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Put an End To Cancer Pain

by Julie Knight, PharmD, Charlene Whittlesey, PharmD, BCPS, and Sorin Buga, MD, FACP

Knowledge image

Pain, as defined by the International Association for the Study of Pain, is “an unpleasant sensory and emotional experience associated with actual or potential tissue injury or de­scribed in terms of such damage.” In other words, pain is whatever you per­ceive it to be. We all feel pain differently; therefore, the pain experience is unique to each person.

Cancer-related pain can be caused by the cancer itself or by its treatment. Chemotherapy can cause nerve dam­age, leading to joint pain and pain in your hands, feet, and other areas of your body. Surgery and radiation are also pain-causing culprits. In general, pain is classified as being acute (lasting less than six weeks), subacute (lasting six weeks to three months), or chronic (lasting more than three months).

If you’re in pain, it’s important to seek treatment for it. Treatment for pain can include medication, nonpharmaco­logic therapies, and certain medical procedures.

Author of Article photo

Dr. Julie Knight

Several different types of medication are used to treat cancer pain.

♦ Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) These medications often are successful in treating pain associated with cancer. However, it’s important to follow instructions for the use of NSAIDs, as overuse can lead to serious complications.

♦ Acetaminophen This common over-the-counter medication often is used in conjunction with opioid medications. In fact, some prescriptions contain a combination of an opioid (like hydrocodone) and acetaminophen. Liver toxicity is possible when acet­aminophen is taken in high doses, so it should be only taken as directed.

♦ Muscle Relaxants Muscle tightness and spasms are common cancer pain symptoms. Muscle relaxants can effectively relieve these symptoms, but they may cause drowsiness or dizziness.

♦ Topical Medications In some situa­tions, medications in the form of creams, ointments, and patches can alleviate localized pain. These medications may take some time to work, so you should use them for several days before decid­ing whether they are helpful.

Author of Article photo

Dr. Charlene Whittlesey

♦ Antiepileptics and Antidepressants These agents are recommended as first- or second-line treatment for neuropathic pain.

♦ Corticosteroids Chronic use of corti­costeroids should be avoided if possible, but these medications may be used to treat various types of pain, particularly bone pain.

♦ Opioids Marked improvement in cancer-related pain control can be achieved with opioid medications. However, with prolonged use, opioids can induce tolerance, and your doctor may need to adjust your dosage after some time. Stopping opioid medications abruptly can cause withdrawal symp­toms, such as nausea, vomiting, diarrhea, and sweating, so it is important to fol­low your doctor’s instructions when it comes time to wean off them. Some people worry that if they use opioids to ease their cancer pain, they will become addicted. This is a myth. However, opioids have been associated with pre­scription abuse, so you should take these medications only as prescribed.

Nonpharmacologic Options
A vari­ety of strategies can be used to help you manage cancer-related pain without, or in addition to, the aid of medications.

♦ Support Groups You can find net­works of cancer survivors, locally or online. Support groups provide a social support system where you can receive encouragement and advice for dealing with cancer’s side effects from other survivors.

Author of Article photo

Dr. Sorin Buga

♦ Psychological Support Services Working with a mental-health profes­sional can help you improve your ability to cope with cancer and its side effects. Psychotherapy is especially beneficial if you have a history of depression, anxiety, or another psychiatric illness.

♦ Physical and Occupational Therapy Exercise prevents physical weakness that can lead to painful joint stiffness and muscle tightness. Aquatic therapy in particular can help relieve pain caused by certain movements.

♦ Transcutaneous Nerve Stimulation (TENS) Although there is currently very little evidence to support this treatment, which uses a battery-powered device to deliver electrical currents through elec­trodes placed on your skin, it may be worth discussing with your doctor. Keep in mind, however, that there are risks associated with using a TENS unit, par­ticularly if you have cancer in your bones.

Medical Procedures
A variety of medical procedures can be done to im­prove cancer-related pain. Interventional approaches, such as nerve blocks or implanted intrathecal pumps, can pro­vide significant pain relief, especially if you’re not responding to pain medica­tions or if you’re experiencing side effects from them. Surgically removing a tumor that’s causing pain or other discomfort may also be an option. In addition, radiation therapy has proven to be very helpful in relieving bone pain. In fact, an emerging field in radia­tion oncology is the use of radionuclides for bone metastasis.

Discuss your treatment options with your doctor, and keep the lines of com­munication open so you can work together to put an end to your cancer pain.

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Dr. Julie Knight is a clinical consultant pharmacist at Tidwell Hospice and Palliative Care in Sarasota, FL, and a clinical assistant professor of pharmacotherapy and transla­tional research at the University of Florida College of Pharmacy in Gainesville, FL. Dr. Charlene Whittlesey is a clinical pharma­cist with the Internal and Hospital Medicine Service at the H. Lee Moffitt Cancer Center in Tampa, FL. Dr. Sorin Buga is an associate clinical professor in the department of Supportive Care Medicine at City of Hope National Medical Center in Duarte, CA.

This article was published in Coping® with Cancer magazine, May/June 2015.