Pain management is an important part of cancer care. Judith A. Paice, PhD, RN, and Betty Ferrell, PhD, RN, provided a review of issues faced by patients and their physicians. Pain symptoms occur in an estimated 25 percent of newly-diagnosed cancer patients, 33 percent of those undergoing treatment, and at least 75 percent of those with advanced disease.
“With such a high prevalence, cancer pain should be anticipated and responded to early in its course rather than only in crisis once it is severe,” Paice and Ferrell wrote.
Barriers to cancer pain relief include factors related to patients, health care providers, and others:
1. Patients are reluctant to complain about pain because of fear issues. Some are afraid of side effects, including addiction. Others fear distracting physicians from treating the cancer, and assume that pain indicates disease progression. Some also have low expectations about the results of pain management.
2. Physicians and nurses in the oncology field often have inadequate knowledge of pain management.
3. Health care plans may offer inadequate reimbursement for cancer pain services.
Treatment for cancer pain includes many options:
1. Opiod drugs. Morphine, hydrocodone, hydromorphone, codeine, fentanyl, buprenorphine, methadone, oxycodone, oxymorphone, tapentadol, and tramadol are all used for cancer pain.
“There is great interindividual variability in response to a particular agent,” Paice and Ferrell reported. “The agent that works for a particular patient is the 'right' drug.” The primary side effects of all opiods are constipation and sedation.
2. Other analgesics. Acetaminophen, aspirin, ibuprofen, naproxen, choline magnesium trisalicylate, indomethacin, ketoralac, and celecoxib are often used in combination with opiods.
Combination drug therapy is especially beneficial to patients who experience burdensome levels of side effects from opiods, because a lower dose of opiods can be used. Primary side effects include liver and kidney damage at high dosage, and bleeding disorders.
3. Adjuvant analgesics. Drugs that are approved for conditions other than pain can be used in combination with opiods, especially for moderate to severe pain.
These include tricyclic antidepressants, serotinin-norepinephrine reuptake inhibitor antidepressants, anticonvulsants, corticosteroids (used to treat inflammation), and bisphosphonates (used for osteoporosis).
Local anesthetics are useful for procedural pain and some cases of neuropathic pain. Ketamine, which is used as a general anesthetic, can be used in smaller doses for cancer pain.
4. Surgical techniques. Nerve blocks and spinal surgery can benefit some patients.
5. Physical and psychosocial techniques. Physical therapy, massage, heat or cold, acupuncture, acupressure, cognitive-behavioral therapy, breathing exercises, relaxation, imagery, hypnosis, and spiritual practices are important options for some patients.
The American Cancer Society provides more details on cancer pain management online.
References:
1. Paice JA, Ferrell B, “The Management of Cancer Pain”, CA Cancer J Clin 2011; 61: 157-82. http://www.ncbi.nlm.nih.gov/pubmed/21543825
2. American Cancer Society. Pain Control. Web. August 19, 2011.
http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/Pain/PainDiary/pain-control-toc
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.
Reviewed September 12, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith