Approximately one-third of patients undergoing cancer treatment experience pain. In advanced cancer cases (spread or relapsed), this rate rises to about two-thirds. For these patients, controlling pain and keeping symptoms under control are important goals of treatment.
Pain affects every aspect of quality of life. Patients with chronic pain (mild, moderate, severe but long term) cannot participate adequately in their daily routine activities, may have problems sleeping and eating, and may be frustrated because they think their family and friends cannot always understand what they are feeling.
Cancer pain is a common problem, it can only be treated by an experienced team. This team should consist of surgeons, medical oncologists, pain specialists, psychiatrists, psychologists, oncology and algology nurses. It should not be forgotten that each patient is different from each other and the treatment to be performed should be arranged according to the individual pain situation of each patient.
What to Ask Your Doctor for Your Pain Control:
What can be done to reduce my pain?
What can we do if medications do not relieve my pain?
What other options do I have for my pain control?
What kind of side effects can I encounter with the drugs I use for my pain?
What can be done to deal with these side effects?
Will my treatment limit my daily activities (work, drive, etc.)
What Causes Pain?
Pain in cancer patients may be due to different reasons. The most common cause is cancer itself. When cancer spreads to soft tissues (muscle, ligaments, etc.), organs or bone, there may be pain due to nerve injury, if the cancerous tissue is pressing on a nerve, or due to increased pressure in the head. It can cause pain in surgery, radiotherapy or chemotherapy. In this case, the pain is referred to as treatment-related. A patient with an amputated arm or leg may still feel pain in the missing limb (phantom pain). This pain is real, but the cause is unknown. Many chemotherapeutic agents can cause numbness, tingling and burning. Radiation can cause painful skin irritation.
Sometimes the pain has nothing to do with the cancer or its treatment. Cancer patients may experience headaches and muscle aches that can happen to anyone. Sometimes, a back or neck hernia, which can happen to everyone, can be the cause of the pain.
There are 3 types of pain:
Visceral Pain: Pain is seen as a result of tissue damage caused by cancer in the organ. It is not often in one spot, it is a sharp pain in the form of aches.
Somatic Pain: It occurs as a result of skin, muscle or bone involvement in a specific area. It is expressed as a throbbing or a feeling of pressure, as if stabbing a knife.
Neuropathic Pain: It occurs due to injury or pressure on peripheral or central nervous system structures. Nerve injury or compression may be due to a peripheral nerve or spinal cord injury, or injury to both. It is expressed as a sharp, burning pain.
Identifying the type of pain is important because each is treated differently.
Barriers in the Treatment of Cancer Pain
Although almost all cancer patients’ pain can be controlled, effective pain relief in these patients can still be a problem. The main reason for this is lack of knowledge, beliefs and fears.
Fear of Addiction: Many patients believe that the use of opioids (narcotic-like drugs) will cause addiction. But this is a rare occurrence. Just like the change in the insulin needs of diabetics, the pain in cancer patients may also change in the need for their medication.
Fear of Side Effects: Patients generally use less than the given dose because they are afraid of possible side effects. However, these side effects can be prevented and corrected.
Insufficient Information: Pain treatments in cancer patients must be treated by teams that are experienced in this field and know alternative treatments.
Inadequate Pain Scoring: Patients often do not talk about their pain without being asked. They want to appear strong. Sometimes they do not talk about their pain even when asked because they are afraid to learn what the current pain means. For these reasons, the pain of many patients remains unresolved.
How Will Doctors Know About Patients’ Pain?
Before starting the treatment of your cancer pain, doctors need detailed information about patients’ pain. This information comes from the patient’s medical history, physical examination, or from family members or friends.
Patients are asked the following questions about their pain.
What is the severity of your pain?
Where is your pain?
How much does pain affect your daily activities?
Are the pains somatic, visceral or neuropathic?
When did it start?
Did the pains change in any way?
Does anything make your pain better or worse?
Do you experience side effects related to the treatment you are taking?
Have you had any psychological problems before?
