If given the opportunity, most newly diagnosed cancer patients would list pain at the top of the list of concerns they had about their future with cancer. More than half of all cancer patents experience moderate to severe pain during their cancer journey. Don't let this intensify your fear, because the majority of those people are able to acquire pain relief. Many patients are able to find that relief with medications initially prescribed by the oncologist, others have to go through trial periods on different medications, and still others do not find relief. If you believe you are in unmanageable pain, consider asking your oncologist for a referral to a pain management specialist or clinic.
Oral medications seem to be the accepted first-line treatments for cancer pain. A partial list of medications that are prescribed as primary or adjuvant treatments, and are used alone or in combination, include:
Analgesics (other than NSAIDSs) - (tylenol) used for mild pain.
Antiarrhythmics - (mexiletine) - reduces pain due to nerve damage, use cautiously.
Anticonvulsants - (gabapentin, valproate) used for neuropathic pain.
Antidepressants - (amitriptyline, desipramine, maprotiline, nortriptyline, paroxetine) used for neuropathic pain.
Antihypertensive - (clonidine) used for neuropathic pain.
Antispasmodics - (baclofen) used for spasticity and neuropathy.
Benzodiazepines - (alprazolam, diazepam, clonazepam) used for overall pain.
Bisphosphonates - (clodronate) may also be used intravenously, used for bone pain.
Cannabinoid - (dronabinol) capsule form of the drug used for pain relief, psychiatrict side effects.
Corticosteroids - (dexamethasone, prednisone) used for bone, visceral, and neuropathic pain.
Hydantoins - (phenytoin, dilantin) used for neuropathic pain.
NMDA receptor - (amantindine, dextromethorphan, ketamine) opioid enhancer.
NSAIDs - (aspirin, ibuprofen, indomethacin, ketoprofen, nabumetone, naproxen) used for mild to moderate pain.
Opioids - (codeine, hydrocodone, hydromorphone, levorphanol, meperidine, methadone, morphine, oxycodone, oxymorphone) - used for moderate to severe pain.
Psycho-stimulants - (dextroamphetamine, methylphenidate, modafinil) used as an opioid enhancer.
If you are prescribed cancer pain medications, you should read the literature given with the medication (or talk to the pharmacist) and be aware of any side effects, contraindications, or signs of over-dosage. Make sure that you take all medications as they are prescribed. If you believe you are having unacceptable side effects, or that the medicine is not working well; contact your physician or oncologist immediately.
Some pain medications are administered rectally, nasally, or absorbed through the skin if the patient is unable to tolerate oral medications. There are many medications that are administered intravenously or through injection, but this is normally done under clinic, hospital, or hospice care.
Alternative and complementary pain management treatments may include:
Acupuncture - releases natural opioids and reduces the perception of pain.
Cognitive - reduces stress and muscle tension, which in turn reduces pain and pain perception:
Herbs and Supplements - may be beneficial to the reduction of pain.
» chondroitin & glucosamine sulfate
» St. John's wort
» vitamin E
» white willow bark
Massage - reduces muscle stress and improves circulation.
Physical therapy and exercise - strengthens muscles, reduces swelling and improves circulation.
Treating the source of pain can include such methods as nerve blocks and nerve destruction. Palliative chemotherapy, radiation, and surgery may also help to reduce pain, by treating the source. Many medical and surgical procedures that are used to treat cancer may also be used to control pain. The patient's overall condition should always be considered when choosing these therapies.
If you would like to learn more about pain treatment for cancer, visit these websites:
American Academy of Pain Management - list of resource links.
American Board of Pain Medicine - list of physicians.
Cancer Pain Org. - state of the art information.
NCI - PDQ on pain management in cancer patients, both professional and patient information.
Stop Pain.org - Beth Israel hospital has put together an excellent site on pain.