Managing Cancer Pain

The World Health Organization developed a 3-step approach for pain management based on the severity of the pain:
For mild to moderate pain, the doctor may prescribe a Step 1 pain medication such as aspirin, acetaminophen, or a nonsteroidal anti-inflammatory drug (NSAID). Patients should be monitored for side effects, especially those caused by NSAIDs, such as kidney, heart and blood vessel, or stomach and intestinal problems.
When pain lasts or increases, the doctor may change the prescription to a Step 2 or Step 3 pain medication. Most patients with cancer -related pain will need a Step 2 or Step 3 medication. The doctor may skip Step 1 medications if the patient initially has moderate to severe pain.
At each step, the doctor may prescribe additional drugs or treatments (for example, radiation therapy).
The patient should take doses regularly, "by mouth, by the clock" (at scheduled times), to maintain a constant level of the drug in the body; this will help prevent recurrence of pain. If the patient is unable to swallow, the drugs are given by other routes (for example, by infusion or injection).
The doctor may prescribe additional doses of drug that can be taken as needed for pain that occurs between scheduled doses of drug.
The doctor will adjust the pain medication regimen for each patient's individual circumstances and physical condition.
Acetaminophen and NSAIDs
NSAIDs are effective for relief of mild pain. They may be given with opioids for the relief of moderate to severe pain. Acetaminophen also relieves pain, although it does not have the anti-inflammatory effect that aspirin and NSAIDs do. Patients, especially older patients, who are taking acetaminophen or NSAIDs should be closely monitored for side effects. Aspirin should not be given to children to treat pain.
Opioids
Opioids are very effective for the relief of moderate to severe pain. Many patients with cancer pain, however, become tolerant to opioids during long-term therapy. Therefore, increasing doses may be needed to continue to relieve pain. A patient's tolerance of an opioid or physical dependence on it is not the same as addiction (psychological dependence). Mistaken concerns about addiction can result in undertreating pain.
Types of Opioids
There are several types of opioids. Morphine is the most commonly used opioid in cancer pain management. Other commonly used opioids include hydromorphone, oxycodone, methadone, fentanyl, and tramadol. The availability of several different opioids allows the doctor flexibility in prescribing a medication regimen that will meet individual patient needs.
Guidelines for Giving Opioids
Most patients with cancer pain will need to receive pain medication on a fixed schedule to manage the pain and prevent it from getting worse. The doctor will prescribe a dose of the opioid medication that can be taken as needed along with the regular fixed-schedule opioid to control pain that occurs between the scheduled doses. The amount of time between doses depends on which opioid the doctor prescribes. The correct dose is the amount of opioid that controls pain with the fewest side effects. The goal is to achieve a good balance between pain relief and side effects by gradually adjusting the dose. If opioid tolerance does occur, it can be overcome by increasing the dose or changing to another opioid, especially if higher doses are needed.

Cancer

Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems.
Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. Most cancers are named for the organ or type of cell in which they start - for example, cancer that begins in the colon is called colon cancer; cancer that begins in basal cells of the skin is called basal cell carcinoma.
Cancer types can be grouped into broader categories. The main categories of cancer include:
Carcinoma - cancer that begins in the skin or in tissues that line or cover internal organs.
Sarcoma - cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.
Leukemia - cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood.
Lymphoma and myeloma - cancers that begin in the cells of the immune system.
Central nervous system cancers - cancers that begin in the tissues of the brain and spinal cord.
Origins of Cancer
All cancers begin in cells, the body's basic unit of life. To understand cancer, it's helpful to know what happens when normal cells become cancer cells.
The body is made up of many types of cells. These cells grow and divide in a controlled way to produce more cells as they are needed to keep the body healthy. When cells become old or damaged, they die and are replaced with new cells.
However, sometimes this orderly process goes wrong. The genetic material (DNA) of a cell can become damaged or changed, producing mutations that affect normal cell growth and division. When this happens, cells do not die when they should and new cells form when the body does not need them. The extra cells may form a mass of tissue called a tumor.

