Cancer Pain Treatment

27th November 2006 at 11:45 GMT by Dr.C.A.Jenner MB BS, FRCA. Permalink.

Article on the types of Cancer Pain and its treatment

Cancer Pain – The Basics

Pain expert Margo McCaffrey defines pain as “whatever the experiencing person says it is, and exists wherever he says it does”. Pain is largely understood as a sensation that hurts and has both physical and emotional repercussions to consider.

Cancer pain, in particular, can be short-lived or long-lasting, mild or severe; can affect one or more organs, bones or organ systems.

There can be many causes of cancer pain, including:

• Pain from the tumor
• Pain from the cancer therapy
• Other normal painful conditions (headaches, backaches etc)

Cancer Pain – The Facts

It is important for the cancer patients to be aware of the fact that they have full right to good pain control. It is necessary for the cancer patient to know that:

• Most pain can be controlled
• Communication is important
• Pain can be measured
• Patients and health care providers can work in tandem for effective pain control.

Research shows that approximately 30% to 50% of people with cancer will experience cancer pain in the course of treatment. On the other hand, a whopping 70% to 90% of people with advance cancer experience bouts of cancer pain.

Treatment of Cancer Pain

The World Health Organization (WHO) has laid down the Three-Step Analgesic Ladder for Cancer Pain Management, which is widely followed by physicians treating cancer pain.

Here briefly outline the treatment plan laid down by the WHO:

Step I – For Mild Pain: Non-narcotic pain medications.

Drugs prescribed at this stage include:

• Analgesics, such as acetaminophen, tylenol
• Nonsteroidal anti-inflammatory drugs, such as motrin and advil
• Adjuvants, such as elavil, tegretol, xanax, valium

Step II – For Moderate Pain: Opioids, adjuvant medications

Drugs prescribed include:

Opioids in combination with NSAIDs or acetaminophen, such as hydrocodone, codeine or oxycodone

Step III – For Moderate to Severe Pain

This stage is best treated with higher doses of opioid medications, given without any other combinations. Examples include morphine, fentanyl, oxycodone and hydromorphine.

Obstacles to Cancer Pain Relief

Inspite of advanced pain management systems being available for cancer patients, subjective reasons related to knowledge, beliefs and fears largely hamper effective treatment. Some of these are:

1. Fear of addiction: Patients fear that medications like opioids and morphine will lead to addiction.
2. Fear of side effects: Though most of the side effects can be prevented or relieved, patients often take less than the prescribed dosage for the fear of side effects.
3. Inadequate knowledge: It has often been seen that the doctors’ and nurses’ personal beliefs interfere with the management of chronic caner pain.
4. Inadequate pain assessment: Some patients just accept pain as a normal part of cancer and fail to report the same to their health care provider. Such patients remain totally bereft of pain relief.
5. Legal obstacles: Doctors, pharmacists and nurses fear legal action while prescribing high doses of medicines, even when genuinely required.