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Will I have pain? What are the options available to treat my pain?

 Pete’s comment:

When I was first diagnosed, I had peripheral pain, which would flare up in my back throughout the day. I was put on Tylenol 3 (acetaminophen with codeine) to help manage it. This worked well and after several sessions of chemotherapy, the pain subsided and I was able to cut back on the medication. Eventually, the pain disappeared completely.

Pain has long been considered an unavoidable consequence of having cancer. However, with new pain medications and a better understanding of how to use them effectively, cancer pain can be well controlled in almost all people.

Not everyone with cancer develops pain. If a tumor grows or spreads, it may press on or invade surrounding organs or nerves. Depending on the location of the tumor, this pressure may cause pain. In addition, procedures used to diagnose or treat cancer may cause pain, such as having a biopsy to take a sample of tissue for diagnosing the type of cancer or having surgery to remove all or part of a tumor.

Pain may be experienced in many different ways, for example, discomfort, aching, a gnawing feeling, a sharp stabbing sensation, or cramping. Pain may be mild or severe, and it may be intermittent or continuous.

Many people are concerned about taking pain medication. Some feel that withstanding the pain is a sign of strength. Some people feel it is a part of having cancer that they have to accept. Some people are afraid of “masking” a problem-if they treat the pain, they think their doctor will not be able to follow their response to treatment. There is no benefit at all to having pain. Regardless of how mild it is, chronic pain can be very disabling. It affects your energy level, your appetite, your ability to sleep, your desire to be with friends and family, and your mood. Tell your doctor or nurse about any discomfort you have, no matter how mild. Try to describe it accurately so that they can decide on the best treatment for you and monitor the effectiveness of the treatment. When describing your discomfort, include the following information:

• Where you feel the pain

• How severe the pain is (Many doctors and nurses will ask you to rate the severity, for example, using a scale of 0 to 10, with 0 being no pain at all and 10 being the worst pain you can imagine.)

• What the pain feels like (e.g., sharp, achy, gnawing)

• Whether you have the pain all the time or only at certain times

• What makes it worse and what makes it better

• How it affects your ability to sleep, your appetite, your activity, your desire to be with friends and family, and your mood

Medications for treating pain are called analgesics. Many different analgesics are available, and they are often prescribed in a stepwise approach, starting with a mild analgesic and progressing to a stronger one as needed until your pain is controlled. First-line over the-counter analgesics includes acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, naproxen). If these medications are not effective, your doctor will prescribe an opioid or narcotic analgesic (e.g., morphine, oxycodone, hydromorphone, fentanyl). Other medications are effective in relieving pain when used in combination with analgesics: certain antidepressant, anticonvulsant, anti-inflammatory, and steroid medications.

Pain medications come in many forms: tablets, liquids to swallow, liquids to be absorbed under the tongue, skin patches, and rectal suppositories. Also, solutions can be given intravenously (into the vein) via a portable pump. The pump is often set to deliver a steady dose of medication into the bloodstream with extra doses that you can deliver as needed. The pump is set up to allow so-called patient-controlled medication administration with a limit to prevent overdose.

Chronic pain medication works most effectively when given on a regular schedule around the clock. This regimen keeps a steady level of pain medication in your bloodstream to prevent you from experiencing pain. New long-acting medications are very helpful because they last for many hours or even days. You don’t need to take long-acting medication as frequently as you do the immediate-release (short-acting) forms. However, even with long-acting medication, most people require an immediate-release pain medication for what is called break-through pain. This is pain or discomfort that you experience during the day or night despite taking the long-acting medication.

When using the immediate-release pain medication, take it as frequently as you need to based on the instructions on the bottle. If you wait too long between doses and the pain becomes severe, the medication will not work as quickly or as effectively. If you find you need the immediate-release pain medication frequently during the day or that it is not effective, ask your doctor about increasing the dose of the long-acting medication.

Of all the many different types of pain medication, what works for one person may not work as well for another. Finding the right medication and the right dose and schedule to keep you without pain might take some time. Be persistent in working with your doctor and nurse until you find a regimen that works for you. If you do not feel satisfied with the degree of relief you are getting, ask the doctor about a referral to a pain specialist. You can also find a pain specialist by calling the Cancer Information Service of the National Cancer Institute or the American Cancer Society.

Some people are concerned about taking pain medication because they are afraid that, if they take it for milder pain, it won’t work if they need it later for severe pain. Many pain medications, particularly narcotics, have no maximal dose. In other words, the dose can be increased indefinitely over time, so that you can be sure to get good pain relief if you need it at some point in the future, no matter how severe your pain may be.

There are several reasons to call your doctor about pain:

• You are not getting adequate pain relief from your medication.

• On a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine, your pain is at a level of 5 or higher most of the time.

• You are not able to sleep because of pain.

• You are not taking the full dose of pain medicine because of its side effects.

