In Search of the Best Pain Clinic in LA: Pain in Cancer Survivors, Part 2 Diagnosis

By | September 20, 2011

Just as the stigmata of Jesus were visible only to the true believers, the many pain syndromes of cancer survivors will be diagnosed only by physicians who know that they exist and look for them.

Chronic pain in cancer survivors presents many unique features and is often more challenging from a clinical standpoint than pain caused by a primary or metastatic tumor. First of all, most of these pain syndromes occur years after the battle has supposedly been won in patients who appear otherwise healthy. In many cases after a frantic search for recurrence, the patients are once again pronounced cured and left to their own devices. There are a plethora of reasons for this response, but primary among them is the fact that physicians are human and there is great reluctance to consider diagnoses which point to a failure, even a small one, in an otherwise successful treatment regimen.

Secondly there are usually no external signs of these conditions and most simple laboratory tests and imaging studies will be likewise negative. The diagnosis is made largely on the basis of history and confirmatory electrodiagnostic testing is uncomfortable and ordered only where there is a high index of suspicion.

Finally many practitioners feel little pressure to make the diagnosis of a condition, which they believe to be untreatable, but here they are wrong on two different counts. The patients need and deserve to know what is wrong with them even if treatment options are limited. Secondly, while treatment of these conditions is difficult, it is often surprisingly effective.

What really makes these cases special is that the pain occurs in the context of a fully functional individual, which means that the first line of treatment employed by many oncologists, high dose narcotics and central nervous system depressants, is inappropriate here. But for the best pain clinic in Los Angeles, this is an invitation to be creative and to craft a regimen of treatment that both relieves pain and preserves function.

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