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Cancer Pain: The Right to Relief

Finding the right cancer treatment plan to manage pain

A Scripps cancer patient enjoys a quiet moment after pain management therapy completes.

Cancer pain, which is usually caused by either tissue or nerve damage, is experienced by 30 percent to 50 percent of cancer patients undergoing treatment. As high as 90 percent of patients with advanced cancer suffer pain.

But for the vast majority of cancer patients, pain can be successfully controlled. According to the medical literature, cancer pain can be effectively managed in 95 percent of cancer patients with drug and non-drug therapies currently available.

With today’s knowledge of cancer and pain-relieving therapies, no one should have to suffer from cancer pain. Surveys, however, indicate that cancer pain is often undertreated in many patients. This has been attributed to a number of factors:

  • Physicians may not be adequately educated about pain control or may be focusing on controlling the disease rather than pain and other symptoms
  • Both physicians and patients may be reluctant to use morphine and other opioids for pain control for fear that it will lead to addiction
  • Patients may be reluctant to report their pain

What is cancer pain?

Pain is transmitted through the body by the nervous system when our nerve endings detect damage to a part of the body. The nerves transmit the warning through defined nerve pathways to the brain, where the signals are interpreted as pain. Sometimes pain results when the nerve pathways themselves are injured. You feel pain when your brain receives the signal from your nerves that damage is occurring. All types of pain are transmitted this way, including cancer pain.

The two most common causes of cancer pain are the cancer itself and the treatment. When the cancer itself causes pain, it may be from the pressure of a tumor on one of the body’s organs or on bone or nerves.

Or, pain can result when blood vessels become obstructed by the tumor. Treatments for cancer that can cause pain include chemotherapy, surgery, and procedures, such as biopsies, blood draws, lumbar punctures and laser treatments.

Pain treatment and the addiction myth

Opioids are considered to be first-line medications for cancer patients and are most often used for moderate to severe pain. They are very effective and addiction by cancer patients is extremely rare, according to the many studies. In one study of 24,000 patients with cancer who used opioids for pain management, only seven became addicted to their medication.

“Pain is my pet peeve,” says Harminder Sikand, PharmD., clinical manager of the Department of Pharmacy at Scripps Mercy Hospital. She worries that pain goes undertreated because of misconceptions about drugs and unfounded fears of addiction.

“If a patient is appropriately treated and is in true pain, we’re not going to create an addict,” she asserts.

Pain education for cancer professionals

Dr. Sikand was a member of the Scripps systemwide Pain Management Task Force. Each Scripps hospital now has its own Pain Management Committee. The Task Force was created to provide pain education to physicians and nurses — especially those at the start of their careers — and to ensure compliance with new pain management standards.

The new standards were set in January 2001 by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the nation’s predominant accrediting body in health care. Under the new standards, a patient has the right to appropriate pain assessment and management.

Dianne Bloomberg, a Scripps Mercy Hospital nurse educator, led the Pain Management Task Force.

“Pain education has become a strong emphasis in hospitals, especially in the last two years,” she says. “That’s when national studies of pain began to reveal that a failure of communication — rather than a failure of modern science — might be the greatest obstacle to relief.”

Speaking a common language for pain management

Patients and medical staff need to speak “a common language of pain” to accurately communicate the location, duration, character, intensity and frequency of pain. Nurses, physicians and technicians use of number of simple pain scales to help patients tell them what the pain feels like, what makes it better or worse and what is acceptable to them.

For example, a patient about to undergo surgery may say that 3 is acceptable on a scale of 0-10 immediately after her surgery. With that pain level agreed upon in advance, the patient and medical team can work together toward a common goal, giving the patient control over what often feels like an out-of-control experience.

But the most important element in controlling pain, says Dr. Sikand, is understanding that only the patient knows what he’s feeling.

“Ultimately, you have to give the benefit of doubt to the patient to accurately express his experience of pain — and that can be hard in a medical setting,” Dr. Sikand says. “But there is so much we can do to help, both pharmacological and non-pharmacological. We have many, many options to provide relief.”

Non-drug therapies for pain management

Complementary and alternative medicine is now widely used to help manage cancer pain, either as stand-alone therapy or in conjunction with medications.

Some people find they can take a lower dose of medicine or manage pain-associated symptoms such as anxiety and fear with therapies such as relaxation, biofeedback, imagery, hypnosis and acupuncture, according to the National Cancer Institute.

In addition, organizations such as JCAHO and the World Health Organization recommend utilizing non-pharmaceutical therapies; their surveys indicate increased patient satisfaction with a multidisciplinary pain management approach.

According to Robert Bonakdar, MD, director of integrative pain services at the Scripps Center for Integrative Medicine and co-chair of the pain management committee at Scripps Green Hospital, acupuncture is one of the most effective complementary and alternative medicine therapies as an adjunct to conventional pain relievers.

“The evidence for acupuncture’s efficacy stems from the release of endogenous opioids, such as one’s own endorphins, as well as its anxiety-reducing effects — both of which help to reduce pain levels,” he explains.

Along with controlling pain associated with surgery, acupuncture is also effective in managing chemotherapy-associated nausea and vomiting, according to a panel of experts at a National Institutes of Health conference held in 1997.

In addition to acupuncture, Dr. Bonakdar says, mind-body techniques such as group therapy, relaxation exercises (such as mindfulness-based stress reduction), hypnosis and imagery appear to reduce emotional distress, which cancer patients often experience. This emotional distress, he notes, may contribute to pain.

“There is now evidence that these therapies may work independently to alleviate cancer pain,” Dr. Bonakdar says.