For more information on how to manage pain, the National Cancer Institute has a booklet entitled Pain Control: A Guide for People with Cancer and Their Families.

This is available on the Internet http://www.cancer.gov/about-cancer

 For more information, search on these other Internet sites:

• Cancer-Pain.org: www.cancer-pain.org

• American Cancer Society: www.cancer.org

• Oncology Nursing Society: www.cancersymptoms.org

• American Society of Clinical Oncology: www.cancer.net

Term:

Analgesics - Medications for treating pain.

There is no benefit at all to having pain

 Finding the right medication and the right dose and schedule to keep you without pain might take some time.

What can I do about the side effects I get from my pain medication?

Pete’s comment:

My pain medication, like most, had a side effect of constipation. This was managed by a combination of Colace and Senokot. I also included prunes in my diet and drank plenty of fluids. After several weeks, constipation was no longer a problem and I was able to eliminate the medication.

Some people are concerned about taking pain medication because of the side effects. Common side effects from pain medication are sleepiness, nausea, and constipation.

• Sleepiness generally passes after a few days. However, if the sleepiness persists, ask your doctor or nurse about adjusting the dose or adding another medication to counteract it.

• Nausea also commonly passes after a few days on pain medication. If it does not, ask your doctor about trying a different pain medication or about taking medication to relieve the nausea.

• Unfortunately, constipation from pain medications does not pass. Taking a combination of a stool softener (e.g., docusate) and a laxative (e.g., senna, bisacodyl, lactulose, polyethylene glycol) on a regular basis can help. Newer medications may be more helpful for some patients on high doses of narcotics for a long time. These are MiraLAX (polyethylene glycol), a powder taken mixed in water, and Relistor (methylnaltrexone bromide), an injection. Ask your doctor or nurse about which medications you should take for constipation, what dose, and how often you should take them. Increasing the amount of liquid you drink during the day will also help reduce the likelihood of constipation.

If you become dizzy or confused from the pain medication, tell your doctor or nurse. Switching the dose or type of medication will usually resolve this problem.

I am afraid of taking my pain medication because I don’t want to get addicted. What should I do?

Some people are concerned about taking pain medication because they are afraid of becoming addicted. Pain medication does not cause addiction when it is taken to treat pain. However, when taken on a regular basis, it does cause tolerance, that is, your body physically adjusts to the level of medication in your bloodstream. If you stop the medication suddenly, you can develop withdrawal symptoms.To prevent these symptoms, if you no longer need your pain medication, taper down the dose of medication gradually rather than stopping it suddenly. Your doctor or nurse will review with you exactly how to do this. Tolerance to the medication is not addiction, which is a desire or craving for the medication to feel high rather than to have your pain relieved. Research studies show that it is extremely rare for patients with cancer to develop addiction from pain medication.

Terms:

Addiction - A desire or craving for the medication to feel high rather than to have your pain relieved

Pain medication does not cause addiction when it is taken to treat pain.

 Are there other treatments for pain that do not rely on taking medication?

For some types of pain, surgery may be helpful by removing all or part of the tumor causing the pain. However, surgery is not an option for many people; in that case, other treatments may be offered. Radiation therapy is effective in treating some types of cancer pain. With external beam radiation therapy, a beam of energy is directed from a treatment machine at precise angles toward a defined target in your body. The therapy can reduce pain by shrinking a tumor that is pressing on or invading surrounding organs or nerves. If you do not feel your pain is controlled adequately with your medication, ask your doctor if radiation therapy would be helpful. However, if your cancer has spread widely throughout your body, external beam radiation is unlikely to be effective for you. For people who have bone metastasis (spread of the primary tumor to the bone) in multiple areas of the body, treatment with a radioactive isotope may be helpful. Strontium-89 is injected into the blood, travels through the body, and collects in the bone where the tumors have spread. It then emits radiation to those areas to shrink the tumors, thus reducing the pain.

If pain is caused by pressure on a nerve, a procedure called a nerve block can sometimes be performed. This involves injecting a local anesthetic or alcohol into or around the nerve near the point where the tumor is pressing. The injected substance blocks the transmission of messages from the nerve to the brain, so that you are no longer aware of the pressure. Blocks may also be done surgically; that is, the nerves are cut to relieve the pain. If you do not feel your pain is controlled adequately with your current medication, ask your doctor if this would be helpful.

A variety of nonmedical strategies may be helpful in treating pain, either alone or in combination with your pain medication: distraction, relaxation, imagery, prayer, meditation, and acupuncture. Specialists in these techniques can perform them or train you to use them to control your pain. If you are interested in them, ask your doctor or nurse for a referral, or contact the National Center for Complementary and Alternative Medicine.

Term:

 Nerve block - Injecting a local anesthetic or alcohol into or around the nerve near the point where the tumor is pressing

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