by Tanya J. Uritsky, PharmD
Pain medications have gotten a lot of press over the past couple of years. It seems a new story about the dangers of pain medications is reported almost daily – from concerns about misuse, to overdose, to drug-drug interactions and overall safety. In light of recent news coverage, let’s review the basic principles of managing cancer-related pain as we sort through some of the new information that is out there.
What the Experts Recommend
For a very long time, the backbone of cancer pain management has been opioid medications – drugs like morphine, oxycodone, and hydromorphone. However, with the changing atmosphere around opioid use and the now known and evolving risks of these medications, experts have begun recommending a different approach.
In managing cancer-related pain, the first step is to try using nondrug methods like physical therapy, acupuncture, or massage. If pain is not able to be controlled with nondrug measures, but is not severely disabling, drug alternatives to opioids are the next step. These can include acetaminophen and non-steroidal anti-inflammatory medications (like ibuprofen or naproxen). However, some people may not respond well enough to these methods and may still require opioid medications to manage cancer-related pain. For these people, opioids can be a good pain management option when they are appropriately prescribed and monitored.
What’s the difference between dependence, tolerance, and addiction when it comes to pain medications?
Dependence: With consistent administration of a medication, the body adapts to its presence, and cessation of the drug’s use results in withdrawal symptoms.
Tolerance: With repeated dosing, the body adapts to the continued presence of the drug, and increasing doses may be needed to provide a sustained effect.
Addiction: A relapsing disease of the brain, characterized by compulsive drug seeking and use, despite harmful consequences.
Breaking Down Your State of Pain
Arming yourself with information about different types of pain may help you better describe your pain and get the most out of your visit with your doctor. Cancer-related pain can be broken down into several different types, or states:
• Acute pain comes and goes quickly and ranges from mild to severe. It is due to muscle or tissue damage caused by things like medical procedures or an injury.
• Chronic pain is ongoing. It does not go away, or it comes back frequently. It too can range from mild to severe and may be caused by the cancer itself or a previous injury.
• Breakthrough pain is a sudden, intense increase in pain that may occur by itself or as the result of a specific activity.
• Neuropathic pain results from damage to the nerves. Often described as a burning or shooting pain, neuropathic pain may be a side effect of chemotherapy or radiation, or it may be due to the cancer itself.
Sorting through the Information
With so much information at our fingertips, it’s tempting to use an online search engine to get more information on any new therapies that are recommended. It would be best to avoid this urge, as much of the information you find online may be outdated or poorly researched. You should only seek out information from trusted sources – as they are likely to be the most accurate and timely.
Ask your provider for information about recommended therapies. He or she can also point you to trustworthy resources for you to research on your own. Likewise, your pharmacist can help you understand any new medications you are prescribed and can let you know what side effects or warning signs to be on the lookout for during treatment.
Monitoring Your Pain
Cancer survivors should be screened for the presence of pain at every appointment, and any new or different pain should always be evaluated by your oncologist. As with any healthcare intervention, when treating pain, it is important to set realistic goals and to frequently reassess these goals and the progress you are making toward them.
Your cancer pain management goals may be small at first, for example, to simply be able to get dressed in the morning without experiencing pain, or to walk to the bathroom more comfortably. Over time, they may progress to include things like taking longer walks or going grocery shopping. You have to decide what quality-of-life measures are most important to you, in addition to the level of pain you are able to tolerate in your daily life.
It is also important to address any adverse effects that your pain medications might be causing and decide if these are tolerable for you. If not, a change in regimen may be warranted. While you may not be able to eliminate the pain entirely, you must find the right balance between pain relief and adverse effects.
Though the methods of cancer pain management may be changing, the basic goal remains the same. Cancer-related pain should be routinely screened and assessed by your oncologist, and it should be treated safely and effectively, with the top priority being to improve your quality of life.
Dr. Tanya Uritsky is a clinical pharmacy specialist in pain management and palliative care at the Hospital of the University of Pennsylvania in Philadelphia, PA.
If your pain is not being managed to your satisfaction, it may need a second look. Ask your doctor for a referral to pain or palliative care specialty services if these are available in your area.
This article was published in Coping® with Cancer magazine, January/February 2017.