Not all tumors are cancerous; tumors can be benign or malignant.
Benign tumors aren't cancerous. They can often be removed, and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body.
Malignant tumors are cancerous. Cells in these tumors can invade nearby tissues and spread to other parts of the body. The spread of cancer from one part of the body to another is called metastasis.
Some cancers do not form tumors. For example, leukemia is a cancer of the bone marrow and blood.
Cancer Statistics
A new report from the nation's leading cancer organizations shows that, for the first time since the report was first issued in 1998, both incidence and death rates for all cancers combined are decreasing for both men and women, driven largely by declines in some of the most common types of cancer.

Biological Therapy

Biological therapy (BYE-o-loj-ee-cal THER-ah-py) is a type of treatment that works with your immune system. It can help fight cancer or help control side effects (how your body reacts to the drugs you are taking) from other cancer treatments like chemotherapy.The immune system of the patient is treated in a bio therapy. It not only strengthens your immune system but also helps in ensuring that you are able fight against the side effects. In a bio therapy the therapist inserts some natural substances into the patient's body.The bio therapy drugs will perform two functions simultaneously. Firstly it will destroy the harmful cells responsible for diseases like cancer . Secondly it will segregate your regular cells from them. This will make sure that your body is able to function in a routine manner. Since these two tasks are performed simultaneously you will be able to get relief in a shorter period in biotherapy.Biotherapy treatment supplies natural substances to fight against diseases to the whole and to the affected region . The therapist identifies the energy levels in the infected area and then goes ahead with the therapy after calculating the amount to be supplemented. The success of bio therapy treatment also lies in allocating the appropriate amount of energy. If the energy levels are in excess or it is not supplied adequately the consequences will be severe. It takes less than a few hours to administer biological therapy. The treatement varies from case to case.Some minor problems may even be cured within 20 or 20 minutes though not in a single session. Most of the therapist will insist that you do a follow up by regular checkups to ensure that the energy levels remain constantly in the body at the same level.Bio therapy is very helpful to cure skin diseases and as well as regularize your digestive system.Bio therapy is well known for treating ailments like cancer. Cancer immunotherapy is not similar to the laser treatment provided for cancer patients. In a laser treatment the harmful cells are killed. But in a bio therapy the therapist kills the harmful substances and as well as makes sure that the routine functions of the normal cells are performed without any disturbances.

Thermography

Thermography is a tool which identifies breast cancer that uses super-sensitive infrared cameras and computer technology to detect heat on the surface of a patient’s breast. The presence of such heat is sometimes the result of intensive chemical and blood vessel activity that is characteristic of precancerous or cancerous tissue.Although some health professionals support the use of thermography (also known as digital infrared imaging).It may not detect small cancers or tumors deeper in the breast and it cannot pinpoint the location of a tumor. Two factors cause cancerous cells to generate heat that theoretically can be detected during thermography:Higher metabolic activity of cancer tissue compared to normal tissue. Cancer cells have higher rates of metabolism (physical and chemical processes in the body) than normal tissues. This higher metabolism registers as an increase in the surface temperature of the breast near the cancerous tissue. This is detected by the infrared camera.Angiogenesis. A cancerous tumor produces a chemical that promotes the development of blood vessels that supply the tumor with the nutrients it needs to keep growing. In addition, the cancer causes normal blood vessels to dilate (open) to provide even more blood to the forming tumor. Both of these activities produce additional heat which may be detected by the infrared camera.The infrared camera used during thermography converts infrared radiation emitted from the skin into electrical impulses and feeds the information into a computer. The computer analyzes the temperature and vascular (blood vessel) changes and produces high-resolution images known as thermograms. These images can be displayed on a monitor for analysis, with areas of raised temperature appearing red and areas of normal temperature appearing blue. They can also be printed or sent to another physician electronically.Thermography has been tested and researched since the 1950s. It originally involved the use of contact plates that measured the heat emitting from the breasts, although thermograms are now produced digitally. In 1982, the U.S FDA approved the use of thermography to help detect breast cancer and some circulation disorders, such as deep vein thrombosis and conditions relating to blood flow in the head and neck.Proponents of thermography claim that the technique can detect signs of precancerous or cancerous cells far earlier than other imaging techniques. For example, mammography technology cannot detect cancer until a tumor has actually begun to form, which may take several years. Thermography is designed to detect the formation of new blood vessels and chemical changes that occur very early in a tumor’s development. Some experts contend that thermography can identify signs of the formation of breast cancer up to 10 years before any other technique can detect them.In addition, thermography is touted as having certain advantages over traditional mammography procedures. During thermography, the machine does not touch the breast, in contrast to the squeezing of the breast that occurs during mammography. In addition, patients are not exposed to the potentially harmful radiation used in mammography.However, many experts have expressed doubts about the effectiveness of thermography in diagnosing breast cancer. For example, the American Cancer Society maintains that thermography is not a reliable diagnostic tool because it misses some cancers and has a high rate of false positives. The ACS warns that thermography should never be used as a replacement for mammograms.Other experts have also criticized thermography for producing too many false results, and have argued that the technique cannot detect the heat of cancers located deep in the breast or under fatty areas. It has also been noted that not all cancers emit heat, and thus would not be revealed by a thermogram.Still, some experts support thermography as a valuable tool in detecting breast cancers. Experts generally agree that thermography should not be used as a stand-alone diagnostic tool, but rather should be used with other diagnostic tools, such as mammograms, ultrasounds and physical examinations.

