Supportive Care

 


Managing Cancer Pain

Pain can affect you in many ways. It can keep you from getting sleep, being active, eating and enjoying family and friends. Pain can make you feel scared, depressed, or anxious.

Cancer pain in particular can be unpleasant and cause discomfort or soreness. Pain may happen suddenly (called acute pain) or continuously over a period of time (called chronic pain). And some pains are not the result of your cancer. Pain can come from your treatment (chemotherapy, radiation, surgery) from a tumor pressing against bone, nerves, or body organs, or from conditions unrelated to cancer (headaches, arthritis, muscle strain).

 

Don't believe the myths about pain medication.

Myth 1.Only take pain medication when you have severe pain. False.
Facts.
Do not wait to take medication until the pain becomes bad. Pain is easier to control when it is mild than when it has become severe. Take pain medicine regularly just as your doctor or nurse tells you.

If you are in pain, alerting your doctor or nurse right away; and getting help sooner rather than later, often makes pain treatment more effective. Most cancer-related pains can be controlled with medicines, surgery, radiation therapy or other treatments. Remember; early treatment of pain is almost always more effective than waiting until the pain is severe or unbearable. When you have less pain, you are more likely to be active and interested in doing the things you enjoy.

There are many medicines used to treat cancer pain. Your doctor may prescribe one or more of the following drugs for different kinds of pain.

  • Opioids (derived from opium) such as morphine and codeine can be prescribed for moderate to severe pain. These can only be obtained with your doctors prescription. Sometimes they are combined with non-opioids to manage moderate pain.
  • Non-opioids (that is, drugs not derived from opium or opiates) are often used for mild to moderate pain. Many of these drugs (acetaminophen's and nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen) are available without prescription.
  • Antidepressants and anticonvulsants are often used for the tingling and burning pains associated with cancer. These drugs can only be obtained by prescription. Taking them does not mean you are suffering from depression or convulsions.
  • Steroids (such as prednisone) are particularly effective for pains caused by swelling. These are available only with a prescription.

Most of these medicines are available in pill form. In some cases, however, they may be given in other forms, particularly if you are having difficulty swallowing. You should ask your doctor whether you can take some medicines as rectal suppositories, patches placed on the skin, or by injection.

There are also some non-medical treatments for relieving pain that you can do yourself. Some relaxation exercises you may want to try include:

  • Slow, rhythmic, breathing.
  • Simple touch, massage or warmth (heat packs).
  • Focussing on peaceful memories or things you would like to do.
  • Listening to music.

These should never be used in place of medications your doctor has prescribed for you, but along with them. Sometimes these activities can help release tension or anxiety you may have built up your condition. They can help you feel more in control of your body.

Myth 2.Pain medications are addicting. False .
The facts. People do not get high on pain medication, and it is not addictive.

Myth 3. Over time, the medication will stop working. False.
The facts. The medication never stops working, but sometimes your body will get used to it and develop what is called a tolerance for it. It this occurs, your doctor may increase your dosage, prescribe a different drug, or use a combination of drugs.

Perhaps the most important thing you can do to relive your cancer pain is to have a pain control plan that you share with your doctor and nurse. Together, you can come up with a program of when to take your medicines, how and when to take extra medicines, how to treat potential side effects, and other things you can do to ease or prevent pain. But don't forget this is a trial-and-error process. For some people,the first pain control plan does not work, and they need to make adjustments.

To help your pain medicine work best, be sure to take it on a regular schedule and as prescribed by your doctor. Do not skip a dose or wait for the pain to get worse before taking your medicine. The goal is to prevent pain. Once you are feeling the pain, it is more difficult to get it under control.

You may want to keep a record of how your pain medication is working, so that you can discuss it more fully with your doctor. There are many different medicines and treatments that an be used to conquer pain, so you and your doctor should discuss what is working for you and what is not. Together, you will find the pain medicine that will help you the most.

Of course, like all medicines, pain medications can have unpleasant side effects. You may or may not get the following.

  • Constipation.
  • Nausea and vomiting.
  • Sleepiness.
  • Slowed breathing.
  • Dizziness.
  • Rashes.

If you experience any of these after taking pain medication, you should contact your doctor immediately. In many cases, these symptoms will only last for the first day or two you are taking the medication.

For constipation, you are encouraged to drink lots of liquids and to eat more fruits and vegetables.

