Matt Brown is a consultant in pain medicine at the Royal Marsden Hospital, and Honorary Associate Faculty of the Institute of Cancer Research.
He trained at King’s College London, winning the War Memorial and Wolfson Foundation Scholarships and graduating with distinction.
Matt fulfilled his long-term interest in clinical research by gaining a National Institute for Health Research’s Academic Clinical Fellowship. This enabled him to conduct novel, award-winning research into pain at both Imperial College and King’s College, London.
Subsequently Matt completed a Doctorate in Medicine at the Institute of Cancer Research (becoming the first anaesthetist in the Institute’s history to do so and winning the Chairman’s Prize at graduation).
Matt has published and lectured widely on the subject of pain in cancer and takes a holistic and balanced approach to the assessment and management of cancer pain and other unpleasant symptoms.
Pain is the most feared symptom in cancer patients and is really common, affecting - depending on the stage of disease, between one-third and two-thirds of patients.
Pain can arise for a number of reasons, these include the disease itself (for example when a tumour presses on a nerve), chemotherapy (which can cause damage to the tiny nerves in the skin), radiotherapy and surgery. Patients who have had cancer for a long time are often very deconditioned making even normal activities painful.
Often, unfortunately, patients may have more than one cause of their pain which commonly results in the pain being severe and challenging to treat.
Pain is a big problem in cancer patients for a number of reasons, firstly it impacts on quality of life, reducing mobility and activity levels and can often be distressing both for patients and their loved ones.
Secondly, pain may have a negative impact on patients’ treatment, for example chemotherapy doses might be reduced if serious nerve damage occurs. Finally, being in severe pain for long periods can lead to the development of anxiety and depression developing (which ironically can make the pain feel even worse)!
Well pain doesn’t sit in isolation – it’s a bit like a pebble dropped in a pond with the ripples spreading outwards. Pain impacts on every area of a patient’s life, and the best way to tackle it is to use a structure approach – focusing on the biological (i.e. the physical causes), psychological and social aspects of the pain. This bio-psycho-social approach means that all areas are covered and no problems are missed.
When I see a cancer pain patient in my clinic I start by taking a history so that I can fully understand their cancer journey, the type of pain they are experiencing and how it is affecting them. I normally accompany this with a physical examination focused on the painful area and a review of any relevant scans.
Education and explanation is really important in managing pain successfully – if someone understands why they are experiencing pain, the symptoms are often less distressing and I spend a lot of time chatting with my patients, explaining my findings and coming up with a management plan.
A combination of approaches can be used to treat pain, often these address not only the physical effects of the pain but also the psychological and social effects.
Approaches can include pain-killing medications ranging from simple drugs like paracetamol through to stronger agents like morphine and anti-nerve pain medicines, injections to block nerves, psychological approaches like relaxation techniques, physiotherapy and complementary therapies like acupuncture. Combining a number of different treatments often leads to a better result.
Because pain and cancer are so closely intertwined, and pain often changes rapidly over the course of the disease, regular review and support is important. If you feel your pain is not adequately controlled I would recommend asking your cancer doctor to consider referring you to your local pain specialist.
For a review in my clinic click here.