What is Pain Management

The ability to improve comfort and provide relief from pain and related symptoms that cancer and cancer treatment may cause.

Many people worry about the potential for their cancer to cause pain. However, the broad spectrum of available analgesic medications and other methods provide numerous options to manage, and often entirely relieve, pain due to cancer.

Causes of Pain in Cancer

Pain in cancer arises from either the cancer or from treatments for the cancer. Cancerous tumors can cause pain when they invade tissues and disrupt the nerves. Sometimes cancer can also invade nerve tissue, also causing pain. Damage to structures, such as may occur when cancer invades and destroys tissues and organs, causes the cells of those structures to release numerous cytokines (biochemicals that activate various components of the immune response).

Among these cytokines are substances that stimulate nociceptors, specialized molecules in peripheral neurons that send pain signals to the central nervous system. Radiation therapy is often effective for pain relief in such situations, as it can shrink the tumor so it no longer pressures nerves and other structures. Sometimes surgery to remove part of the tumor also provides relief.

Surgery for cancer is most often the cause of treatment-related pain. Sometimes surgery for cancer is extensive, and the recovery period can be lengthy and challenging.

Most people are eager to recuperate and return to their normal activities as quickly as possible.

They may feel taking analgesic medications prolongs their recovery or may fear that taking narcotic medications, the strongest pain relievers, will result in addiction. Neither is true.

It may be necessary to take analgesic medications regularly and for an extended time after major cancer surgery to effectively manage the pain. This is important because adequate pain relief not only provides comfort but also allows the body to heal. Protracted pain is emotionally and physically stressful in ways that interfere with healing and quality of life.

Analgesic Medications for Pain Relief

Over-the-counter analgesic medications such as nonsteroidal anti-inflammatory drugs (nsaids) and acetaminophen often provide relief from mild to moderate discomfort and pain. Prescription NSAIDs and narcotic medications may be necessary for moderate to significant pain.

Dependence and addiction are very seldom concerns in people who are taking narcotic pain relievers for such levels of pain. As well, there is little risk for overdose, another major concern.

Though there is a ceiling effect with NSAIDs (a point beyond which increasing the dose does not provide any greater pain relief), this is not the case with opioid analgesics. The body seems able to accommodate the effects narcotics have on the respiratory cycle when the narcotics are necessary to relieve high levels of pain.

However, opioid pain relievers do impair judgment and thought processes enough to make activities such as driving hazardous and ill-advised.

Palliative Treatments for Pain Relief

Radiation therapy and surgery are often options for palliative treatment for pain resulting from cancer. These treatments reduce the size of tumors, relieving their pressure on surrounding tissues. The relief may extend months to years, depending on the cancer. There is no discomfort associated with palliative radiation therapy. Palliative surgery does entail recovery from the surgery, though this typically follows a predictable and fairly rapid course after which relief from the cancer pain is often pronounced or complete.

Other Methods of Pain Management

Other methods that may help a person cope with pain include acupuncture, biofeedback, hypnosis, yoga, and meditation. These methods incorporate mind-body interactions that provide physical, mental, and emotional changes to lessen the effects of pain. Acupuncture is also effective for relieving nausea and other discomforts associated with chemotherapy. These methods may be alternatives to medication that allow management of pain and return to normal activities.

See also CHRONIC PAIN; NEURON; TERMINAL PAIN.

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