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When Cancer Pain and Chronic Pain Coexist

by Pamela J. Haylock, PhD, RN, FAN, and Carol P. Curtiss, MSN, RN-BC

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During a session on survivorship issues at the Oncology Nursing Society’s 39th Annual Congress, a nurse described a situation that shocked the audience. A cancer survivor in her care, we’ll call him Hank, had painful mouth sores as a side effect of chemo­therapy. Hank’s oncologist prescribed a medication to relieve the pain, but he did not mention that the drug contained an opioid, nor did he notify Hank’s primary care physician of the new pre­scription. When Hank went to have the prescription filled, he was distraught when his pharmacist refused. Moreover, the pharmacist also refused to refill his usual prescription for the opioid medi­cation he used to manage his chronic, severe back pain. Hank called his oncology nurse looking for answers, but she had none.

So what happened here? Hank’s prob­lem is a result of several issues. First, due to recent crackdowns on opioid abuse, many pharmacies have protocols in place to catch people who doctor-shop to obtain multiple prescriptions. Since Hank was trying to fill two different opioid prescriptions from two different doctors, it signaled a red flag. Second, his oncology providers failed to fully assess and understand Hank’s medical history and health status. Third, there was poor communication all around. If you find yourself in a situation where you are dealing with cancer pain in addition to chronic pain, here are some things you should know if you want to avoid a situation like Hank’s.

Approximately one in four people in the U.S. has intense pain that interferes with daily life.

Author of Article photo

Dr. Pamela Haylock

Pain: The Basics
Approximately one in four people in the U.S. has intense pain that interferes with daily life. Pain that is expected to be a short-term prob­lem, usually caused by injury, trauma, or surgery, is called acute pain. Conversely, chronic pain, also called persistent pain, (the type that is associated with late stages of cancer and long-term conditions like arthritis and neuropathy) can last for months, years, or a lifetime. Both types of pain, if moderate to severe, require a personalized management approach.

Many types of non-pharmacological therapy are used to relieve pain; for example, heat therapy, cold therapy, relaxation exercises, guided imagery, massage, physical therapy, and music therapy. These can be used alone or in conjunction with pain-relieving medica­tions. When medication is added to the equation, the World Health Organization recommends that pain first be treated with non-opioid medications (such as aspirin and acetaminophen). If pain is moderate to severe, then opioid medica­tions (like morphine) may be used as needed for pain management.

Carol Curtiss

Efforts for Safe and Effective Treatment
Though opioids tend to get a bad rap, they are safe for most people. However, they can cause adverse effects, such as constipation and clouded thinking, and some people who take opioids may be at risk for addiction and overdose. While most people who are prescribed opioids take them as intended, unfortunately, opioid diversion (use of prescription medication by someone other than the person for whom it is prescribed) and misuse are not uncommon. Consequently, local, national, and global drug control efforts to stem opioid abuse are being ramped up.

Healthcare providers, who are obli­gated to relieve their patients’ pain, also are being held accountable by agencies that oversee drug use (such as the DEA), and they are expected to identify people who might be at risk for opioid prescrip­tion abuse. Though this should not deter doctors from prescribing opioids to peo­ple who need them, it does mean that healthcare providers must take steps to safeguard against the misuse of opioid pain relievers.

One way this is being done is by issuing an opioid treatment agreement. Opioid treatment agreements are written contracts that are signed by an indi­vidual who is prescribed opioid pain medication and the healthcare provider managing his or her chronic pain, who subsequently assumes responsibility for their patient’s opioid prescriptions. These documents clearly state the con­sequences of prescription drug abuse and identify the responsibilities of the pain treatment team as well as the per­son receiving opioid therapy.

A Personalized Approach to Pain Management
If you’re dealing with pain, especially coexisting cancer pain and chronic pain, it’s important to get it under control. Work closely with your healthcare team – your oncologist, nurses, primary care physician, phar­macist – to create a personalized pain management plan. Your plan ideally should address your physical, psycho­logical, spiritual, and social needs. When talking to clinicians, respond honestly and completely to questions about your health history, current medications, and pain status. Be sure that everyone in­volved in your care knows whether you have an opioid agreement in place. They will use that information to de­vise a pain control plan that doesn’t conflict with the agreement.

Effective communication among the members of your healthcare team is paramount, especially when dealing with coexisting pain conditions. Con­firm that everyone in your healthcare team communicates with each other. If you experience new or worsening pain, let your team know. Successful pain control is possible, but it does require a team effort.

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Dr. Pamela (PJ) Haylock is an oncology nurse, oncology care consultant, adjunct professor in the RN to BSN program at Schreiner University in Kerrville, TX, and past president of the Oncology Nursing Society. Oncology nurse Carol Curtiss is an oncology clinical specialist consultant, ad­junct faculty at Tufts University School of Medicine in Boston, MA, and past president of the Oncology Nursing Society.

This article was published in Coping® with Cancer magazine, January/February 2015.