More on early, aggressive pain management

http://www.cityofhope.org/blog/cancer-pain-tips

BREAKTHROUGHS
7 TIPS FOR MANAGING CANCER PAIN: FIRST, CONTROL IT EARLY
September 4, 2014 | by Nicole White RSS

“There’s more to cancer care than simply helping patients survive. There’s more to cancer treatment than simple survival.

Cancer patients should report their pain to their caregivers, and enlist their doctors to help them manage it. Pain does not have to be part of daily life, even during cancer treatment, says City of Hope’s Betty Ferrell and other experts in palliative care.
Constant pain should not be part of conquering cancer, insists Betty Ferrell, Ph.D., R.N., director of nursing research and education at City of Hope. She wants patients and caregivers alike to understand, and act on, this principle.

Ferrell, an international expert in palliative care, and her colleagues have spent years investigating pain management and the barriers that prevent patients from receiving the help and medication needed to manage their pain. Overcoming these barriers starts with understanding that pain management is vital. Even when people are fighting cancer, their day-to-day lives should not hampered by physical pain.

“Patients and caregivers need to understand that pain is important,” she said. “Pain has a tremendous impact on quality of life. There is an urgency. If pain is not controlled, their lives are out of control.”

Patients and their caregivers must know how to assess and talk about pain, Ferrell said. She and other experts in palliative care are committed to helping patients and caregivers address fears and misconceptions about pain medication and management.

“We can have the most effective drugs in the world, but if people aren’t taking them, they’re not going to help,” Ferrell said.

Of the seven tips on managing cancer pain, two are crucial.

1. Control pain before it becomes severe.

2. As a cancer patient, you deserve the best pain relief.

Other tips for cancer patients experiencing pain:

3. Quantify your pain. Rate pain on a 0 to 10 scale, with zero being no pain and 10 being the worst pain. Track when the pain started, what makes it better or worse, where it’s located and how long it lasts. Be able to describe the kind of pain sharp: shooting, dull or burning. The description will help caregivers treat it effectively.

4. Call your nurse or doctor about pain. Do not hesitate to reach out to your caregiver if your pain is new, if it is getting worse or if it is keeping you from your everyday activities.

5. Remember that you have many treatment options. Doctors have many pain-controlling medicines at their disposal, and they can be given in many ways. If one doesn’t work well, patients and doctors can try another kind.

6. Do not let fear of addiction prevent you from taking medication to manage pain. Ferrell says a common fear patients and their caregivers have is that they will become addicted to their pain medication. She stresses that patients need to understand the difference between normal physical reactions to medication and drug addiction.

For example, tolerance to a drug – requiring an increase in dosage when the body adjusts to the current medication – is normal and is not addiction. Physical dependence is also not addiction. Anyone taking opioids (morphine-like medicines that are commonly used for pain) is likely to become physically dependent for a period time. If you stop the opioid abruptly, you will experience withdrawal symptoms, such as shaking, agitation, fear and chills. This is why it’s important not to stop the medication abruptly and to taper off the dosage.

Normal, physical reactions to necessary pain medication are different from a psychological addiction, Ferrell says. Addicts crave drugs to satisfy physical, emotional and psychological needs – not for pain relief.

7. Follow directions when taking pain medication. Communicate with your doctors, nurses and caregivers when you have questions about how to take your medication, encounter problems getting your medicine, feel the medicine doesn’t work, experience side effects, or have concerns or questions about using pain medication.

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Caregivers should also note that sometimes their loved one will be reluctant to report their pain.

“People will often say ‘I have cancer, so of course I have pain,’” Ferrell said. “We have to constantly emphasize that there is much that can be done.”

The hopeful message of Ferrell’s research: Pain can be managed, and these barriers can be overcome. Misconceptions can be dispelled through teaching and support.

“So often, the public, patients, even medical professionals only think about pain in advanced disease,” Ferrell said. “People are doing so well surviving cancer, and many survivors have ongoing pain problems.”

Palliative care – care that focuses on quality-of-life issues – isn’t only for people with advanced disease. All patients and survivors – and their caregivers – should have care plans and survivorship plans that emphasize quality of life, and that includes a daily life without physical pain.

Cancer patients and survivors do not have to settle, and should not hesitate to enlist their doctors, nurses, a palliative care specialist and pain specialists to get them the treatment they need to stop pain.”

Hello Tony,

I am so sorry to hear that you wife is experiencing pain such as you described. I will ask you just a few questions about her pain, and will also suggest that you keep in close contact with her oncologist or a palliative care physician as they are skilled in cancer pain control.

In the U.S. we ask individuals to rate their pain on a 0-10 scale. 0 is no pain, and 10 is the worst pain imaginable. How would she score herself on this scale? Is her pain interfering with her regular daily activities? Is she experiencing any new loss of sensation, numbness of tingling in her feet/toes/legs? Is she having bowel of bladder control issues that are new, or loss of balance?

Has she taken any opioids like morphine before? Physicians generally follow an analgesic ladder to treat pain. She could ask the oncologist if taking an NSAID such as ibuprofen would be alright, or perhaps Tylenol if her liver functions are fine. If her pain level is anywhere above a 4-5 on that 0-10 scale though, she should seek assistance from the physician to prescribe a short acting opioid. It is best to treat her pain earlier rather than later. It is much more difficult to control pain when it has become severe, and as research has shown, early pain control will decrease the occurrence of nerve sprouting and further increased pain episodes.

I hope this will help you both! Increasing levels of pain significantly impacts a persons quality of life, so please do not hesitate to insist on aggressive pain management from her providers.

Karen, RN, CHPN