What you should know

A person with cancer does not have to suffer from unrelieved cancer pain. As a caregiver of someone with cancer, you should be aware that pain-relieving therapies are available. In almost all cases, cancer pain can be adequately managed with drug and non-drug therapies.

Cancer pain needs to be taken seriously. If left untreated, cancer pain can affect every aspect of life--the ability to work, to interact with other people, to rest, and to heal. If a person's pain is ignored or not taken seriously, that person may feel like no one understands what he or she is going through, which can cause feelings of isolation, frustration, anxiety, stress, and depression. Studies have shown that patients with cancer pain are also less able to commit to fighting their disease
(Cleeland C, JAMA 1998;279:1914-15).

Cancer pain can be treated
Cancer pain is usually treated with analgesic medications. There are also complementary (non-drug) methods, such as massage, acupuncture, biofeedback, hypnosis, that can be used along with the pain medications to obtain additional relief. Sometimes surgery, radiation therapy, or other treatments are used to shrink the tumor if it is pushing on organs, bone, or nerves and causing pain.

Pain relief is most effective when medications are taken on a fixed schedule throughout the day, for example every 8 or 12 hours, to achieve "around-the-clock" pain control with an additional, supplemental dose available as needed for "breakthrough pain". Unfortunately, some people will try to take the medication only when they need it, waiting until they are in pain before seeking relief. Don't let them wait until the pain comes back: it is more difficult to regain control of pain than to maintain pain relief.

Getting the right pain medication
It's important to know that there are different types of cancer pain and different types of medication used to treat cancer pain. Often more than one medication is necessary to effectively manage cancer pain. For example, many people with chronic cancer pain also experience intermittent flares of severe pain called breakthrough cancer pain. These flares of pain are normal and can occur even though a person is taking analgesic medications on a fixed schedule for pain control. (It's called breakthrough pain because the pain "breaks through" the regular pain medication schedule.) Like other cancer pain, breakthrough pain can severely impact a person's quality of life. Thus, breakthrough cancer pain needs to be treated with the appropriate medications. Instead of being taken on a fixed schedule, breakthrough pain medications are taken as needed (i.e., when the pain occurs). These medications are often referred to as supplemental or "rescue" medications.

Managing cancer pain is not a "one-shot" deal. It may take several tries to get the right combination of medications. And some medications take time to before they begin working. Also a person's level of pain may change over time and over the course of the illness, necessitating a change in medication or the frequency of medication. Good pain relief should not leave the patient feeling overmedicated. If the medication stops the pain but leaves the person "in a fog" or unable to get out of bed, then the medication should be changed or the dosage adjusted. If your loved one is not experiencing adequate pain relief or is feeling overmedicated, you should contact his or her doctor or nurse to discuss adjusting the dose or trying another type of medication.

Barriers to cancer pain management
Several barriers often stand in the way of good pain management. Some physicians have not received adequate training in pain management or they may be more focused on the control the disease rather than control of the pain ( Von Roenn JH, et al., Ann Intern Med 1993;119 121-6). Another barrier is that pain may be underreported by the patient or there may be language or cultural differences. For example, studies have shown that elderly and minority patients with cancer are less likely than other groups to receive optimum pain relief. The severity of their pain is more likely to be underestimated by their doctors ( Barnabei R, JAMA;279:1877-82; Cleeland CS, et al., Ann Intern Med 1997;127:813-16). If you think that barriers such as these may be influencing the expression or treatment of pain in the person you're caring for, initiate a discussion about pain with the patient and his or her physician. If the patient is not getting adequate pain relief, you may want to request a consultation with a pain management specialist.