Progress Treating Cancer Pain
Cancer pain is not inevitable, and not all cancer patients experience pain. Yet when pain does occur, it can often be treated successfully with nonprescription or prescription pain relievers, or even complementary approaches such as relaxation techniques and herbal supplements.
Far too often, however, cancer pain is not adequately treated. And the result can generate side effects of its own: headaches, weakness, sleeplessness, loss of appetite, anxiety, and even depression.
Sometimes pain can be associated with the actual treatment for the cancer, such as pain or discomfort after surgery, or a skin rash from radiation. This type of pain usually disappears after the treatment ends, and medications are available to alleviate it during the course of treatment.
At other times, the pain can be associated with the cancer itself. This can arise from a tumor causing pressure on organs, nerves or bone, or a cancer-related blockage of an organ or blood vessel. When cancer metastasizes (spreads) to other organs or bones, it can cause direct pain in those sites as well.
It is not always possible to identify or treat a single source of the pain. In such cases, there are a number of pain-relief options available. These include nonprescription pain relievers (aspirin, acetaminophen, ibuprofen); prescription pain relievers (codeine, methadone and morphine); and non-medicinal pain treatments (relaxation techniques, herbal supplements, visualization/imagery).
In a study published in the Journal of Pain and Symptom Management, fentanyl citrate, given as a nasal spray, was found to reduce breakthrough pain in some cancer patients. Dr. Giovambattista Zeppetella of St. Joseph's Hospice in London compared the effectiveness of intranasal fentanyl citrate (INFC) with morphine and found that it provided an effective alternative to morphine for immediate, temporary pain relief.
"The rapid onset and short duration of INFC make this preparation more appropriate than short-acting morphine," Zeppetella concluded. He said it is also easy to administer by patients themselves, without the need to call a healthcare professional for assistance.
Another study, also published in the Journal of Pain and Symptom Management, focused on how to accurately assess a cancer patient's level of pain. This is important because doctors are now beginning to consider pain as a 5th vital sign, in addition to blood pressure, pulse, respiratory rate, and temperature.
Dr. Frits van Dam of Antoni van Leeuwenhoek Hospital in Amsterdam and colleagues have developed a Pain Monitoring Program that combines nurse education with a standardized daily pain rating scale. They contend that their system will greatly improve the daily monitoring of pain levels in cancer patients.
van Dam noted that only 30 percent of the control patients in their study could recall a nurse or physician talking with them about their pain. In addition, fewer than half of the nurses in the control group correctly assessed their patients' pain levels.
However, after implementing the Pain Monitoring Program, more than two-thirds of the nurses were able to accurately assess cancer pain levels in their patients. But the program did not appear to have a significant impact on improving communications about pain between patients and their healthcare providers, particularly when low levels of pain were being experienced.
Finally, an intriguing survey commissioned by a group called Partners Against Pain found that more than three-quarters (78 percent) of patients in chronic pain are so dissatisfied with their prescription and over-the-counter (OTC) pain medications that they are ready and willing to try new treatments.
In its national survey of more than 1,000 people, the group found that two-thirds of pain patients rate their OTC medication as not completely effective. In addition, of those who rely on prescription drugs, more than half (52 percent) said their therapies were similarly not effective.
Many surveyed patients reported suffering from pain for years, with 62 percent experiencing pain for at least 5 years. Even for those patients who say their pain is under control, it often has taken a long time to get relief. Some 43 percent of patients suffered for a year or more before they felt their pain was under control; for 21 percent it took 5 years or longer.
SOURCES:
National Cancer Institute (http://www.nci.nih.gov)
Journal of Pain and Symptom Management, December 2000; 20:424-439
Journal of Pain and Symptom Management, October 2000; 20:246-252
Journal of Pain and Symptom Management, October 2000; 20:253-258
Partners Against Pain, an educational program sponsored by Purdue Pharma
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