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Cancer Pain Management

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Cancer related image Photo: Getty Images

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.

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