Patients with advanced cancer often have pain as their chief complaint. Although advances in cancer treatment have lengthened survival among cancer patients, cancer pain remains under treated in patients. It has been estimated that 25% of all cancer patients who die, do so without adequate pain relief, despite the fact that the tools for adequate pain control are available. With advanced disease, 90% of patients with cancer require strong opiates to control their pain. However, many physicians remain concerned about inadvertently making a patient an addict if they prescribe narcotics to treat pain. Cultural and attitudinal barriers, knowledge deficits among health care professionals, and the influence of state and federal drug regulatory agencies also contribute to the fact that the pain experienced by cancer patients, all too often, is under-treated.
Cancer pain is classified according to pain duration and quality. Duration of pain can denote the acute or chronic nature of pain. It is common to experience anxiety, apprehension and depression in patients with cancer pain. The types of pain most commonly experienced by cancer patients are:
- Acute cancer related pain
- Chronic cancer related pain
- Pain unrelated to cancer
- Pain in opiod tolerant cancer patients
- End of life pain
After an appropriate medical history review and a physical, a pain physician will tailor a suitable pain treatment program. Because everyone has a different response to medications and therapies, the other types of drugs with pain relievers. They include anti-inflammatory steroids, anticonvulsants, and antidepressants. These drugs may be effective treatments for specific types of pain or pain with specific causes. For example, the doctor may prescribe antidepressants to help relieve certain types of pain. However, it doesn’t necessarily mean that the patient is suffering from depression. Similarly, steroids often are effective in relieving pain associated with inflammation.
Cancer pain can be controlled effectively through therapies already available today. Pain treatments range from mild, nonprescription pain relievers, to stronger prescription medications, to neurological surgery, to alternative therapies such as relaxation, biofeedback, guided imagery, and acupuncture.
Oncologists and pain specialists can devise a treatment plan based on the type and severity of pain, side effects, and how the patient responds to the treatment. Some common approaches to treat cancer pain include:
1. Oral Medicines- Aspirin & NSAIDs, Opiods, Adjuvants
2. Intravenous drugs
3. Transdermal drug delivery systems
4. Nerve blocks
5. Interthecal drug pumps
6. Neuroablstive procedures
Although they have cancer pain, many patients are afraid of getting addicted to pain medicines. When cancer pain medicines are given and taken in the right way, patients rarely become addicted to them. To be sure, they should talk to the doctor, nurse, or pharmacist about how to use pain medications safely. Many patients only need pain medicines for a time, until the cause of the pain goes away due to other treatments like chemotherapy, radiotherapy or surgery. When they are ready to stop taking the medicine, the doctor gradually lowers the amount of medicine they take. By the time they stop using it completely, the body has had time to adjust. Some patients will need to take pain medicines for the long-term. Taking medicines regularly should not make patients feel like an “addict.”
Physical dependence, tolerance to medication and addiction are three different issues in people treated with strong pain medications. The patient’s physician can explain the subtle but important difference between them. It’s often easier to control pain in its early stages, because it becomes severe. Therefore, it is better for cancer pain patients to ask for adequate pain relief.
A primary care physician or oncologist can help explain the possible options for pain relief and can make a referral, when necessary, to a pain medicine specialist for optimal pain management.
About Walton Rehabilitation Health System:
Walton Rehabilitation Health Systems (WRHS) is a leading not-for-profit comprehensive, multi-specialty, dedicated provider of physical medicine and rehabilitation. Our mission is to be an advocate for wellness by providing a continuum of services to treat the whole person. WRHS, whose reputation extends throughout the south, is a trusted partner with just the right expertise and treatments to help people with disabling injuries and illnesses return to work and to a fulfilling life. By pursuing its mission, WRHS has grown to include Walton Pain and Headache Centers, Walton Community Services, Walton Options for Independent Living, Walton Foundation for Independence, and Walton Technologies. We are located at: 1355 Independence Drive, Augusta, GA 30901-1037. For more information visit www.wrh.org or call 866-4-WALTON.
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