Pain Management...

Also see Patient Care

Not all cancer patients have pain, but those who do need not suffer. There are many medications and treatments designed to alleviate the pain and keep you comfortable. Pain that is not controlled leads to depression, loss of function, withdrawal from society, malnutrition, irritability, agitation, slow rehabilitation, and sleep disorders. It is the goal of the cancer team to treat pain quickly, aggressively, in an effective fashion to relieve pain as much as possible with as few side effects as possible. When reporting pain, it is very helpful for your care team to know the answers to these questions:

• What makes the pain better or worse? Eating, sitting, walking, etc.?
• What is the quality of the pain? Sharp, dull, stabbing, burning, etc.?
• Does the pain radiate? Where to?
• What is the severity of the pain, on a scale of zero to ten?
• When does the pain occur? Day or night, after meals, constant, etc.?

Cause of Pain
When cancer causes pain, it does so by a number of mechanisms. Tumors can grow in bones, or organs, that can cause pain. Other tumors are associated with inflammation and swelling and cause inflammatory pain. Some tumors may invade or push against nerves and cause neuropathic pain. Pain can be associated with depression and anxiety and can often be the expressed nonspecifically as agitation, anxiety, or restlessness. Thus it is often necessary to use a number of different medications in small amounts to get at each component of the pain. In this way, pain can be maximally treated with the fewest side effects.

Medication Schedules
All pain medications work best when used in appropriate amounts frequently. Do not allow pain to return to its maximal level prior to taking the next dose as this results in increased suffering and greater drug use, because it takes larger amounts of medication to effect uncontrolled pain than it than takes to control pain at an acceptable level. If your medications are to be taken every 4 hours, or every 8 hours, try to stay on schedule. Some medications are to be taken “as needed”, usually every 2 to 4 hours. Take these medications as soon as the pain begins, and don’t wait until the pain is at its peak. This minimizes medication use and maximizes comfort and quality of life.

Fear of Addiction
Some patients fear addiction to narcotics, and so may use their medications infrequently or not at all. These fears cause a great deal of unnecessary suffering for the patient and their family and caregivers. Patients in pain, who take pain medication to treat pain, will not become addicted. Cancer patients are using pain medications to alleviate pain in hopes of feeling “normal”, and it is healthy to feel normal. If the pain worsens or the cancer progresses there maybe a need to increase the dose of the medications, but this does not indicate addiction.

Side Effects of Pain Medications
All pain medications are constipating, especially narcotics. Patients who go more than 24 hours without a bowel movement, are considered constipated. It is important for all patients using these medications to make every effort to have one bowel movement per day. This can be done with liberal use of stool softeners and laxatives. If these medications are not effective, let your doctor know as soon as possible.

Treatments Other Than Pain Medications
Radiation is primary used for the control of pain that is very localized. Radiation is also often used to control bone pain. Large painful spleens or lymph nodes and tumors can be reduced in size and result in significantly improved comfort. Surgery is, on rare occasions, used to perform nerve blocks or ablations so that the patient no longer feels the sensation of pain. Patients also experience pain relief with physical therapy, back rubs, a warm bath or whirlpool, ice, meditation, and group and individual psychotherapy.