Pain Management

Pain is subjective. It affects each person differently, depending upon factors such as age, personality, perception, pain threshold and past experiences with pain. If you have cancer, it does not necessarily mean you will have pain. However, if you do experience pain, it should be acknowledged and treated so you can focus on more important things - like healing.

Unrelieved pain can affect every area of your life, including eating, sleeping, activity, mood, concentration and even your immune system. You don’t have to let pain control you - you can control it. With proper pain management techniques, it is possible to get relief from cancer pain. This could help you sleep and eat better, enjoy the company of family and friends, and continue with your work and hobbies.

At Cancer Treatment Centers of America (CTCA) at Southwestern Regional Medical Center, we understand that pain control is an essential component of the cancer treatment process. That is why we offer a separate Pain Management Program—to address this common and often underestimated problem for cancer patients. Our goal is to not only bring you relief from pain, but also to help improve your overall sense of well-being and quality of life.

Southwestern's Pain Management Department

At Southwestern, the focus is on you and your individual needs. Our physician-led, patient-centered Pain Management Program aims to empower you to make judgments and decisions free from the distraction of pain. The goal is to get your pain under control and to improve your quality of life. It is about fulfilling not what our doctors want, but what you need.

Southwestern’s pain management team is comprised of three dedicated pain management physicians, with sub-specialty board-certification, and a supporting staff of registered nurses to assist them. Our pain management team takes care of all of the perioperative in-patient and out-patient pain management needs at the hospital. “As the vast majority of our patients live outside of the Tulsa area, we are uniquely positioned and experienced to be able to care for their needs even while they are away from our institution,” says Dr. Mark Axness, Medical Director of Pain Management and Anesthesiology Services at Southwestern.

According to Dr. Axness, most of his patients, who had already been treated at other institutions prior to arriving here, state that their pain had not been adequately controlled or addressed. Dr. Axness believes cancer patients in many other hospitals do not receive adequate or appropriate attention to pain because there is often only one person available to address their pain management issues—their medical oncologist. Yet, most traditional oncologists do not specialize in the field of pain management.

At Southwestern, our pain management physicians specialize uniquely in treating pain. “Having dedicated pain management physicians facilitates appropriate and rapid management of patients’ pain,” says Dr. Axness.

Your Pain Assessment and Plan

As a patient at Southwestern, you will have direct access to a physician who specializes in pain management, and who will treat your pain aggressively. Upon your arrival, you will have an initial evaluation by one of our pain management physicians. You will be given an extensive pre-treatment history and physical exam, including appropriate lab and radiology studies. Part of this evaluation will involve an assessment of your pain.

This 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

In addition, Southwestern's pain management team uses the Wong-Baker Faces Scale (also knows as a “Comfort Scale”) to determine the intensity of your pain. Facial expressions arranged on a scale from zero (no pain) to 10 (worst possible pain) help you rate your pain level.

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

Once your pain management physician 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 your pain on an individual basis.

We also understand that it may be difficult for you to talk about your pain. To help you describe your pain, we encourage you to keep a record or a journal of your pain experience. This may include information about the location of your pain, how it feels, if it has changed, which pain treatments help relieve it, etc. By tracking your pain, your pain management physician will be better able to determine the pain control methods that will work best for you.

Our pain management team will work closely with you, and the rest of your cancer care team, to develop a personal pain management plan tailored to your needs. This treatment plan will be initiated immediately and will be altered as frequently as is needed. This plan will include appropriate pain management techniques to help control your cancer pain and discomfort and/or alter your perception of it. You may receive conventional pain-reduction treatments, such as medication, and/or more advanced procedures. In addition, your plan management plan may include complementary treatments, such as acupuncture, acupressure, and mind-body techniques, to help relieve your pain.

Throughout your treatment, your pain management physician will follow up with you as often as necessary to treat your pain aggressively. Our goal is to provide you with integrated and consistent care and support. The Pain Management Department also provides educational information about pain management, including how pain affects your well-being, how to adequately treat your pain and fears about pain treatment.

A Team Approach

Since our doctors and practitioners are housed under one roof, our pain management physicians are able to consult regularly with other Southwestern departments to balance pain medicine with supportive options. “We are totally integrated with the rest of the medical staff, including internal medicine, surgery, medical oncology, radiation therapy and radiology. There is a seamless flow of patient care from one specialty to the next,” says Dr. Axness. This team approach ensures that you get uninterrupted, comprehensive cancer care.

The following are examples of how our pain management team interacts with the other Southwestern departments:

Medical oncology:

Our pain management physicians work with our medical oncologists to understand your oncology treatment plan, so we can better tailor your pain management plan around your needs. “As most of our patients live away from the Tulsa area [and come and go from home to Southwestern], it is absolutely vital that we are in frequent touch with the oncologists so we know what the ongoing plans are. This is a very unique challenge and one in which we excel,” says Dr. Axness.

Hospitalists (in-patient physicians):

Our pain management physicians work with our hospitalists to understand the in-patient treatment plan of our hospitalized patients, so that we can change our therapy as needed. In-patient treatment plans for pain management can change a number of times per day. Therefore, we are in constant communication with the hospitalists to address these needs.

Surgical oncology:

Our pain management physicians work with our surgical oncologists to handle all the perioperative pain management needs of our surgical patients.

Radiation oncologists:

Our pain management physicians frequently assess patients who have metastatic disease that is causing pain. After an appropriate assessment (involving history and physical, as well as appropriate laboratory and radiology studies), we will refer patients for consultation and treatment with a radiation oncologist.

Imaging services:

Our pain management physicians’ dependence on the Imaging Services Department is critical. Our team frequently requires sophisticated imaging to determine sources of pain, and appropriateness of our treatment plan to resolve the discomfort. Also, we commonly use imaging modalities during interventional procedures to verify correct placement of medications or devices.

Pain Management Techniques

The Pain Management Department at Southwestern offers a full complement of traditional medical, interventional and allied therapies. We use several therapeutic approaches to pain management aimed at helping you resume activities you enjoy and improve your overall enjoyment of life.

Pharmacological pain relief

Many of our patients have excellent pain control using medication therapy. 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.

Non-pharmacological pain relief

Non-pharmacological pain control attempts to promote your comfort. Our pain management physicians consult with other Southwestern departments, such as surgical oncology and radiation oncology, to provide methods such as:

• Radiation therapy - Aims to reduce pain by shrinking the tumor
• Surgery - When a tumor is pressing on nerves or other body parts, surgery to remove all or
• part of the tumor can relieve pain
• Nerve injections, implanted pain pumps, or nerve stimulation devices

Additional pain relief methods

Our pain management team also works with other Southwestern departments, such as oncology rehabilitation, mind-body medicine and pastoral care, to provide additional methods for managing cancer pain, including:

• Relaxation therapy, guided imagery, visualization
• Exercise, physical therapy
• Auriculotherapy
• Transcutaneous Electric Nerve Stimulation (TENS)
• Massage, skin stimulation
• Cold or heat applications
• Emotional support and counseling
• Spiritual help

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

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. Our pain management physicians try to be accessible and approachable so you feel comfortable coming to us as soon as you experience pain.

For helpful tips on understanding and managing cancer pain, read our April 2007 newsletter, featuring the role of pain management in cancer care.