Chris Curry
In the quiet, sterile corridors of a cancer clinic, the conversation often centers on scans, stages, and survival rates. But for the person sitting on the exam table, the most pressing question is often much more visceral: “How much is this going to hurt?”
Managing the physical and emotional toll of a cancer diagnosis is a complex challenge that extends far beyond the tumor itself. In a recent episode of A Cancer Conversation, two of the Georgia Cancer Center’s leading voices in supportive care—Dr. Lauren Bigham, director of the Psycho-Social Oncology program, and Dr. Egidio Del Fabbro, director of Palliative Medicine—sat down to discuss how an interdisciplinary approach is shifting the focus from simply treating a disease to caring for the whole person.
The Complexity of “Total Pain”
For many patients, pain is not just a physical sensation but a disruptive force that ripples through every aspect of life. Bigham refers to this as “total pain”—a concept that recognizes how physical discomfort is inextricably linked to psychological, social, and even spiritual distress.
“Pain can keep you from your job, your hobbies, and your family,” Bigham noted during the discussion. When these connections are severed, the resulting anxiety and depression can actually amplify the physical perception of pain, creating a grueling cycle for the patient.
Del Fabbro emphasized that cancer pain is rarely straightforward. It can be neuropathic, caused by nerve damage from the cancer or chemotherapy, or nociceptive, resulting from tissue injury. Because the sources are so varied, the solution must be equally diverse.
While medications like opioids are often a necessary tool, they are only one piece of the puzzle. The goal, according to Del Fabbro, isn’t just to mask the pain but to restore “function”—the ability for a patient to move, think, and engage with the world.
One of the more fascinating strategies discussed was the “Gate Control Theory.” The idea is that the brain can only process so many signals at once. By introducing non-painful impulses—such as light rubbing, TENS units, acupuncture, or massage—patients can effectively “close the gate” on pain signals.
Even movement, which may seem counterintuitive to someone in pain, plays a critical role. Del Fabbro pointed to Tai Chi and brisk walking as evidence-based ways to release natural endorphins and improve neuropathic pain.
Overcoming Fear and Barriers
A significant portion of the conversation centered on the stigmas surrounding pain management. Some patients suffer in silence due to “opioid phobia,” fearing addiction or dependence. Others experience the opposite: a paralyzing fear that they won’t have enough medication to survive the day.
The specialists stressed that the key to navigating these fears is a deep, trusting rapport between the patient and the medical team. “Nothing is set in stone,” Del Fabbro explained, noting that treatment plans are constantly adjusted based on a patient’s progress and their use of complementary therapies.
Often, the most important member of the treatment team isn’t wearing a white coat. Caregivers provide what the doctors call a “collateral history”—a real-world perspective on how much a patient is actually struggling at home.
Caregivers are also the front line of safety, helping to manage complex medication schedules and ensuring that powerful drugs are stored securely to prevent accidental misuse or “medication confusion”.
As the Georgia Cancer Center continues to bridge the gap between cutting-edge research and compassionate patient care, the message from Bigham and Del Fabbro remains clear: supportive care is not an “end-of-life” service. It is a vital, ongoing partnership designed to help patients live their lives as fully as possible, from the moment of diagnosis through survivorship.
For those navigating the complexities of cancer, the conversation about pain is no longer a silent one. It is a dialogue rooted in science, empathy, and the unwavering goal of improving the quality of every day.
Lindsey Morris
