American Cancer Society's Guide to Pain Control: Understanding and Managing Cancer Pain

By American Cancer Society and Betty Ferrell

Effective pain management enables people with cancer to live the lives they want to leadto eat, sleep, spend time with loved ones, work, pursue hobbiesand this helpful guide explains the many pain-relief options available, including medicines and other methods. Readers will discover how to achieve acceptable pain control and how to understand the optimal balance between pain relief and the potential side effects of pain medications. The book addresses step-by-step ways to describe pain and communicate pain-relief needs; common barriers to pain relief and how to overcome them; and practical tips and strategies for coping with side effects of pain medication.

• Language: English
• Publisher: American Cancer Society, Inc.
• Release date: Apr 1, 2012
• ISBN: 9781604431100

Book preview

Books published by the American Cancer Society

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Because Someone I Love Has Cancer: Kids’ Activity Book

Cancer in the Family: Helping Children Cope with a Parent’s Illness, Heiney et al.

Cancer: What Causes It, What Doesn’t

Caregiving: A Step-By-Step Resource for Caring for the Person with Cancer at Home, Revised Edition, Houts and Bucher

Coming to Terms with Cancer: A Glossary of Cancer-Related Terms, Laughlin

Couples Confronting Cancer: Keeping Your Relationship Strong, Fincannon and Bruss

Crossing Divides: A Couple’s Story of Cancer, Hope, and Hiking Montana’s Continental Divide, Bischke

Eating Well, Staying Well During and After Cancer, Bloch et al.

Good for You! Reducing Your Risk of Developing Cancer

Healthy Me: A Read-along Coloring & Activity Book, Hawthorne (illustrated by Blyth)

Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery, Second Edition, Eyre, Lange, and Morris

Kicking Butts: Your Path to Quitting Smoking

Our Mom Has Cancer, Ackermann and Ackermann

Also by the American Cancer Society

American Cancer Society’s Healthy Eating Cookbook: A celebration of food, friends, and healthy living, Second Edition

Celebrate! Healthy Entertaining for Any Occasion

Kids’ First Cookbook: Delicious-Nutritious Treats to Make Yourself!

Published by

American Cancer Society

Health Promotions

1599 Clifton Road NE

Atlanta, Georgia 30329, USA

© 2004 American Cancer Society

All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the prior written permission of the publisher.

Printed in the United States of America

Cover designed by Jill Dible

5 4 3 2 1 04 05 06 07 08

Library of Congress Cataloging-in-Publication Data

American Cancer Society’s guide to pain control : understanding and managing cancer pain.— Rev. ed.

p. cm.

Previous ed. has subtitle: Powerful methods to overcome cancer pain.

Includes bibliographical references and index.

ISBN 0-944235-52-2 (pbk. : alk. paper)

1. Cancer pain. 2. cancer pain—Treatment. I. Title: Guide to pain control. II. American Cancer Society.

RC262.A645 2004

616’.0472—dc22

2003025526

Brief Contents

CHAPTER 1

Understanding Cancer Pain

CHAPTER 2

Coping with the Emotional and Social Impact of Cancer Pain

CHAPTER 3

Achieving Effective Pain Control

CHAPTER 4

Describing and Measuring Your Pain

CHAPTER 5

Pain Relief through Medication

CHAPTER 6

Other Medical Approaches to Pain Management

CHAPTER 7

Complementary Nondrug Treatments

CHAPTER 8

Managing Side Effects of Opioids

CHAPTER 9

Cancer Pain in Specific Groups

EDITOR

Amy Brittain

MANAGING EDITOR

Gianna Marsella, MA

BOOK PUBLISHING MANAGER

Candace Magee

DIRECTOR,PUBLISHING

Diane Scott-Lichter,MA

DIRECT CHANNELS

ANAGING DIRECTOR

Chuck Westbrook

EDITORIAL REVIEW

Terri Ades, MS, APRN-BC, AOCN

Director of Cancer Information

American Cancer Society

Atlanta, Georgia

Betty R. Ferrell, PhD, FAAN

Research Scientist

City of Hope National Medical Center

Duarte, California

A Note to the Reader

The information contained in this book is not intended as medical advice and should not be relied upon as a substitute for talking with your doctor. This information may not address all possible actions, precautions, side effects, or interactions. All matters regarding your health require the supervision of a medical doctor who is familiar with your medical needs. For more information, contact your American Cancer Society at 800-ACS-2345 or http://www.cancer.org.