What do you know about pain and pain control
After all questions are answered and your physical examination is done, if necessary, x-ray, MRI and blood tests may be requested to plan your treatment. For example, if the pain is a bone pain and a fracture is suspected, an X-ray would be appropriate.
Pain Rating Scale
It is used to help patients express their pain. These scales can be used in patients older than 3 years.
The Most Commonly Used Scales Are:
How Is Cancer Pain Treated?
After all research on your pain has been done, a treatment plan is created and discussed with you. Cancer pain can be reduced in many ways, including treatment of the underlying cancer with options such as chemotherapy, radiotherapy or surgery. Medicines are the first methods to be applied in the treatment phase. Opioids (narcotics, the strongest available painkillers) and non-opioid drugs, additional painkillers (drugs that are mainly used in other diseases but can reduce pain in some special cases) can be used for this purpose. Physical therapy or surgery may be a treatment option for some patients. Pain pumps and pain batteries attached to the spine can be used to reduce pain when pain does not respond to current treatments or when side effects occur.
Patient and Family Education
Here are some important messages for the patient and family:
There is no benefit to living with pain.
Pain can be controlled mostly with some oral medications.
If these drugs are insufficient, different alternative treatments are available to reduce pain.
Morphine and morphine-like drugs are often used to relieve pain. If these drugs are used to reduce pain in cancer patients, they are rarely addictive.
Communication with doctors and nurses is very important.
Doctors and nurses wouldn’t know how much pain you have if you didn’t tell them.
Doctors and nurses want to know about the problems drugs can cause because there is always something that can be done for these problems.
Doctors and nurses want to know if there is a problem with the supply or use of medicines.
If your pain does not improve, ask your doctor to refer you to a pain specialist.
However, your doctor will give you important information about the drugs to be used for your pain management. However, it will be very helpful to have the following in writing in order not to make mistakes later on.
List of all prescribed drugs, which one is used for what purpose? When and how should it be taken?
Possible complications? What to do if it develops?
List of contraindicated drugs?
Control appointment time
List of telephone numbers that can be reached during weekdays, evening hours or weekends for your questions or possible problems:
Difficulty in taking medications
Change in the character of the pain, newly developing pain or the situation that the drugs do not reduce the pain
Nausea and vomiting that prevents you from feeding for more than 1 day
Stopping bowel movements for more than 3 days
Problems that can be experienced in waking the patient during the day or keeping him awake
What are the Side Effects of Pain Medicines and How Can They Be Taken Under Control?
Side effects that develop after opioid use can often be easily controlled. When they are first used, some patients may experience drowsiness and others may experience nausea. Vomiting does not happen very often. In most patients, these side effects disappear within 1-3 days. There are different anti-nausea medications that can be used today for nausea and vomiting that may develop. Opioids are started at low doses and dose adjusted to reduce drowsiness and drowsiness. The main purpose of adjusting the dose is to achieve maximum pain relief with the lowest side effects.
Opioids cause constipation to some extent in many patients. Constipation usually occurs a few days after the start of use and continues throughout the drug use. Constipation can sometimes be very painful and even require hospitalization, so its development should be prevented if possible. Constipation can be prevented by following the following ways:
Increasing fluid intake
Increasing the intake of fibrous products such as fruits and vegetables
Exercising with the knowledge and recommendation of your doctor or physiotherapist
Use of laxatives, bowel softeners as needed
Drug Tolerance
Some patients using opioids for pain may require higher doses over time. This may be due to increased pain or the development of drug tolerance. If tolerance develops, small increases in dose or a change in medication will usually help relieve pain. People sometimes mistake drug tolerance and addiction as the same thing. Both are very different from each other. Tolerance develops over time, showing that the body needs a higher dose of the drug to get the same effect. Increasing the drug dose is not a sign of dependency.
Stopping Opioids
Abrupt discontinuation of opioids sometimes causes symptoms such as a flu-like illness or diarrhoea. Therefore, it should be discontinued gradually. Your doctor will inform you about drug discontinuation.