Some patients will have pain that cannot be relieved with medicines. In these cases, pain can be reduced through radiation therapy (to shrink a tumor), nerve blocks (to block the pain at a nerve source), neurosurgery, or surgery.

Myth 4. It is better to live with pain than to complain too much. False.
The facts.
Controlling pain is an important part of your care, so you should always tell your doctor or nurse when you are feeling pain. It is not a weakness to discuss your pain with your health, care partners. Relief from pain will give you more energy to fight the cancer and live your life.

 

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Cancer Pain Relief And Palliative Care In Children

Most children with cancer may experience pain as a direct result of the disease, as a side effect of treatments or invasive clinical procedures, or as an aspect of psychological distress. In more than 70% of cases, that pain may at some stage become severe.

Although the means to relieve pain are widely available, in developed and developing countries alike, their use in children has often been very limited. Fears of drug addiction, lack of knowledge of children's perception of pain and illness, use of inappropriate drug doses, and failure to understand the value of supportive non-drug measures have all contributed to widespread inadequacy in the control of pain in children with cancer.

 

The nature of children's pain.
Children understand the basic concept of pain at a very young age and can describe both its emotional and physical aspects. Physical pain is unquestionably a sensation in a part, or parts, of the body, but it is always unpleasant and is therefore also an emotional experience. The pain system is now known to be much more variable and complex than was previously believed.

Pain in children with cancer is usually related to the disease or to its treatment. The same type of tissue damage can cause pain of different nature or severity in different children or in the same child at different times. The physical environment and the attitudes and behavior of caregivers, as well as children's own behavior, thoughts and emotional states, can profoundly increase or decrease children's cancer pain.

Comprehensive care of children with cancer includes:

  • Curative therapies.
  • Pain management.
  • Symptom control.
  • Compassionate support both for the children and for their families.

The diagnosis of cancer abruptly changes the lives of all family members. The initial reactions of parents are disbelief, anguish, and despair, and the sudden feeling that they have little control over their lives or the life of their child. They become anxious, frightened, and uncertain about the future. Normal life temporarily stops.

Parents and children therefore require special psychosocial and spiritual support to help them learn to live with cancer.

Many children with cancer may not receive comprehensive care even though this should be possible in almost all countries. It is essential for health providers to recognize that children, their parents and their siblings will all react to a potentially fatal illness differently, according to their own personalities, past experiences and perception of the disease. To support and assist children effectively, it is important to know them and their families, their beliefs about life and death, and their current sources of emotional support. Such an approach is central to the concept of palliative care.

Children frequently experience prompt pain relief, although some may suffer persistent pain for a lengthy period. When curative therapies are not available, death is often rapid.

The most common childhood malignancies, such as leukemia, lymphoma and neuroblastoma, often produce diffuse bone and joint pain.

In the developed world, the major sources of pain in children's cancer are diagnostic and therapeutic procedures.

In the developing world, most pain is disease related.

Children can also experience pain after the disease has been controlled; this is caused by the late effects of cancer and its treatment.

 

 

Public education
Children with cancer often suffer pain.

Practical guidelines for alleviating children's pain recommend both drug and non-drug therapies:

  • Opioid drugs are safe and effective for children, when used appropriately for pain control. Appropriate administration of opioid  drugs does not lead to abuse and addiction, as popularly supposed.
  • Simple and practical non-drug pain-control methods can be combined with drug therapies to provide effective relief of children's cancer pain.

 

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Cancer Pain Relief And Palliative Care In Adults

Pain can affect you in many ways. It can keep you from getting sleep, being active, eating and enjoying family and friends. Pain can make you feel scared, depressed, or anxious.

Cancer pain in particular can be unpleasant and cause discomfort or soreness. Pain may happen suddenly (called acute pain) or continuously over a period of time (called chronic pain). And some pains are not the result of your cancer. Pain can come from your treatment (chemotherapy, radiation, surgery), from a tumor pressing against bone, nerves, or body organs, or from conditions unrelated to cancer (headaches, arthritis, muscle strain).

The simplest dosage schedules and least invasive pain management modalities should be used first.

The FIVE essential concepts in the WHO (World Health Organization) approach to drug therapy of cancer pain are:

  • By the mouth.
  • By the clock.
  • By the ladder.
  • For the individual.
  • With attention to detail.

The first step in this approach is the use of acetaminophen, aspirin or another NSAID for mild to moderate pain.

When pain persists or increases, an opioid such as codeine or hydrocodone should be added (not substituted) to the NSAID.

