Chronic Cancer Pain Management
by Patricia Ringos Beach, MSN, RN, AOCN, ACHPN
All pain is not created equal, but chronic cancer pain can be controlled and relieved. The acute pain of a toothache tells you to go see a dentist. However, chronic cancer pain is no longer a warning and has little meaning except as a reminder of an illness.
Chronic pain, defined by duration, may persist for weeks, months, or years. It is
• unique to each individual,
• generated from within the brain, involving many central regions of the brain, and
• influenced by past pain experiences.
Very often, chronic cancer pain is managed successfully with opioids or narcotics. Many people are reluctant to take these medications because of a fear of addiction or of starting them too soon in their illness. However, research is very strong in this area and demonstrates that when used for cancer pain, there is very little chance of addiction. Although dependence will develop, the benefits of controlling your pain far outweigh it. You will be more active and enjoy a better quality of life with your pain controlled.
The right combination to manage your pain can be
although it is not always the first one tried.
Single preparation opioids have a wide variation in dose and can often be increased as needed without a ceiling dose. They can be used over a long period of time to manage pain. These medications are delivered in a variety of ways, including pills, capsules, liquids, skin patches, drug pumps, injections, and suppositories.
Opioids may be used alone or with other non-opioid medications. The right combination to manage your pain can be found although it is not always the first one tried. Your physician should be able to help you obtain pain relief or refer you to a specialist in pain or palliative medicine.
Below are the keys for the successful management of chronic cancer pain:
- Constant pain should be treated
with around-the-clock dosing, that
is, medication taken on a regular
Do not wait until you feel the pain or until the pain is severe to take medication. There are several timereleased pain medication preparations available that allow pain to be controlled at an even level over 24 hours. These medications are usually taken every 8, 12, or 24 hours. Implantable drug pumps that constantly deliver medication are also available.
- There should be a plan for times
when the pain worsens.
This is called “breakthrough” pain. Usually your physician will order a quick-acting pain medication that you can take as needed.
- Recognize and treat side effects.
Constipation is almost always an issue; therefore, you should start a routine to prevent constipation when taking opioids. Prevention (with a stool softener and laxative) is better than treatment.
Although opioids may produce side effects, most people are not allergic to them. You may experience nausea, drowsiness, or itching, but a true allergy would involve difficulty breathing. Tolerance to side effects, except for constipation, will develop. Describe to your doctor what symptoms you experience when you take an opioid, and let him or her determine if it is a side effect or a true allergy.
Always report to your physician how well the medication is working to relieve your pain. Very often, if the medication relieves the pain but does not last until the next dose, the right drug is being used but perhaps should be taken at shorter intervals. If the medication helps a little but not enough, it may indicate that a higher dose is needed. And if medication does not help at all, a different medication should be prescribed. Also report any new pain or change in pain to your physician.
Non-pharmacologic interventions for pain management should be incorporated into the plan of care as well. These interventions may include massage therapy, relaxation therapy, prayer, and counseling. Just like pain medication, these do not last indefinitely. However, if used regularly, they can help relieve pain.
Your healthcare team is interested in controlling your pain. You should expect pain relief. A decrease in pain is associated with improved quality of life, more successful adherence to treatment regimens, and even prolonged life expectancy.
♦ ♦ ♦ ♦ ♦
Patricia Beach is a clinical nurse specialist in Oncology and Palliative Care at St. Vincent Mercy Medical Center in Toledo, OH. To contact Patricia, visit www.ringosbeach.com..
This article was originally published in Coping® with Cancer magazine, March/April 2009.