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Dealing with Pain
Many cancer patients and survivors experience pain as a result of their treatment, or because the cancer has metastasized. The pain may be continuous or intermittent, and often ends after treatment is over. But for approximately a third of cancer survivors, the pain continues long after treatment has ended. This chronic pain can range from mild to severe and coping with it can be a daily struggle.
The cause of chronic pain can be from the side effects of certain drugs or from a direct result of the tumor working on bones, muscles or nerves. Cancer survivors are most likely to feel either bone pain or neuropathic (nerve) pain. The good news is that palliative and supportive care units can now draw on a number of medications and other treatments to manage or eliminate chronic pain. Some of the other treatments which are effective are analgesics, opiates, anti-depressants and anti-convulsant drugs. Complementary therapies such as acupuncture, massage and hypnosis are also effective agents against chronic pain.
“Pain assessment is hard because it is all about communication,” states Michael Fisch, MD, Chairman of the Department of General Oncology at MD Anderson Cancer Center in Houston, Texas. Fisch is also a researcher in the field of pain management.
There are entire textbooks written on pain, but a patient should be able to rely on his/her physician to come up with answers to solve the pain. Key in this is finding descriptive words to pinpoint the feeling and location of the pain. Is it a tenderness or pressure? Does it feel fiery, like a bee sting? Does the area feel hot or cold, or is the pain continuous, dully throbbing or sharp?
Assessing the pain in this manner is an essential first step and it is often the hardest since patients and doctors may have different words to describe the pain. Doctors often ask the patient to rate the pain on a scale of 0 to 10 and report whether it is continuous or intermittent. Additionally, providers should ask about the nature of the pain, such as does it feel sharp or burning, are there triggers and what time of day the pain occurs. Asking a patient to keep a journal may help identify non-obvious patterns.
The National Comprehensive Cancer Network published an update to its clinical practice guidelines for adult cancer pain in 2010. The guidelines detail medicines, dosing, and delivery method for physical pain, emotional and spiritual pain, as well as depression. Effective pain management involves knowledge, skill and a willingness to try new things. Anticonvulsants and antidepressants are now used for neuropathic pain. Bisphosphonates, which are prescribed for bone mineral loss, have proven effective for some bone pain.
Physical therapy can break up scar tissue that is causing muscle pain, and massage and compression garments are useful in swelling from lymphedema. Regular walking and stretching can ease both bone and muscle discomfort.
The experience of pain is so individualized that it shouldn’t be surprising that pain management is individualized, too. What works for one patient may not give relief to another, so the key is to continue to try new methods. Meditation, guided imagery and music therapy may work with some individuals, but not all. Emphasis should be placed on the need for patience and persistence when dealing with chronic pain. If one type of therapy doesn’t work for you, don’t hesitate to approach your doctor to try another.
Penobscot Valley Hospital is currently raising funds for a palliative care program. Palliative care should not be confused with hospice care, which is geared toward meeting the needs of patients at the end of life. Focusing on quality of life, palliative care is specialized medical care for people with serious illnesses. Its goal is to provide relief from symptoms, pain and the stress of serious illness. The goal is to improve the quality of life for both the patient and the family. The PVH Cancer Support Group is excited about the advent of this specialized care in our local community.
The PVH Cancer Support Group meets on the second and fourth Tuesday of each month at 6 pm in Conference Room B of the hospital. Meetings this month are on November 13 & 27. Patients and their families or caregivers are welcome to come, share, ask questions, and enjoy the camaraderie of others who are traveling on their cancer journey.