Maximizing Cancer Pain Management
by Betty Ferrell, RN, PhD, MA, FAAN, FPCN, and Tami Borneman, RN, MSN, CNS, FPCN
Madeline Brown is a 42-year-old woman diagnosed with stage II ovarian cancer. She has responded well to surgery and chemotherapy and in many ways has resumed her life. However, Mrs. Brown has been experiencing pain, pelvic and vaginal discomfort, and moderate to severe peripheral neuropathy. The pain is causing significant disruption in her life. As the months progress and her pain continues, Mrs. Brown becomes anxious and depressed, and her family becomes increasingly concerned.
Mrs. Brown’s story, unfortunately, is not uncommon. Pain affects people throughout cancer treatment and recovery. Untreated pain can negatively affect a person’s physical, psychological, social, and spiritual well-being. The following are a few key recommendations for maximizing cancer pain management.
The first step toward pain relief is assessing your pain. You can rate your pain on a scale of 0 (no pain) to 10 (severe pain).
Assess and Report Your Pain
The first step toward pain relief is assessing your pain and communicating it to others. You can rate your pain on a scale of 0 (no pain) to 10 (severe pain). Providing a rating of your pain will help healthcare professionals understand your pain and monitor progress in treating it. Describing the effectiveness of your pain management plan is also vital. For example, when Mrs. Brown described her pain as “numbness and burning” and reported that it was worse in her fingertips and in her abdomen, this helped her physician to prescribe the right medication.
Many kinds of medications are available. If one doesn’t work well for you, there are others you can try. Addiction rarely occurs in people who are taking medications for pain. Addiction is a psychological need. However, tolerance, which means that you may need to increase doses of your pain medication, may occur. Physical dependence is normal and predictable, but this is NOT addiction. Pain medications can be taken over months and years while still being effective. Withdrawal symptoms may occur when the medication is stopped abruptly.
In our case study, Mrs. Brown was prescribed a medication for her peripheral neuropathy, as well as an opioid. A nurse practitioner educated Mrs. Brown about taking her medicines around the clock. The nurse practitioner also prescribed a laxative to treat the constipation commonly associated with pain medications.
Seek Psychosocial Support
Pain can be an overwhelming symptom, and considering how greatly it can affect a person’s quality of life, support is needed. Mrs. Brown confided in her doctor about how her cancer pain was altering her life. She was referred to a social worker who was able to provide some counseling and suggestions for her discomfort. The social worker also connected her with a support group for ovarian cancer survivors.
Managing pain is a partnership between you and your healthcare provider. It begins with open discussion and utilizing available resources.
When Cancer Pain Becomes More Serious
Cancer pain can affect your emotional, social, and spiritual well-being. Distress is a term used to describe unpleasant feelings or emotions that may interfere with your ability to cope with cancer. It is normal to be distressed when you receive a diagnosis of cancer. However, distress can sometimes become more serious, leading to severe depression or acute anxiety.
Signs of Depression
- persistent feelings of sadness or emptiness
- loss of interest or pleasure in activities previously enjoyed
- loss of appetite or overeating
- disrupted sleep or oversleeping
- decreased energy on most days
- feelings of guilt, worthlessness, or helplessness
- difficulty concentrating, remembering, or making decisions
- thoughts of death or suicide
- inability to cope with pain or fatigue
- questioning your faith or religion
Signs of Anxiety
- feelings of panic or loss of control
- unprovoked anger or irritation
- increased muscle tension
- sweaty palms, racing pulse, and/or difficulty breathing
Talk with your doctor or nurse about ways to resolve your depression or anxiety. Contact your doctor immediately if you have thoughts of suicide, you cannot eat or sleep for several days, you are having trouble breathing and you feel shaky, or if nothing you do seems to help.
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Dr. Betty Ferrell is a professor and research scientist, and Tami Borneman is a senior research specialist, both in the division of Nursing Research & Education in the department of Population Sciences at the City of Hope National Medical Center in Duarte, CA.
This article was originally published in Coping® with Cancer magazine, January/February 2010.