Pain Management

An Overview of Pain

Matt Nye, oncology certified pain management nurse at CTCA at Eastern Regional Medical Center, shown here with a pain management device.

The International Association for the Study of Pain has defined pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is subjective. It affects each person differently, depending upon factors such as age, personality, perception, pain threshold and past experiences with pain.

Aside from physical sources, stresses such as psychological, emotional, financial and social struggles, can also influence your experience of pain. Insomnia, fatigue and anxiety may make you more sensitive to pain, while rest, sleep and diversion may help reduce pain. If you are in pain, it should always be acknowledged and treated.

Dimensions of Cancer Pain

Pain from cancer or cancer treatment may be acute or chronic. Acute pain is severe and usually lasts for a limited amount of time. It generally results from tissue damage. Once the cause of pain has been identified, it can be successfully managed. Chronic pain, on the other hand, is persistent and is usually present for greater than three months. Because the cause of chronic pain often cannot be altered, the nervous system will adapt, which may cause depression, anxiety and/or insomnia.

If you have pain, the severity and prevalence of your pain may depend on many factors, including the type of cancer, the site (location) and stage (extent) of your disease, and your pain threshold (or tolerance for pain). You may experience pain from the cancer itself, or as a side effect of cancer treatment. Cancer pain that lasts a few days or longer may result from:

• The tumor causing pressure on tissues, bones, nerves or organs
• Poor blood circulation because the cancer has blocked blood vessels
• Blockage of an organ or tube in the body
• Metastasis – cancer cells that have spread to other sites in the body
• Infection or inflammation
• Side effects from surgery, radiation therapy or chemotherapy
• Stiffness from inactivity
• Psychological responses to illness, such as tension, depression or anxiety

You could also have pain that is completely independent from cancer or cancer treatment (i.e., headaches, backaches, muscle strains, arthritis or other common pains).

The best way to control pain is to prevent it from starting or to address it right away, before it becomes more severe. Pain may get worse if you wait, and it may take longer or require larger doses of medication to get relief. It is important to stay on top of pain by notifying your doctor as soon as you experience it.

Pain Management at CTCA

At Cancer Treatment Centers of America (CTCA), we are here to help you fight cancer. Aside from exploring available treatment options for you, we aim to address the factors that could inhibit your treatment. We understand that unrelieved pain can affect your eating, sleeping, activity, mood, concentration, and even your immune system. That is why we developed a separate Pain Management Program—to give pain the recognition and attention it needs.

At CTCA, the focus is on you and your individual needs. Our Pain Management Program aims to empower you to make judgments and decisions free from the distraction of pain. The goal of our program is not only relief from pain, but also to help improve your overall sense of well-being and quality of life.

Pain Assessment

Upon your arrival at CTCA, you will have an initial evaluation by one of our pain management practitioners. Part of this evaluation will involve an assessment of your pain. An accurate assessment of your pain experience provides a basis for various pain management techniques.

A comprehensive assessment includes information about the following dimensions of your pain:

• Location
• Intensity
• Factors influencing its occurrence (i.e., what makes it better or worse)
• Observed behaviors during pain
• Psychosocial variables (e.g., attitudes, situational factors)
• Effects of therapy and patterns of coping

"Comfort scales" illustrate facial expressions to help you rate your pain level.
Discover more pain management tips in our April 2007 newsletter.

Pain Management Plan

Once your pain management practitioner determines your pain level, he/she can determine the nature of your pain, where the pain is, how long you have had pain, and what makes it better or worse. Since each person experiences cancer differently (i.e., patients vary in diagnosis, stage of disease, and responses to treatments), we manage cancer pain on an individual basis. We will work closely with you to develop a personal pain management plan that is part of your comprehensive treatment plan.

Throughout your cancer treatment, your pain management practitioner will follow up with you as often as necessary to aggressively treat your pain. Our pain management team will also consult regularly with your overall care team to balance pain medicine with supportive options.

Pain Education

As a patient at CTCA, you will also have access to educational information about pain management, including how pain affects your well being, how to adequately treat your pain, fears about pain treatment and how to talk about your pain.

Pain Management Techniques at CTCA

Based on your treatment plan, your care team at CTCA will provide pain management techniques to help control your cancer pain and/or alter your perception of it.

CTCA uses several therapeutic approaches to pain management. One therapeutic approach, pharmacological pain control, involves the use of analgesic drugs (or painkillers) and other medications that intensify the analgesics' effects or modify your mood or pain perception. Another approach, non-pharmacological pain control, attempts to promote your comfort and evaluate the effectiveness of therapy, using methods such as:

• Behavioral techniques
• Radiation therapy to shrink the tumor
• Surgery to remove part or all of the tumor
• Neurological and neurosurgical interventions
• Traditional nursing and psychosocial interventions

Because of the complex nature of cancer-related pain, successful pain management usually involves a combination of techniques.

Learn More: Pain Management Tips

For helpful pain management tips, read our April 2007 newsletter, featuring the role of pain management in cancer. To subscribe to our free monthly e-newsletter, visit the CancerCenter Newsletter Sign Up page today.