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Welcome relief

Author: Kari Bohlke, ScD

Everyone has likely heard one of the following at some point: “Keep a stiff upper lip.” “Grin and bear it.” “Play through the pain.” When it comes to cancer, however, these suggestions do not apply. Untreated pain can interfere with virtually every aspect of life, from the ability to sleep to the ability to enjoy the company of family and friends. Talking openly with health care providers about pain can ensure appropriate care at the right time. Pain management is an important part of cancer care, and many treatment centers have providers who specialize in this area.

Talking with an expert

“Pain is one of the most common symptoms associated with cancer,” explains Raed Rahman, DO, director of pain management at Cancer Treatment Centers of America® (CTCA) in Zion, Illinois. Pain can result from the cancer itself or from treatments such as chemotherapy, radiation therapy, and surgery.

“One of the barriers to adequate pain relief,” says Dr. Rahman, “is that some patients believe that pain is something that they have to live with.” The consequences of this can be far-reaching: “If pain goes unrelieved, it denies that individual comfort and greatly affects daily activities. What I tell patients in the clinic is that most people are multi-taskers: they can do many tasks at one time. But when patients have severe pain, or pain for many months, they can become unitaskers: they’re focused only on the pain and may need help with a lot of common daily tasks.”

Many options for pain management

“You can manage pain in the human body in a lot of ways,” continues Dr. Rahman, pointing to such options as medication, physical therapy, acupuncture, massage therapy, chiropractic care, mind-body support, and pastoral care. Depending on the situation, procedures that treat the cancer or that block nerves from sending pain messages can also provide relief. The key to finding what’s right for a given individual is a comprehensive pain evaluation. “The pain can be physical, psychological, or psychosocial. You need an idea of exactly where the pain is coming from or what’s making it worse.”

An important goal of pain management (and of care at CTCA® in general) is to treat the entire person. In some cases this may involve using more than one approach to pain management. Use of pain medication in combination with a nonpharmaceutical treatment such as relaxation, for example, may result in better pain control and overall wellness than either approach alone. Recognizing and treating common problems such as depression and anxiety can also change the perception of pain.

For patients who experience pain, the right place to start is a discussion with a primary care provider. “Usually, due in part to the existing patient/ physician relationship,” says Dr. Rahman, “the primary care provider knows the patient better than anyone else and can implement basic pain management strategies.” But if these strategies aren’t successful, a referral to a pain management specialist may be beneficial.

When undergoing a pain assessment, a patient will likely need to answer several questions about the nature of the pain. In addition to the location and the severity of pain (which is often measured on a scale of 0 to 10), it’s helpful for the doctor to have information about what the pain feels like, whether it’s constant or intermittent, and what factors make it better or worse. Words that can describe different types of pain include sharp, dull, throbbing, burning, and shooting.

Pain medications

Although medications are not the only way to manage pain, they are effective and important options for many people. Pain medications come in a range of strengths, from over-thecounter remedies such as ibuprofen and acetaminophen to strong prescription drugs such as oxycodone and morphine. If a physician approves over-the-counter medications that provide adequate relief, these may be all that is needed. If moresevere or persistent pain is an issue, however, a doctor may suggest stronger drugs. Use of these medications to treat pain, says Dr. Rahman, can help a patient maximize quality of life and ability to function.

If strong pain medications are needed, experts in pain management can develop a treatment plan that fits a patient’s shortand long-term needs. In some cases it may be necessary to try more than one type of medication to find the one that works best. “When you look at the basic chemistry of these pain medications,” says Dr. Rahman, “they’re like brothers and sisters; they have a lot of similarities but minor differences.” So, if the first medication isn’t adequate or produces intolerable side effects, there is likely another drug or treatment approach that may work well.

It’s also important to keep in mind that a pain medication strategy can be developed with a patient’s daily activities in mind. “I don’t prescribe these medications to patients so that they sleep all day or can’t function,” says Dr. Rahman. “That’s not the purpose. The purpose is for the patient to take the medication when needed and to function at home, to function at work, and to live their life.”

For certain types of pain, a doctor may recommend a different type of medication. The tingling and burning that can accompany nerve damage, for example, may respond to treatment with an antidepressant or antiepileptic drug. Similarly, pain caused by swelling may respond to medications that reduce the swelling, such as an anti-inflammatory.

Holistic care provides hope

“In most patients cancer pain can be successfully controlled with appropriate techniques and safe drugs,” concludes Dr. Rahman. “Working with a pain management specialist, patients don’t have to live with pain. The overall approach to pain management should be comprehensive in nature and involve a holistic plan that includes using one or more of the methods discussed earlier.”

The goal is not only to ensure that patients feel better but also to allow them to function better and to live the life they want to lead. An individualized and comprehensive approach to pain management can help achieve this goal.

Reference

Pain Control. NIH Publication No. 12-6287. National Cancer Institute website. Available at: http://www.cancer. gov/cancertopics/coping/paincontrol.pdf. Accessed November 12, 2012.

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