Treatments for Pain

Introduction
Many cancer patients may think that pain is just a normal part of cancer/cancer treatment. They may expect pain to accompany treatment and simply "deal with it" when it arrives. Pain does not have to be an unavoidable byproduct of cancer. There are many ways to treat cancer related pain and it can almost always be relieved. You have a right to pain relief and you should inform your doctor if you experience any discomfort. ⁽¹⁾ If your primary doctor cannot find an appropriate plan to relieve your pain, you should seek a pain specialist. Pain is associated with tissue damage and is easiest to relieve when it is treated as early as possible. In 90% of cancer patients, pain can be controlled; unfortunately pain is often not adequately treated. ⁽²⁾ Getting help for pain is not a sign of weakness. So be sure to tell your doctor if you feel any pain or discomfort. ⁽³⁾

Importance
Pain is associated with a higher level of anxiety in patients undergoing cancer treatment. ⁽⁴⁾ Unmanaged pain is also a major risk factor for depression and suicide in cancer patients. ^{(5) (6) (7)}

Treatment
Treating pain makes life more enjoyable for the patient and makes completing the prescribed treatment easier. Some patients may be worried about a risk of addiction to pain medication but in actuality, only a small portion of patients become addicted to even the strongest pain killers (opioids/narcotics). ⁽³⁾ Nausea, sleepiness and constipation are the most common side effects that are associated with opioids. The side effects generally go away within a few days after starting treatment.

It may also be helpful for the patient to keep a diary or record of pain so the health care provider can effectively treat the pain. Generally, the goal of a successful pain management system is to decrease discomfort while increasing thinking ability, emotional well-being, and interaction with friends and family. ⁽³⁾

The treatments for pain described here are far from a full listing but include examples of drugs that work in a variety of ways.  There are many different brands of these drugs and all brands may not be listed here for any particular drug.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• Aspirin
• Ibuprofen

COX2 Inhibitors
These drugs work by inhibiting the cyclooxygenase-2 enzyme.

• Celecoxib (Celebrex®)

Opiates and derivatives
Opiates are a group of drugs containing derivatives of opium, the dried juice of a poppy seed pods. Opiates are primarily used as strong analgesics (pain relievers). Opiates also may reduce anxiety and cause drowsiness, euphoria or feelings of relaxation.

• Codeine
• Fentanyl
• Hydrocodone
• Hydromorphone
• Meperidine
• Methadone
• Morphine
• Oxycodone

Other pain medications

• Acetaminophen

1. Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right. Anesth Analg. 2007 105(1):205-21 [PUBMED]
2. Weiss SC, Emanuel LL, Fairclough DL, et al.: Understanding the experience of pain in terminally ill patients. Lancet 357 (9265): 1311-5, 2001 [PUBMED]
3. The National Cancer Institute. Pain. U.S. National Institutes of Health. Accessed Aug. 8, 2007. [http://www.cancer.gov/cancertopics/pdq/supportivecare/pain/]
4. Stark D, Kiely M, Smith A, et al. Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol (2002) 20(14): 3137-48 [PUBMED]
5. Patrick DL, Ferketich SL, Frame PS, et al.: National Institutes of Health State-of-the-Science Conference Statement: Symptom Management in Cancer: Pain, Depression, and Fatigue, J Natl Cancer Inst. (2003) 95(15): 1110-7 [PUBMED]
6. Ciaramella A, Poli P: Assessment of depression among cancer patients: the role of pain, cancer type and treatment. Psychooncology (2001) 10 (2): 156-65 [PUBMED]
7. Breitbart W, Chochinov HM, Passik SD. Psychiatric symptoms in palliative medicine. In: Doyle D, Hanks G, Cherny N, Calman K (eds). The Oxford textbook of palliative medicine, 3rd edn. Oxford: Oxford University Press, 2004:74671.