Medical Devices

A medical device is intended for use in:

• the diagnosis of disease or other conditions, or
• in the cure, mitigation, treatment, or prevention of disease,
• intended to affect the structure or any function of the body of man or other animals, and which does not achieve any of its primary intended purposes through chemical action and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes.

A pump for continuous subcutaneous insulin infusion, an example of a biomedical engineering application of electrical engineering to medical equipment.

Some examples include pacemakers, infusion pumps, the heart-lung machine, dialysis machines, artificial organs, implants, artificial limbs, corrective lenses, cochlear implants, ocular prosthetics, facial prosthetics, somato prosthetics, and dental implants.

Stereolithography is a practical example on how medical modeling can be used to create physical objects. Beyond modeling organs and the human body, emerging engineering techniques are also currently used in the research and development of new devices for innovative therapies, treatments, patient monitoring, and early diagnosis of complex diseases.

Medical devices can be regulated and classified (in the US) as shown below:

1. Class I devices present minimal potential for harm to the user and are often simpler in design than Class II or Class III devices. Devices in this category include tongue depressors, bedpans, elastic bandages, examination gloves, and hand-held surgical instruments and other similar types of common equipment.
2. Class II devices are subject to special controls in addition to the general controls of Class I devices. Special controls may include special labeling requirements, mandatory performance standards, and postmarket surveillance. Devices in this class are typically non-invasive and include x-ray machines, PACS, powered wheelchairs, infusion pumps, and surgical drapes.
3. Class III devices require premarket approval, a scientific review to ensure the device's safety and effectiveness, in addition to the general controls of Class I. Examples include replacement heart valves, silicone gel-filled breast implants, implanted cerebellar stimulators, implantable pacemaker pulse generators and endosseous (intra-bone) implants.

Disciplines in biomedical engineering

• Bioelectrical and neural engineering
• Biomedical imaging and biomedical optics
• Biomaterials
• Biomechanics and biotransport
• Biomedical devices and instrumentation
• Molecular, cellular and tissue engineering
• Systems and integrative engineering

In other cases, disciplines within BME are broken down based on the closest association to another, more established engineering field, which typically include:

• Chemical engineering - often associated with biochemical, cellular, molecular and tissue engineering, biomaterials, and biotransport.
• Electrical engineering - often associated with bioelectrical and neural engineering, bioinstrumentation, biomedical imaging, and medical devices.
• Mechanical engineering - often associated with biomechanics, biotransport, medical devices, and modeling of biological systems.
• Optics and Optical engineering - biomedical optics, imaging and medical devices.

What is Biomedical Engineering?

Biomedical engineering (BME) is the application of engineering principles and techniques to the medical field. It combines the design and problem solving skills of engineering with medical and biological sciences to help improve patient health care and the quality of life of individuals.

As a relatively new discipline, much of the work in biomedical engineering consists of research and development, covering an array of fields: bioinformatics, medical imaging, image processing, physiological signal processing, biomechanics, biomaterials and bioengineering, systems analysis, 3-D modeling, etc. Examples of concrete applications of biomedical engineering are the development and manufacture of biocompatible prostheses, medical devices, diagnostic devices and imaging equipment such as MRIs and EEGs, and pharmaceutical drugs.