CANCER PAIN MANAGEMENT

  • Dec 21, 2016
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What is pain?

An experience that affects, and is affected by, both the mind and the body. It involves the perception of a painful stimulus by the nervous system and the reaction of a person to this.

What causes pain in people with cancer?

  • Pain is most often caused by the cancer itself. But pain can also be caused by the treatment or the tests done to diagnose cancer. You may also have pain that has nothing to do with the cancer or its treatment. Like anyone, you can get headaches, muscle strains, and other aches and pains.
  • Whether you have pain and the amount of pain you have depends on thetype of cancer, its stage (extent), and your pain threshold (tolerance for pain). Most of the pain occurs when a tumor presses on bones, nerves, or body organs.

 

What do I need to know about pain control?

  • You should never accept pain as a normal part of having cancer. All pain can be treated, and most pain can be controlled or relieved.
  • Only you know how much pain you are in. Telling your doctor and nurse when you are in pain is very important because pain is easier to treat when it first starts.
  • You have the right to be treated for your pain, and you should insist on it.

 

How do I assess my pain score?

Using a pain scale is helpful in describing how much pain you’re feeling. To use the Pain Intensity Scale below, try to assign a number from 0 to 10 to your pain level. If you have no pain, use a 0. As the numbers get higher, they stand for pain that’s getting worse. A 10 means the worst pain you can imagine.

You may find it helpful to keep a record or a diary to track details about your pain and what works best to ease it. You can share this record with those caring for you. This will help them figure out what method of pain control works best for you. Your records can include:

  • Words to describe the pain
  • Any activity that seems to increase or decrease the pain
  • Any activity that you can’t do because of the pain
  • The name, dose, and time you take your pain medicines
  • The times you use other pain-relief methods (such as rest, relaxation techniquesdistractionskin stimulation, orimagery)
  • The number you rate your pain at the time you use a pain-relief measure (medicine or method to reduce pain)
  • Pain rating 1 to 2 hours after using the pain-relief measure
  • How long the pain medicine works
  • Pain rating throughout the day (to get an idea of your general comfort)
  • How pain interferes with your normal activities, such as sleeping, eating, sex, or work
  • Any side effects you have that may be from the medicines

 

What are the basic principles of taking pain medications?

The principles outlined in this section are based on the World Health Organisation (WHO) three step analgesic ladder which is currently the most widely accepted guideline:

  • By the mouth – ideally the oral route should be used first line.
  • By the clock – regular analgesia ensures blood levels are maintained and reduces the need for as when need
  • By the ladder – analgesia should be increased in response to the degree of pain according to the WHO analgesic ladder.
  • Individual dose titration – to achieve optimal pain relief with fewest side effects.
  • Use of adjuvant drugs – if appropriate.
  • Attention to detail – analgesia should be reviewed regularly and adjusted as necessary

 

Do I get addicted if I take cancer pain medication?

  • Addiction is a common fear of people taking pain medicine. Such fear may even keep people from taking the pain medicine. Or it may cause family members to encourage you to hold off as long as you can between doses.
    • Addiction is defined as uncontrollable drug craving, seeking, and continued use. Whenopioids are taken for pain, they rarely cause addiction as defined here. When you are ready to stop taking opioids, the doctor will lower the amount of medicine you’re taking over a few days or weeks. By the time you stop using it completely, your body has had time to adjust.

     

    What are the side effects of cancer pain medications?

    Some medicines can cause nausea and vomiting, itching, constipation, or drowsiness. A few can cause liver or kidney damage. But the choice of pain medications and dose titration will be done by your specialist as per your body tolerability and keeping in mind of all the side effects.

    When pain is not relieved, you may feel:

    • Tired
    • Depressed
    • Angry
    • Worried
    • Lonely
    • Stressed

     

    When cancer pain is relieved, you are more able to:

    • Enjoy being active.
    • Sleep better.
    • Enjoy family and friends.
    • Eat better.
    • Prevent depression

     

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