Knowing your Needs

Although pain occurs in about two thirds of all patients with advanced cancer, it is important to remember that it can be completely or mostly controlled in a great majority of cases.

Although tumors themselves are usually painless, they can cause pain by pressing on or invading neighboring structures—a bone, or a nerve or the wrappings around the liver, for example—so there may be pain originating from those organs or tissues.

If you do experience pain, the first thing your doctor will do is ask you to describe your pain in detail This might include the site of the pain, type, intensity, and duration of the pain, and things that make the pain better or worse. The answers to these questions will help in planning the right treatment for you. Your doctor may need to do some additional tests, such as imaging tests (ie, x-rays, bone scans, ultrasound, CT scans, or MRI scans), which can help identify potential sources of the pain.

Several different health care professionals (HCP) may be involved in the management of your pain. Some facilities have pain control teams who will help develop a pain management strategy that is tailored to your situation.

 

How Cancer Pain Can Be Treated

There are many different types of treatments used in the control of pain, including:

• Treatments aimed at the tumor itself, such as radiation or chemotherapy, which may decrease pain by causing the tumor to shrink
• Pain-killing medications (analgesics)
• Specialized techniques to relieve pain, such as acupuncture, relaxation techniques, biofeedback, transcutaneous electrical nerve stimulators (TENS devices), nerve blocks, and epidural injections

Of these treatments, pain-killing medications are perhaps the most widely used.

 

Pain-killing Medications (Analgesics)

There are five basic principles for using analgesics successfully for pain management:

1. Use the right medication
2. Use the right dose
3. Use the right schedule
4. Use the right route
5. Control any side effects

The right medication. There are many different analgesics but they can be thought of in three groups of increasing power. Your doctor will try to match the painkiller to your level of pain. Mild analgesics such as acetaminophen (for example, Tylenol™), aspirin, or ibuprofen are typically used for mild pain. Moderate analgesics include drugs such as codeine and oxycodone. Examples of strong analgesics include morphine and hydromorphone.

The right dose and schedule. Once a choice of medication is made, your doctor will also match the proper dose to your level of pain. Perhaps the single most important message to follow with the use of painkillers is to do the right schedule: if you have pain just occasionally, then it may be fine to take painkillers occasionally if that is what your doctor recommends. But if the pain is there most of the time or all of the time, you need to take your painkillers regularly so that there is enough of the medication in your body to keep the pain under control. That means taking the dose of medication that your doctor recommends (and not taking less) and taking it regularly just as it has been prescribed. If you do that then not only will your pain be controlled properly, but you will actually end up using less painkillers per day than if you wait until the pain really hurts and then take a lot of painkillers to try to switch the pain off.

The correct time interval depends on the actual medication that your doctor has given you. Some medications need to be taken every 4 hours, while others are slow-release preparations that can be taken less frequently. If you take the medication regularly, then your body gets a steady amount of drug all the time, which means you'll get the best chance of good pain control.

The right route. Sometimes it may be difficult for you to take tablets or syrup—you may have difficulty in swallowing or some other problem. In this case, other dosage forms, such as suppositories or skin patches can be used. If you need more analgesic than you can comfortably swallow or give by suppository, your doctor may recommend that the painkiller be given by slow steady injection under the skin using a device called a 'pain pump'. The pump gives you a steady dose of medication usually for several days or a week. Most pumps have a button that can be pressed if you need extra doses of medication (breakthrough doses) if the pain is particularly bad at a certain time.

Control any side effects. Nausea, constipation, and drowsiness are side effects that can be seen with analgesics. They are more common with strong analgesics, but they can be controlled. Anti-nausea medications are usually very effective, and your doctor might recommend that you take these medications either with your analgesics or beforehand. Many anti-nausea medications are available as suppositories. If you do experience bad nausea, it may be helpful to use such a suppository and take your regular dose of analgesic when your nausea improves. Constipation, which is more common with stronger analgesics, can be controlled with laxatives such as stool softeners and stimulants. Drowsiness is more common when you first start taking a stronger analgesic or when a dose is increased but usually wears off after a few days. You should avoid driving or doing anything potentially hazardous to you or other people if you are feeling drowsy.

 

Dispelling Myths About Analgesics

Some patients worry that if their painkillers are gradually increased in strength it is possible to become addicted or lose mental abilities. This is not true. If you have continuous or long-term cancer pain, then strong painkillers are not addictive. You need them to keep the pain at bay.

Also, the use of strong painkillers is not a sign that the end of your life is imminent. A lot of people think that morphine is only used at the very end of life, but doctors prescribe morphine as treatment for cancer pain quite early after the pain starts if it is needed at that time.

The myths and fears of cancer pain may actually make the pain seem to be worse, and on the other hand, effective relief of pain will decrease the fear as well as controlling the pain.

 

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