Maintaining Quality of Life in the Face of Cancer-Related Pain
by Tanya J. Uritsky, PharmD
When I saw that Mary was returning to the hospital for a potentially curative treatment, I had to stop by her room. As I walked in, she immediately started to cry. I thought to myself, What did I do? Before I could complete that thought, she jumped up and hugged me. She said, “Tanya, you were able to do what no one has been able to do in 10 years. I was able to live again. Thank you.” This is treating pain in cancer – restoring quality of life and functionality.
Pain is frequently associated with other side effects. Some are physically apparent, like nausea or vomiting. Others may not be so obvious, like depression or anxiety. Moreover, adverse effects of pain medications can create additional problems that will need to be addressed. The first step to treating cancer pain is letting your doctor know about it.
Addressing Cancer Pain
If your doctor doesn’t ask about your pain level, be sure to speak up. You may also want to talk with a pain or palliative care specialist about treating your cancerrelated pain.
The first step to treating cancer pain is letting your doctor know about it.
Arming yourself with information about different types of pain may help you better describe your pain and get the most out of your visit.
♦ Acute pain comes and goes quickly and ranges from mild to severe. It may be caused by medical procedures or an injury to muscle or tissue.
♦ Chronic pain either does not go away or comes back frequently. It too can range from mild to severe. A tumor or previous injuries can cause this type of pain.
♦ Breakthrough pain is a sudden, intense increase in pain that may occur by itself or as the result of a specific activity.
♦ Neuropathic pain is caused by damage to the nerves. Often described as burning or shooting, this pain may be a side effect of chemotherapy or radiation, or it may be caused by the cancer itself.
Treating Cancer Pain
A range of pharmacologic options is available to treat pain. Opioids (like morphine and oxycodone) are often part of cancer pain treatment. They can be very effective for moderate to severe pain. However, they do not come without risks. These medications do have side effects. It is recommended that you take laxatives and stool softeners to prevent constipation while on these medications. In addition, over-sedation and confusion should be monitored and reported. Many people fear becoming addicted to these types of medications; however, using pain medications as prescribed to treat cancer pain rarely leads to addiction.
Acetaminophen and non-steroidal anti-inflammatory medications (like ibuprofen or naproxen) can also be effective for cancer pain. They may be particularly helpful for pain caused by disease in the bones. Following the maximum dosage limits of these medications will decrease the risks associated with treatment. Always ask your doctor before taking these types of medications.
Antidepressants and anti-seizure medications may be helpful in managing cancer pain due to nerve injury. Additionally, non-pharmacologic therapies, such as physical therapy, acupuncture, or massage, may be an option.
Regardless of the specific regimen, keep a log of which medications you take, how often you take them, and the dosages taken. Smartphone apps and online resources, such as MyMedSchedule.com, can help you keep track. It is also a good idea to use only one pharmacy so that the pharmacist can accurately assess your risk for drug-related complications and monitor any potential drug interactions.
Going Beyond the Physical
Physical pain is often complicated by emotional, spiritual, and psychological burdens. Leaning on members of your healthcare team who can help manage emotional issues, like anxiety and depression, will also help with pain control and help improve your quality of life.
A cancer diagnosis does not mean you have to live in pain. Many therapies can be used to achieve good pain control and restore your quality of life.
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Dr. Tanya Uritsky is a clinical pharmacy specialist in pain management and palliative care at the Hospital of the University of Pennsylvania.
This article was published in Coping® with Cancer magazine, September/October 2012.