of modern, more aggressive cancer treatment can also be responsible for inflicting significant pain. This is evident due to the greater potential for damage to the peripheral nervous system leading to neuropathic pain. Cancer drugs that are toxic to nerve cells can leave a patient with chronic pain in the hands and feet.

At the end stage of disease, patients may feel abandoned by the medical community. They are told there is nothing more that can be done and instructed to get their affairs in order. 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 levels.

Natural Treatment of Cancer Pain
My training in natural healing has taught me to approach cancer pain from a different perspective. I regard it as a message, a desperate cry for help from the body, alerting us that there is a severe toxic condition that the body's own detoxification system is unable to eliminate. In cancer patients, this involves the buildup of one particular substance. 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 byproduct 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 anaerobic metabolism and release lactic acid. This is the substance responsible for the localized pain experienced the day following the workout. Lactic acid must then be 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 hundredfold, 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.

In natural healing, my aim is to build up the body's ability to heal itself. Although with advanced cancer I am 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 stop eating—and start juicing. Fresh, raw, (preferably 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 (SuperFood) 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. The goal is to eventually consume one glass every hour, or up to a gallon daily. In addition to the juices, a tablespoon of flaxseed oil is also necessary as a source of alpha linolenic acid. This omega-three essential fatty acid does not promote tumor growth and is noted for its anti-inflammatory effects. This nutritional foundation will provide the nutrients required by the body to heal and begin the detoxification process.

Due to the nature of their disease, cancer patients are very toxic. In addition to the toxicity received from cancer treatments, tumor cells are 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.

Dr. Max Gerson, a physician who devoted much of his life to studying cancer, also stressed the importance of colon cleansing and its role in decreasing cancer pain. In addition, he developed a simple pain formula for his patients to use until the colon cleansing was effective in reducing pain. His patients were instructed to take one aspirin tablet (five grams) with 100 milligrams of vitamin C and 50 milligrams of niacin, up to four times per day.

Many cancer patients have found that hot castor oil packs can also help relieve pain. This is done by saturating a cotton or flannel cloth in castor oil and 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. Histamine is commonly associated with allergic reactions due to its ability to dilate capillaries and increase blood vessel permeability. Prostaglandins are hormone-like substances that can stimulate contracitility of the smooth muscles in the body. Kinins are peptides that can act on smooth muscles and nerve endings. An increase in these substances can directly contribute to pain when they come in contact with the pain-sensing nerves in the body, or they indirectly cause pain 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. Several cups of herb teas should also be consumed in addition to the required amounts of water.

Massage and Acupuncture
Other alternative 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 helping to provide pain relief. Massaging toward the heart moves the lymphatic fluid and assists the body in removing accumulated toxins. Contrary to popular belief, there is no evidence proving that massage will spread your cancer. 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 with the SuperFoods 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 important, he was completely free of pain. In fact, he had been able to wean himself entirely off the morphine, 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. Thoughts previously obsessed with dying were replaced with hope and living. His life was extended by several more 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 his bedside.

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