Palliative care is an interdisciplinary medical caregiving approach to help mitigate pain symptoms caused by cancer or cancer treatment procedures. This method positively affects the quality of life in the final years of a patient’s life. It is a combination of treatments that includes pain control and addressing other physical and psychological problems that the patient and family are experiencing.

Extreme pain has severely affected the mental and physical health of Ms N., who suffers from intrahepatic cholangiocarcinoma and retroperitoneal metastasis. In March 2021, she visited FV Hospital, malnourished and in severe persistent pain. Her suffering caused her insomnia, anxiety and depression. Ms N. kept asking, “Why do I have to endure such pain?”.

Ms N. was assigned to Dr Nguyen Nam Binh at FV Pain Clinic. After taking a thorough look at her clinical history and careful examination, Dr Nam Binh realised that Ms N. needed to use morphine to relieve her pain. However, Ms N. and her family members were wary of using morphine as they were afraid of its side effects and potential addiction to long-term opiate usage.

Understanding this concern, Dr Nam Binh carefully explained to Ms N. and her family that using the right medicine with the right dose and regimen is safe, effective and will not cause side effects or addiction as dosage is calculated using the brief pain inventory (BPI). After consideration, Ms N. and her family agreed to the treatment plan.

In parallel with the use of pain relievers during treatment, the patient also needed psychological support. Dr Nam Binh observed that Ms N. had symptoms of stress and depression, and found ways to support her during her care.

Through the examination and consulting process, the doctor explained to Ms N. that stress and depression would increase her pain level and wanted to prescribe antidepressants and tranquilisers to improve her mood. At the same time, these medications help to increase the analgesic effect of morphine so that the dosage can be reduced. Ms N. agreed, and after only a few days, her pain and her mood had greatly improved. With that result, Ms N. became more confident in her treatment.

FV doctors not only support patients with drugs, but advise that they listen to therapeutic music as part of their treatment regimen. This meditative music has gentle, uplifting melodies so that patients can sleep more easily and peacefully.

However, not long after the initial success of her treatment, Ms N’s condition worsened due to an infection of her chemotherapy injection port and issues related to her metastatic tumour. Ms N.’s pain increased and was difficult to control with oral medication. Her doctors switched from oral to continuous subcutaneous pain relief via a disposable pain control (PCA) infusion set, or pump. This method allows the patient to move and live comfortably while a fixed amount of drug is continuously administered under the skin following the calculated dose allocated by the doctor. As a result, patients receiving this method of pain relief do not need to check the time to ensure they take their medicine regularly, as is the case with oral pain control, and can enjoy their normal activities.

Many types of pumps are available on the market, varying according to size, infusion speed and function. Doctors will select the most appropriate type for each case. For Ms N., her doctor chose a pump with a volume of 250 ml, for use within five days. Once Ms N. has almost finished the morphine and consulted with her doctor via phone using FV’s Telemedicine service, her carer comes to the hospital for a new pump.

After three months of treatment, Ms N.’s quality of life has improved and she can enjoy happy moments with her relatives and friends. This is the ideal result for her doctors. The process of palliative care for patients with cancer is a process of interaction, coordination and close sharing between the patient and their care team. By ensuring the patient and their family members are more comfortable and relaxed, doctors can help to make this period more peaceful and help to mitigate their grief.

According to Dr Nguyen Nam Binh, who works at FV’s Pain Clinic, cancer patients need appropriate pain relief for their level of pain.

Experiencing late-stage cancer is a painful challenge. However, thanks to the advances in pain control from more developed countries, patients do not need to suffer.

There are many different pain relief methods ranging from medication to modern intervention, such as using nerve plexus blockade, epidural analgesia and a continuous intramedullary injection pumps. When receiving palliative care at the Pain Clinic, FV Hospital, patients will receive treatment to control their pain to live comfortably, despite their illness.