One of the most important fears after a cancer diagnosis is suffering during chemotherapy. But patients also are afraid that the cancer will cause suffering from pain that can’t be treated. Almost all patients with cancer are most afraid of pain and controlling it.
It is so important that cancer patients and their caregivers know how to manage pain because patients in pain do not eat, do not drink do not exercise, and do not interact. One of the major misconception for pain control is that the patient will become addicted. Patients may want to save medicine for it when it gets really bad. It needs to be very clear that the best pain control is early intervention. When pain is developing is the time take a painkiller. Don’t wait til it reaches 10/10.
In fact studies have shown that when you wait too long, the benefit is much less and you may end up taking more because it is much more difficult to control pain when it is out of control. The problem of addiction for cancer patients is really not a clinical problem. Over the last 17 years I have seen very few patients where we had problems getting them off pain medication. The benefit is bigger by far than these few issues. Patients have more energy, eat better, avoid dehydration, and are emotionally better off, all of which are basic for better treatment outcomes.
Patient with pain are usually exhausted. They feel drained and can’t sleep at night, and, because of the pain, don’t eat and lose weight.
It is absolutely critical to communicate clearly with your oncologist to make sure your pain is adequately treated. There are basic principles and steps which should be followed to have the best outcome. We usually start with over-the-counter painkillers such as Advil®, Aleve®, or Tylenol. But they may not be enough. Then we use stronger combinations such as Percocet®, Vicodin®, or Lortab®.
It is critical for pain control to take the pain medication on a regular time schedule. To try to save these medications and wait until the pain peaks is absolutely wrong. Take them as they are prescribed every 4 or 6 hours. It is also important to have a medication for breakthrough pain in case you still have pain despite taking your prescribed medicine on a regular schedule. If pain still continues, sometimes increasing the dose may help. In other cases you may need a stronger breakthrough drug.
With NSAIDs such as Aleve or Advil, you need to watch out for your stomach. It can get upset, particularly if you have a history of gastritis or ulcer. Make sure your oncologists knows about your history.
If pain is difficult to control with these measures and you need breakthrough medicine more than four or five times a day, you may need a longer acting morphine agent. In recent years significant advances have been made to develop highly active morphine medications, such as patches or lollipops. These patches only need to changed every three days and deliver small doses of pain medicine through the skin. Interestingly, some patients develop pain on the third day, and studies have shown that some patients need to change the patch every two days because they are detoxifying the drug faster.
Document how often you take breakthrough pain medication and the pattern of your pain to allow your doctor to make more effective recommendations.
There are a couple of important fact you need to know: When you put on a patch it takes at least 10 hours to reach levels which can be effective and the absorption through the skin varies significantly among patients. If you get sick with nausea, vomiting or feeling dizzy or woozy, take the patch off immediately and consult with your oncologist. If you suddenly don’t need any breakthrough drugs, you may need to reduce the dose of the patch, perhaps due to the effect of chemotherapy or radiation.
Pain management is not easy and requires often a pain management team which has special expertise in pain medications and technologies such as nerve blocks to handle patients whose problems continue.
The most common side effect of pain medications is constipation which should be handled with stool softener right away. Constipation needs to be monitored and discussed with your oncologist.
The most important issues are if your pain is not well-controlled or if you are having side effects from the pain medicine, you need to contact your doctor’s office to make sure that you don’t need adjustments or interventions.