Pain that is persistent, or moderate to severe at the outset, should be treated by increasing opioid potency or using higher dosages.

 

DON'T BELIEVE THE MYTHS ABOUT PAIN MEDICATION

Myth 1. Only take pain medication when you have severe pain. False .
Facts.
Do not wait to take medication until the pain becomes bad. Pain is easier to control when it is mild than when it has become severe. Take pain medicine regularly just as your doctor or nurse tells you.

If you are in pain, alerting your doctor or nurse right away; and getting help sooner rather than later, often makes pain treatment more effective. Most cancer-related pains can be controlled with medicines, surgery, radiation therapy or other treatments. Remember early treatment of pain is almost always more effective than waiting until the pain is severe or unbearable. When you have less pain, you are more likely to be active and interested in doing the things you enjoy.

There are many medicines used to treat cancer pain. Your doctor may prescribe one or more of the following drugs for different kinds of pain:

  • Non-opioids (that is, drugs not derived from opium or opiates) are often used for mild to moderate pain. Many of these drugs (acetaminophen's and nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen) are available without prescription.
  • Opioids (derived from opium) such as morphine and codeine can be prescribed for moderate to severe pain. These can only be obtained with your doctors prescription. Sometimes they are combined with non-opioids to manage moderate pain.
  • Antidepressants and anticonvulsants are often used for the tingling and burning pains associated with cancer. These drugs can only be obtained by prescription. Taking them does not mean you are suffering from depression or convulsions.
  • Steroids (such as prednisone) are particularly effective for pains caused by swelling. These are available only with a prescription.
    Most of these medicines are available in pill form. In some cases, however, they may be given in other forms, particularly if you are having difficulty swallowing. You should ask your doctor whether you can take some medicines as rectal suppositories (drugs which you insert into your rectum), patches placed on the skin (dermal patches), or by injection (depots).

There are also some non-medical treatments for relieving pain that you can do yourself. Some relaxation exercises you may want to try include:

  • Slow, rhythmic, breathing.
  • Simple touch, massage or warmth (heat packs).
  • Focussing on peaceful memories or things you would like to do.
  • Listening to music.

These should never be used in place of medications your doctor has prescribed for you, but along with them. Sometimes these activities can help release tension or anxiety you may have built up due to your condition. They can help you feel more in control of your body.

Myth 2. Pain medications are addicting. False .
The facts.
People do not get high on pain medication, and it is not addictive.

Myth 3. Over time, the medication will stop working. False.
The facts.
The medication never stops working, but sometimes your body will get used to it and develop what is called a tolerance for it. If this occurs, your doctor may increase your dosage, prescribe a different drug, or use a combination of drugs.

Perhaps the most important thing you can do to relive your cancer pain is to have a pain control plan that you share with your doctor and nurse. Together, you can come up with a program of when to take your medicines, how and when to take extra medicines, how to treat potential side effects, and other things you can do to ease or prevent pain. But don't forget this is a trial-and-error process. For some people,the first pain control plan does not work, and they need to make adjustments.

To help your pain medicine work best, be sure to take it on a regular schedule and as prescribed by your doctor. Do not skip a dose or wait for the pain to get worse before taking your medicine. The goal is to prevent pain. Once you are feeling the pain, it is more difficult to get it under control.

You may want to keep a record of how your pain medication is working, so that you can discuss it more fully with your doctor. There are many different medicines and treatments that can be used to conquer pain, so you and your doctor should discuss what is working for you and what is not. Together, you will find the pain medicine that will help you the most.

Of course, like all medicines, pain medications can have unpleasant side effects. You may or may not get the following:

  • Constipation 
  • Nausea and vomiting. 
  • Sleepiness. 
  • Slowed breathing. 
  • Dizziness. 
  • Rashes.

If you experience any of these after taking pain medication, you should contact your doctor immediately. In many cases, these symptoms will only last for the first day or two of your taking the medication.

For constipation, you are encouraged to drink lots of liquids and to eat more fruits and vegetables.

Some patients will have pain that cannot be relieved with medicines. In these cases, pain can be reduced through radiation therapy (to shrink a tumor), nerve blocks (to block the pain at a nerve source), neurosurgery, or surgery.

Myth 4. It is better to live with pain than to complain too much. False.
The facts.
Controlling pain is an important part of your care, so you should always tell your doctor or nurse when you are feeling pain. It is not a weakness to discuss your pain with your health care partners. Relief from pain will give you more energy to fight the cancer and live your life.

 

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