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PAIN AND PAIN MANAGEMENT

Mesothelioma patients and their families many times fear physical pain as much as the disease itself. It is important to understand, however, that most cancer pain can be controlled. Nine out of ten cancer patients will find relief by using a combination of medications. No patient should have to deal with unmanaged pain.

Causes of Cancer Pain

Pain from the tumor. Most cancer pain occurs when a tumor presses on bone, nerves, or body organs, and may vary according to location, (i.e., a small tumor pressing on a nerve or vital organ may cause severe pain, while a larger tumor elsewhere may cause little discomfort.)
Pain from cancer treatment. Cancer treatments, including surgery, chemotherapy, and radiation may also cause pain. Painful conditions are more likely to occur in patients whose immune system has been suppressed as a result of these therapies.
Pain from other causes. Like everyone else, cancer patients have pain that has no relationship to their illness. Headaches, muscles strains, or other aches and pains associated with arthritis, kidney stones, etc., may cause pain, too. These conditions can normally be treated along with cancer pain.

Each patient's pain is unique, therefore, it is important that each individual have a treatment plan that addresses his/her individual needs. The patient and his/her doctor must work together to reduce unnecessary pain and improve quality of life.

Types of Pain

The three most common types of cancer pain are:

Acute pain. Defined as pain that comes on quickly and may be severe, but lasts a relatively short period of time.
Chronic pain. Defined as pain that may range from mild to severe and persists or progresses over a long period of time.
Breakthrough pain. Defined as pain that occurs in patients with chronic pain that is controlled by medications.

Pain Control

The type of medicine and the method by which the medicine is administered will depend on the type and cause of the pain. Following is an overview of the types of medicines used to relieve pain.

For Mild to Moderate Pain

Nonopioids: Many of these medications are available over-the-counter (without a prescription); others require a prescription. Some drugs included in this category are acetaminophen, aspirin, and ibuprofen. Check with your doctor before using these medications, especially if you are on chemotherapy.

For Moderate to Severe Pain

Opioids: Also known as narcotics, these may include morphine, fentanyl, hydromorphone, oxycodone, meperidine, codeine, and methadone. These drugs are available through prescription only. Nonopioids may be used in conjunction with opioids for moderate to severe pain.

For Breakthrough Pain

Rapid-onset Opioids: Available by prescription, this is a short-acting opioid (such as immediate-release oral morphine) which relieves pain quickly. It is used with a long-acting opioid for persistent pain.

Side Effects of Pain Medication

Most medications have some side effects, although they may affect different people in different ways and at different levels. Generally, most side effects will occur in the few first few hours of treatment and then will gradually disappear. If side effects persist, the doctor may choose to switch a patient's pain medication to make sure the patient gets maximum pain control with a minimum of side effects.

Cancer pain is most often treated with opioid medications. Some of the most common side effects of these drugs are:

Nausea and vomiting: Normally, these side effects occur a day or two after first taking a particular medicine. If you experience these side effects, be sure to tell your doctor so that something can be prescribed to help.
Sleepiness: When first taking opioids, some patients may feel drowsy or sleepy. For most patients, this side effect will disappear in a day or two.
Constipation: The best way to prevent constipation is to drink plenty of fluids such as water or juice, and to eat more fruits (uncooked, skin on) and vegetables as well as whole grain breads and cereals. Adding 1 to 2 tablespoons of unprocessed bran to your food may also help. Exercise to the extent you are able also prevents constipation. If you still have a problem, your doctor may prescribe a stool softener or laxative.

More serious side effects are rare, however, if you have trouble breathing, experience dizziness or a rash, call your doctor immediately.

Ways of Administering Pain Medication

Pain medications may be administered in a variety of ways. Following are the most common:

Oral. The medicine is taken by mouth in a pill, capsule, or liquid form.
Transdermal (Skin) Patch. A bandage-like patch is placed on the skin, continually releasing medicine through the skin over a 2-3 day period.
Injection. Injections may be administered in one of the following ways:
- Subcutaneous (SC) injection - medicine is placed just under the skin using a small needle.
- Intravenous (IV) injection - medicine is placed directly into a vein through a needle.
- Intrathecal and epidural injections - medicine is placed into the fluid around the spinal cord (intrathecal) or into the space around the spinal cord (epidural).
- Pump - the patient can help control the amount of pain medication taken. When pain relief is needed, a computerized pump connected to a tube in the patient's body is activated by the patient pushing a button. This allows a preset dose of pain medication to be delivered.

If one medication or delivery method does not work for you, there is almost always another one that can be tried. Speak frankly with your doctor about the pain medicine or method that works best for you. You may need a different pain medicine or combination of medicines if:

Your pain is not relieved.
Your pain medicine does not start working in the time specified by your doctor.
Your pain medicine does not work for the length of time specified by your doctor.
You have breakthrough pain.
You have undesirable side effects.
Your pain interferes with your normal activities.

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