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Understanding and Preventing Post Surgery Pain for Mesothelioma Patients: An Outline
I. PAIN AND ITS
EFFECTS
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Many cancer patients feel that
pain is a sign of weakness. They underestimate the importance of pain relief as part of
their treatment regimens and as part of their lives. |
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This attitude toward pain relief
is counterproductive and actually does compromise the quality of their cancer treatment.
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Pain management is an integral
part of the healing process. |
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Pain has physical, emotional and
psychological components. |
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If it goes untreated, pain can
destroy relationships with loved ones |
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Pain can destroy the will to live. |
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Pain can lead to the following: |
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- Depression
- Loss of appetite
- Irritability
- Withdrawal from social interaction
- Anger
- Loss of sleep
- Inability to cope
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A great
majority of cancer-related fatigue is caused by trying to stave away the pain. |
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Pain may be worsened by fear of
death, suffering, deformity, financial disability or isolation. |
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Cancer-related pain may be
relieved in 90 to 99% of cases. Of these cases, 85 to 95% may be treated through something
as simple and effective as oral administration of pain relievers. |
II. WHAT CAN BE
DONE
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Three types of pain: |
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- Somatic:
Results from a tumor pressing against a bone or an organ.
- Neuropathic: Results from a tumor
touching and adversely stimulating nerves throughout the body.
- Breakthrough: Temporary, moderate to severe
flare in pain that occurs even though you may be taking medications regularly.
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Managing the pain requires honesty
and communication. |
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Possible treaters include the
oncologist, a neurologist/neurosurgeon and an anesthesiologist, as well as nurses, or any
one of those combinations. |
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Keep a journal.
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The journal should contain: |
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- Instructions regarding which medications to take
- Instructions regarding dosage amounts
- Questions regarding instructions
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Devise an individualized pain
treatment regimen with your treating team. |
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Treat breakthrough pain
immediately. Do not wait for it to build up. |
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Do not let anyone rush your visits |
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Remember these five principles of
treating cancer-related pain: |
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By the mouth: Most medication can be
orally administered.
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By the clock: Take medication at
regularly scheduled intervals.
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By the ladder: Start with the least
medication needed first -- analgesics, NSAIDs and adjuvants, followed by weak narcotics
followed by stronger narcotics.
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For the individual: It is your treatment
regimen. Ensure that it works for you.
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Attention to detail: Make certain that
you and your treating team know everything you need to know about your pain management
therapy to ensure that you get the most benefit and endure no unwanted complications.
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III. TYPES OF
PAIN MEDICATION
There are several types of pain
medication available to patients with cancer-related pain.
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NSAIDs: Non
Steroidal anti-inflammatory medications. These counter low levels of pain. They have an
efficacy threshold; beyond a certain level of pain, they cannot work. They include: |
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- Acetaminophen
- Aspirin
- Ibuprofen and others.
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Opioids: They can be
oral (pill or liquid), patch, suppository, or injection. There are two types: |
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- Partial agonist: Stronger than an NSAID, but
also has an efficacy threshold.
Example: buprenorphine
- Full agonist: Does not have an efficacy
threshold. Generally prescribed in doses to be taken every four hours or increments of
four hours (ie: every 8 hours, every 12 hours). Additionally, these can be increased in
dosage safely.
Examples: morphine, hydromorphone, codeine,
oxycodone, hydrocodone, methadone, levorphanol, fentanyl.
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Adjuvants:
This refers to other medications such as steroids and antidepressants that assist in pain
relief. For example, antidepressants in this case, are used to relieve the burning and
tingling resulting from radiation and chemotherapy. |
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Relaxation/meditation and
distraction: These do not involve medication. The first consists of
breathing exercises and visualization. The second involves different activities to
distract the mind from the pain. Other methods include imagery, skin stimulation and
exercise. |
In certain cases, when all
other forms of medicinal administration have failed, a nerve block or nerve cordotomy or
other surgical procedure might be in order.
IV. ADMINISTRATION
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Pain medication is primarily
administered orally in the form of tablets or liquid. It is also delivered by the
following methods: |
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- Skin patch (transdermal)
- Suppository pill
- Patient controlled analgesia (PCA)
- Parenteral route:
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- Intramuscular (IM) injections
- Subcutaneously (under the skin or sub Q)
- Intravenously (IV)
- Intraspinally
- Intraventricularly
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A patient’s response to
various opioids taken orally (or whatever the first preferred administration method was)
be observed before switching method of administration. |
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Morphine usage leads to addiction. |
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Fact: Patients’
prescriptions are safely decreased as deemed necessary by their treating physicians.
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My body will develop a tolerance
to the medication; it will then lose its potency. |
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Fact: Dosage can be safely
increased to continue to manage pain.
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Morphine and other opioids will
induce respiratory failure. |
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Fact: The body adjusts to
the increase in morphine in the bloodstream, and respiration will continue unabated.
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Opioids are for patients declining
or near death. |
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Fact: Opioids are
prescribed for patients in pain to help them function and heal more effectively.
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ACTUAL
SIDE EFFECTS AND WARNINGS |
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Certain situations require
emergency assistance. They include: |
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- Failure of breakthrough pain remedies.
- Inability to get up or walk because of pain.
- Inability to sleep because of pain.
- Crying and getting upset about feeling pain.
- Unwillingness to move or muscles that are very tense when
moving.
- Patients’ ability to move or not is a very good
indicator of their actual pain, despite their claims of health.
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Drug reactions and overdosage are
not common. However, if they do occur, they must be reported immediately. Symptoms can
include: |
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- Disturbing hallucinations
- Ringing or buzzing in ears
- Severe trembling, uncontrolled muscle movements, seizures
- Numbness or tingling in lower legs or feet
- Unprecedented incontinence
- Constipation
- Uncontrollable nausea or vomiting
- Hives, rashes, swollen face
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Sources consulted for this article included the
following online reports: "The Pain Control Program" by Wendy Robbins, MD, and
Robert W. Allen, MD; "Pain Management" by Texas Cancer Online; "Finding and
Getting the Most from Cancer Pain Treatment" by Lycos Health with WebMd; and
"Cancer Pain" from a collaborative effort of the American College of
Physicians/American Society of Internal Medicine online.
| *** POSTED MAY 8, 2002 *** |
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PATIENT PROFILES
