by Charlene Thurston, RN, ANP, Director of Hospice, from the Fall 1993 Hospice Currents Newsletter
Most patients who are facing life-threatening illness are confronted with many different types of fears. Of these, one of the most common is fear of pain, especially for people with cancer.

Since cancer is such a prevalent disease, affecting 1 in 4 people in the U.S., we felt an article on cancer pain might be worthwhile. To begin, there are three points we’d like to make:

1. While many people with cancer do have pain, many other people with cancer do not.

2. For those people who do have pain, their pain can be well controlled in the great majority of cases.

3. Hospice is committed to keeping abreast of the most current guidelines for treatment of pain and to providing good pain control with the least amount of sedation. It is virtually impossible for patients to maintain an acceptable quality of life if they’re constantly suffering with pain.

In the past 15 to 20 years, research done in hospices and major cancer centers has dramatically improved the way in which we treat cancer pain. While pain is a complex symptom with many emotional, social and spiritual components as well as physical, and while there are many non-drug approaches that are very beneficial, we will focus on the medications used for physical pain in this article.

The World Health Organization has recommended clear guidelines for the treatment of cancer pain. Mild to moderate pain should be treated with drugs like aspirin, Tylenol, and anti-inflammatories such as Ibuprofen, Naprosyn, etc. The recommendation for moderate to severe pain is to add an appropriate narcotic, with morphine being the narcotic of choice in most cases.  The dose that is considered appropriate for the patient is whatever relieves the pain without causing undue drowsiness.

For some kinds of pain, e.g., bone pain or nerve pain, other drugs and/or procedures may need to be added to achieve good relief. Radiation is often very effective for bone pain, antidepressants and anticonvulsant drugs are often effective for nerve pain. Other procedures such as nerve blocks may be helpful as well. The continuous administration of medication by means of a small, portable pump which the patient wears around his/her waist has been an effective option for good pain relief. Above all, patients and health care professionals must become educated and comfortable using medications appropriately. Many of the fears we once had about the use of drugs have proven to be unfounded. Given for the appropriate symptoms and prescribed in appropriate dosages, over 90% of patients with cancer will have their pain well-controlled, usually with easy to take oral medications.

Funded by the Palliative & Supportive Care of Nantucket Foundation, the Palliative & Supportive Care Program is operated as a department of the Nantucket Cottage Hospital, which is an affiliate of Massachusetts General Hospital, and a member of Partners HealthCare. Palliative & Supportive Care of Nantucket is a specialized health care program dedicated to providing excellent physical, psychological, social, and spiritual care to persons with life-threatening illness and their families.

A Partnership in Caring

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