Two thirds of patients with cancer have pain that is severe enough to prevent them from doing their activities of daily living. Poor appreciation of this problem and the inability to assess pain was the reason why pain was poorly relieved in these patients.
The aim of cancer pain management are to:
Minimize pain and suffering
Improve quality of life
Provide psychological support for patients and their families
What are the common misconceptions about cancer pain?
Cancer causes intolerable pain that cannot be relieved - in fact some patients with cancer pain never have pain. For those who do, cancer pain can be relieved.
Pain means that cancer is getting worse - Pain can be due to cancer or the effects of cancer treatment, Sometimes the pain is unrelated to cancer.
“Shots” or injections will be needed to control cancer pain - at least 90% of cancer pain can be effectively relieved by simple medications that are taken by mouth. “Shots” are almost never necessary.
Patients who use narcotics will become addicted - patients who take narcotics for pain rarely, if ever, become addicted.
If strong narcotics like morphine are used too early in the treatment, they will not work later if the pain gets worse - strong medications like morphine stay effective as long as they are needed. If pain increases, the medication dose can be increased.
What causes cancer pain?
Not all people with cancer have pain, and those who do, do not necessarily have it all the time, nor is it always severe. Pain associated with cancer usually comes from one of three sources. The cancer itself may be the cause of the pain if it pushes against bones, nerves, or organs in the body. Sometimes, pain can be caused by cancer therapy. In addition, pain may be unrelated to the cancer but is aggravated by it.
How is cancer pain relieved?
Although the doctor will help ease the pain, there are some things the patients can do to make things a little better. Changing some habits in the lifestyle may help.
Coffee intake must be reduced. Caffeine in coffee increases adrenaline levels that increase the sensitivity to pain. Similarly, cigarettes also stimulate adrenalin. Toning the body by regular exercises strengthen the muscles so that the bouts of pain can be better handled. While the exercise may not feel good at first, in the long run, it helps. A healthy diet, avoiding unhealthy junk foods keeps the body supplied with essential nutrients. Laughing is good physically; and it helps to increases the amount of oxygen in the blood. It also helps to relax the muscles. It provides some relief from the stress and anxiety that often accompany illness.
One of the most important ways doctors work to control pain is to raise the threshold of an individual to pain. This is the level at which pain is felt. The idea is to build up a resistance to pain so that one doesn't feel it so much when it occurs. Patients may learn methods of resisting pain such as by hypnosis. Hypnosis is effective because it trains the mind to attack pain stimuli automatically without having to think about it. Hypnosis can be made convenient for most patients under the supervision of a professional and by using hypnotic tapes that can be played at home. Although not everyone will respond to hypnosis, anyone who has pain can help to control it by reducing stress in his or her life. Stress makes pain hurt more, and reducing stress automatically raises the pain threshold. The family can be a strong source of support if the patient is experiencing the discomfort associated with cancer.
The use of analgesics or pain relieving medicines and pain management is not synonymous. Not only is pain a complex experience, but also all pain does not respond equally to narcotic analgesic. Use of analgesics is regarded as a part of multimodal approach to treatment. They should not be reserved for terminal care as they are safe, well tolerated and effective at all stages of the disease.
In some cases helper drugs may be required. These may include:
Anti-depressants for neuropathic pain, concurrent depression, and pain related sleep disturbances
Anti-convulsants for neuropathic pain
Anti-emetics to control morphine related nausea and vomiting
Anti-anxiety drugs for sleep deprivation
Local anaesthetic to block the nerves