Pharmacological Management Of Cancer Pain

What is cancer pain?

• Cancer pain is an unpleasant feeling and emotional experience related to cancer. Pain is one of the many symptoms that may tell you something bad is happening to your body. Cancer occurs when cells grow and split without control or order, often making too much tissue (tumor). Cancer cells can pass through the blood or lymph vessels, and spread to other areas of the body. The body has special cells that receive signals when there is damage or an injury. These cells send a message to the brain. When the brain receives the message, you will feel pain.
  
  
• Cancer pain may be acute or chronic. Acute cancer pain comes on suddenly and does not last for a long period of time. Chronic pain persists or grows worse during the whole time that you have cancer. It may not always be present and may sometimes come with breakthrough pain. Breakthrough pain is the on and off episodes of pain that may occur even if you are taking pain medicines. This pain usually comes very fast and lasts for 30 minutes. With cancer pain, you may feel depressed or hopeless, or have problems eating or sleeping. Diagnosing and treating cancer pain as soon as possible may help you enjoy your life more.

What causes cancer pain?

Cancer pain may come from where the cancer started. It may also come from other areas in the body where the cancer has spread. Any of the following may cause or trigger cancer pain:

• Cancer growth: As the cancer grows and becomes bigger, it may damage, block, or put pressure on tissues, nerves, and blood vessels.
  
  
• Harmful chemicals: Cancer cells may produce chemicals that harm and cause pain to the body.
  
  
• Treatments: These include chemotherapy, radiation therapy, or surgery.
  
  
• Others: Cancer affects your body in many different ways. It causes your body to become weak that may lead to other serious problems, such as bed sores or constipation (dry, hard stools). You may also suffer from having troubled breathing, seizures (convulsions), nausea (upset stomach), or vomiting (throwing up).

How is cancer pain diagnosed?

It may be easier to diagnose your cancer pain if you have a pain diary. A pain diary helps track pain cycles, and lets you know when and how the pain may start and end. You may also need any of the following to check how much pain you have or find its cause:

• Physical examination: Your caregiver will look for painful areas during a physical exam. He may touch, press, or stroke different sites or points on your body.
  
  
• Imaging tests: You may need imaging tests to look for the cause of your cancer pain. These may include x-rays, a computed tomography (CT) scan, and a magnetic resonance imaging (MRI) test.
  
  
• Pain scales: These are special tools that can help caregivers measure how much pain you feel. There are many pain scales that include numbers or cartoon faces. Your caregiver may ask you to rate the pain on a scale of 0 to 10.
  
  
• Stimulation tests: Stimulation tests tell exactly which nerves or muscles are affected by pain.

What is pharmacological management of cancer pain?

Caregivers may need to treat your cancer pain and its cause by giving medicines. Medicines work by blocking pain signals going to the brain or by changing how the brain sees pain signals. It is best to work together with your caregiver to decide the pain control treatments that are best for you. You may need one or more of the following:

• Analgesics: This is a group of medicines that includes most painkillers. Each type of analgesic has its specific use and unwanted side effects.
  
  
  • Narcotic analgesics: These medicines are used for moderate to severe (very bad) pain. They may be used to control the cancer pain, or after having surgery and other procedures. Unwanted side effects include sleepiness, problems with breathing, seizures (convulsions), slow or fast heartbeat, nausea, or vomiting. You may also have dry, hard bowel movements, fainting spells, itchiness, or problems passing urine.
    
    
  • Non-narcotic analgesics: These work by changing the way the body senses pain and by cooling the body. They are used to relieve mild to moderate pain from headaches, muscle aches, colds, and fever. Side effects include allergic reactions, such as skin rash, itching, or trouble breathing. Taking non-narcotic analgesics more than what your caregiver told you may increase your risk of having liver damage.
    
    
  • Non-steroidal anti-inflammatory drugs: This family of medicine, also called NSAIDs, helps decrease pain and inflammation (swelling). Some NSAIDs may also be used to decrease a high body temperature. These medicines can cause stomach bleeding or kidney problems in certain people. There is also a higher risk of having a heart attack or a stroke with long term use of NSAIDs.
  
  
• Anesthesia: This numbing medicine is used to control pain and make you comfortable during a procedure or surgery. It works by blocking pain signals from the nerves. There may be risks and side effects when having anesthesia, such as vomiting, memory loss, blurring, or feeling confused. Breathing or bladder problems, infections, or nerve damage are not common side effects.

What other medicines may be given to help ease cancer pain?

Depending on the cause of your cancer pain, your caregiver may also need to treat the cancer first. Cancer may be treated with chemotherapy or radiation therapy. If there is an infection, you may be treated with antibiotic or anti-viral medicines to kill the germs. Your caregiver may suggest other medicines to help control your pain or prevent the side effects of pain medicines. You may need one or more of the following:

• Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and relaxed.
  
  
• Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.
  
  
• Anti-depressants: These medicines may be used to help decrease or prevent the symptoms of depression. Anti-depressants lift up your mood and help relieve your cancer pain.
  
  
• Muscle relaxers: This medicine helps relax your muscles. It is also given to decrease pain and muscle spasms.
  
  
• Radiopharmaceuticals and biphosphonates: Radiopharmaceuticals and biphosphonates help decrease cancer growth, pain, and inflammation that happens when cancer gets inside bones.
  
  
• Sedative: This medicine is given to help you stay calm and relaxed.
  
  
• Steroids: This medicine may be given to decrease inflammation.

What might happen if cancer pain is not treated?

Cancer pain may affect many areas of your life. It can affect your appetite (ability or desire to eat), how well you sleep, your energy and your ability to do things. It can also affect your mood (how you feel about things) and your relationships with others. It is sometimes hard to find the cause of cancer pain. You may feel that it is impossible to get rid of your cancer and pain. This can cause a cycle of suffering, sleeplessness and sadness. If caregivers can help control your cancer pain, you will suffer less and enjoy your life more.

Where can I find support and more information?

Having cancer pain is a life-changing condition for you and your family. Accepting that you have cancer pain may be hard. You and those around you may feel sad, frightened, and anxious. These feelings are normal. Talk to your caregiver, family, or friends about your feelings. Contact the following for more information about cancer pain:

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

• American Cancer Society
  250 Williams Street
  Atlanta , GA 30303
  Phone: 1- 800 - 227-2345
  Web Address: http://www.cancer.org
  

• National Cancer Institute
  6116 Executive Boulevard, Room 3036A
  Bethesda , MD 20892-8322
  Phone: 1- 800 - 422-6237
  Web Address: http://www.cancer.gov
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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