Modern Technology has allowed us to put man on the moon. However we have not been able to reduce the pain and suffering cancer patients live with on a daily basis. Here is a look at the many methods of pain relief which are available to a cancer patient.
Pain is the most common reason for which patients seek help from doctors, nurses and medicine men. In 1995 a study by the Robert Woods Johnson Foundation concluded that 42 % of cancer patients received inadequate pain relief. The number one reason for inadequate pain control was “fear of addiction”. These fears were expressed by both the physicians and family members. It was also found that the physicians were not aware of the latest research and techniques which were available for cancer patients. The AMA and other professional bodies are now attempting to change “physician knowledge” and “philosophy” with reference to pain management for cancer patients. It is essential that physicians realize the goal with cancer patients is not cure but pain management. That study also found that many physicians made attempts to restore cancer patients to their productive life. Sharing the goal of pain management with the family and patient can be helpful in keeping the patient pain free in the terminal stages of life. Appropriate intervention will reduce pain and suffering. Further, it will prolong quality of life.
The physiology and biochemistry of pain is much better understood now than it was in the good old days. New drugs and new approaches are being developed continuously. For example hypnotherapy and very small doses of versed can be used effectively in the management of cancer pain. However pharmacological methods remain the cornerstone of management. In this article the author will discuss ten essential steps in the proper management of cancer pain.
Be Proactive
Anticipate pain before the patient complains of it. Modern methods of pain management include regular pain medications. Short acting and long acting medications are available. Supplemental PRN doses can be given for breakthrough pain. A larger dose of a pain is required to bring it under control than to keep a pain under control.
Pancreatic cancer pain: Pain for this condition can be greatly reduced or terminated by intra-operative splanchnicectomy. A similar objective could be achieved by celiac plexus obliteration. Patients who have this procedure suffer from minimal pain and have a good mood. Their survival times are longer too!
Knowledge is Power
When a patient has cancer he is most likely to have neuropathic pain. This pain is often described as, “the shooting, lightening-like, stabbing pain”. It is usually made worse by movement. Neuropathic pain is not usually responsive to narcotics. Multidisciplinary approaches should be used in the management of this type of pain. In terms of classification, this type of pain falls under the chronic pain category. Managing chronic pain is much more difficult than managing acute pain because narcotics are generally not useful. Anticonvulsants are used extensively; these include Dilantin, Tegretol, and Valproic acid. Gabapentin (Neurontin) is now considered the best choice for neuropathic pain.
Gabapentin (Neurontin) was thought to be a GABA agonist. New studies have shown that Gabapentin is not a GABA agonist as per the originally classification. It's exact biochemical pathway is not clearly understood. On the other hand Baclofen is a true GABA agonist and is considered useful for the management of neuropathic pain.
Always be aware that when a patient is on two or more drugs then the drugs will influence the overall effectiveness of each of those drugs. The following actions are common:
Synergism
Synergism is said to occur when the joint action of drugs is greater that the combined total. So, when synergistic drugs are give to the patient at the same time their combined effects are greater than the sum of their independent effects.
Synergestic action: 1 + 1 = 2.5 Synerism can be both beneficial and harmful. It all depends upon the synergetic reaction. Beneficial effects may be obtained when two potentially toxic drugs are used to achieve the desired therapeutic effect without causing harm to the patient. Harmful effects occur, for example, when alcohol and some depressants are combined by the patient.
Additive (Sum) Action
1 + 1 = 2. This is an example of an additive drug interaction. The combined effects are equal to the sum of the two independent effects of the medications.
Antagonism
Antagonism is the cancelling effect of one drug upon another. A sedative administered with a stimulant may antagonize or cancel the effects of the stimulant. Of course, the degree of antagonism varies from complete cancellation of the effect to varying degrees of reduced effectiveness.
Paradoxical Reactions
In some patients prescribed medications may have the opposite reaction to one that is desired. Nitrazepam which is a sleeping medication sometimes causes the patient to become “wide awake and restless”. Antiepileptic drugs (AEDs) may aggravate preexisting seizures and trigger new seizure types. Doctors and nurses must always be alert to such reactions.
Mind Control
Management of the mind is a major step in managing pain. Patients suffering from depression suffer from more pain. Prevention of depression is therefore the first step in controlling pain. Neuropathic pain is difficult to manage at the best of times. When the patient is depressed he is going to experience more pain. Tricyclic Antidepressants and selective serotonin reuptake inhibitors (SSRIs) should be used to prevent depression.
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