Managing Pain

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Although many people don't realize it, pain is treatable. Significant advances in pain control have been made over the last decade. Studies have demonstrated that the fear of pain, including the fear that it will worsen, can make people perceive it as more severe. Just knowing there are options for treating pain often helps people to begin to perceive it as less severe.

How Cancer Causes Pain

There are several different ways that cancer may cause pain. Pain can be due to a tumor physically pressing on an organ or body part. This type of pain is refered to as "mass effect." The most straight forward way to stop or lessen pain caused by mass effect is by surgically removing as much of the tumor as possible. For cancer patients who are not good candidates for surgery, other treatments such as radiation and/or chemotherapy may be used to achieve the same effect.

Another way cancer may cause pain is if it grows directly into a nerve. In this case the person may feel referred pain, which is pain felt at a place different from that where the injury is occurring, along the nerve's path. This type of pain is sometimes treated by making he whole nerve numb through a process called a nerve block.

When tiny cancer cells get inside bones and damage their structure the resulting pain is refered to as "bony" pain. In such situations radiation therapy is frequently employed to destroy most of the tumor cells, lessening the pain and allowing the bone to begin healing.

Sometimes it is not the cancer that causes pain but the treatment. Radiation therapy can cause pain when damage is done to healthy tissue making it fibrosed or hard. When radiation therapy is used on the intestine, a person may experience cramping and diarrhea. Many of the narcotics used to treat pain can cause severe and painful constipation. To remedy this people taking narcotic pain medicine may also need to take a stool softener. Chemotherapy can aggravate nerves causing neuropathy, or nerve sickness, which may manifest as numbness, tingling, or pain often in the feet and lower legs or the hands. Finally, when surgery is used to remove a tumor pain may result from tissues injured during the process or by the formation of scar tissue.

Clinical studies of pain suggest that about one-third of cancer patients experience moderate to severe pain. However, a recent study from the World Health Organization reports that 70 to 90% of all cancer pain can be controlled. (Cancer Pain and Pain Management by, Kara Bucci, MD and Joel W. Goldwein, MD)

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How Cancer-related Pain is Treated

When planning pain treatment physicians often use the model of a pain ladder. The first step is the treatment of mild pain with over-the-counter analgesics such as aspirin, Motrin¨(ibuprofen), or Tylenol (acetaminophen). Some of these drugs are classified as NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).

If these are not enough to control a patient's pain, physicians climb to the next step on the ladder adding a stronger medication, such as an opioid (or narcotic) to an NSAID. Some opioid medications, like Vicodin and Percocet, are already mixed with an NSAID. Most of these medications are available in numerous forms including: pills, liquids, suppositories, shots, and even skin patches that can be worn for several days.

The third step on the pain ladder involves increasing the dose of the prescribed opioid. Other groups of medicines such as anti-depressants, corticosteroids (anti-inflammatory drugs), seizure medications, and blood-pressure medications, primarily used to treat other disorders can be used to treat pain and are usually used in combination with an NSAID or an opioid.

Many pain specialists believe the best way to treat pain lasting for more than a few days is for the patient to take enough medication so that it doesn't wear off before the next dose. When medication wears off, "breakthrough" pain occurs. Usually people need less medication to prevent breakthrough pain than to get rid of it once it occurs.

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Aren't Narcotic Drugs Addictive?

It is important to distinguish between addiction and tolerance. Addiction is the loss of control associated with taking a drug. Behaviors that imply addiction include stealing drugs or money for drugs, lying to get them, and using drugs that are harmful to oneself. (Cancer Pain and Pain Management by, Kara Bucci, MD and Joel W. Goldwein, MD). Rarely does the use of narcotics in the treatment of cancer-related pain cause addiction, however, it is not uncommon for people being treated for chronic pain to develop a tolerance to their medication, meaning that they need more of it in order to get the same effect. Provided that they are not engaging in dishonest behaviors to obtain the medication, and they are not harming themselves with it, their need of the medication is not addiction.

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Are There Side Effects?

Side effects to drug-based pain management are common and most often include nausea, sedation and drowsiness, and constipation. Frequently patients develop tolerance to the sedative effects of narcotics so even though the same dose will continue to control pain it will no longer make them drowsy. Unfortunately this is not true for medication that causes constipation and many people experiencing this side effect need to take a stool softener or laxative. A patient experiencing severe nausea may need to switch medications; the fact that one medicine causes nausea does not necessarily mean that another similar medicine will do the same.

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Are There Pain Treatments That Don't Involve Medicine?

Yes, there are several such treatments, the least invasive of which is called Transcutaneous Electrical Nerve Stimulation (TENS). Low grade, non-painful electrical bursts are administered to strategically located areas in the skin. Another treatment modality involves the injecting of a numbing medication by an anesthesiologist directly into the nerve that goes to the painful area. The treated area will go numb and the patient may have trouble moving it. In cases of severe, unremitting pain, neurosurgeons can cut the nerve that goes to the affected area. Usually this treatment is only considered when the affected area has already lost function.

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Other Alternatives

Acupuncture, a modality of Traditional Chinese Medicine, involves stimulating selected points in the body with thin needles. In Asia, acupuncture has long been viewed as a reliable method for treating not only pain but also disease. While studies are just beginning to be done on the effectivness of acupuncture in treating disease and many Western physicians are reluctant to use it for treatment, there are many reports of acupuncture's usefulness in treating pain. In one study of acupuncture in cancer patients experiencing pain, slightly over half of those treated reported that their pain improved. For an overview of Acupuncture you might visit Yahoo! Health: Acupuncture.

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Online Bibliography

Oconolink: Cancer Pain and Pain Management by, Kara Bucci, MD and and Joel W. Goldwein, MD

Shaare Zedek Cancer Pain and Palliative Care Reference Database: a searchable database of over 20,000 references related to cancer pain and palliative care.

Yahoo! Health: Acupuncture

Remember to always consult your primary care doctor before trying any new treatment or if you have questions or concerns about the treatment you are receiving!

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