Contents

Foreword by Betty R. Ferrell, PhD, FAAN

Advances in Understanding Pain

Partnering to Manage Paini

The Role of this Book in Pain Control

Everyone Has a Right to Pain Relief

Introduction

The Impact of Cancer Pain

Cancer Pain Is Undertreated

Methods of Pain Control

What You Can Do

How to Use This Book

About the American Cancer Society

Acknowledgments

CHAPTER 1

Understanding Cancer Pain

What Is Cancer?

What Is Pain?

Types of Pain

Acute Pain

Chronic Pain

Breakthrough Pain

Nociceptive Pain

Neuropathic Pain

Factors that Influence Pain

Causes of Pain

Diagnostic Procedures

Cancer Treatment

Tumor-Related Pain

Pain Due to Other Causes

Help is on the Way

CHAPTER 2

Coping with the Emotional and Social Impact of Cancer Pain

Pain’s Impact on Quality of Life

Measuring Quality of Life

Common Feelings about Cancer and Cancer Pain

Factors that Affect Feelings about Pain

Individual Reactions to Pain

Pain and Depression

Pain and Anxiety

The Impact of Pain on Relationships

Support from Friends and Family

Asking for Help

When to Seek Counseling

Finding Support

Support Groups

Individual Therapy

Family Therapy

Choosing a Counselor

Why Do Some People Need Help and Others Don’t?

Will Insurance Pay for Counseling and Therapy Services?

CHAPTER 3

Achieving Effective Pain Control

Myths and Misconceptions about Cancer Pain

Myth 1: People Become Addicted to Pain Medications

Myth 2: Taking Too Much Pain Medication Will over Time Decrease Its Effectiveness

Myth 3: Pain Is a Normal Part of Having Cancer

Myth 4: Pain Means that the Cancer Is Growing

Myth 5: Pain Can’t Be Treated

Myth 6: Doctors Don’t Understand Pain

Myth 7: Good Patients Don’t Complain

Myth 8: Focusing on the Pain May Be a Distraction from Treating the Cance

Myth 9: People Should Be Able to Tough it Out

Myth 10: Pain Medications Cause Unpleasant Side Effects

The Importance of Communication

Communicating with Your Health Care Team

Communicating with Caregivers

Barriers to Communication

Language Barriers

Cultural Background

Pain Is Subjective

Limited Knowledge and Time

When to Seek Additional Help

CHAPTER 4

Describing and Measuring Your Pain

The Language of Pain

Talking about Your Pain

Talking with Family Members and Caregivers about Pain

Talking with Your Health Care Team about Pain

How Pain Is Measured

The Initial Pain Assessment

Preparing for a Pain Assessment

When the Person with Cancer Is Unable to Discuss Pain

Tools for Rating Your Pain

Numeric Scales

Word Scales

The Faces Scale

Color Scales

The Brief Pain Inventory

What to Do after the Initial Pain Assessment

Your Pain Treatment Plan

Communicating about Pain and Pain Relief

The Pain Log

Assessment for Recurrence of Pain

CHAPTER 5

Pain Relief through Medication

Determining Pain Medication(s) Appropriate for You

Types of Medications Used to Control Cancer Pain

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Acetaminophen

Opioids

Other Types of Pain Medications

Adjuvant Medicines

Methods Used for Drug Delivery

Oral

Transmucosal

Sublingual

Transdermal (Skin Patch)

Rectal Suppositories

Injections

Patient-Controlled Analgesia (PCA)

Managing Your Drug Therapy Program

Controlling Breakthrough Pain

Tolerance, Dependence, and Addiction

Drug Tolerance

Drug Dependence

Psychological Dependence and Addiction

Changing Your Pain Medicine or Drug Therapy Plan

Pain Records, Charts, and Logs

What to Include in a Pain Record

CHAPTER 6

Other Medical Approaches to Pain Management

Palliative Therapy for Pain Control

Palliative Radiation Therapy

Palliative Chemotherapy

Hormonal Therapy

Bisphosphonate Therapy

Palliative Surgery

Nerve Blocks

Temporary Nerve Blocks

Permanent Nerve Blocks

Side Effects of Nerve Blocks

Location of Nerve Blocks

Spinal Opioid Infusion

Neurosurgery

CHAPTER 7

Complementary Nondrug Treatments

What Are Complementary Nondrug Treatments?

How Complementary Nondrug Treatments Can Help Control Pain

Access to Complementary Nondrug Treatments

Complementary Nondrug Methods

Acupuncture

Biofeedback

Distraction

Exercise

Humor Therapy

Hypnosis

Imagery and Visualization

Meditation

Music Therapy

Psychotherapy/Counseling

Relaxation

Skin Stimulation

Spirituality and Prayer

Transcutaneous Electrical Nerve Stimulation (TENS)

Yoga

CHAPTER 8

Managing Side Effects of Opioids

Opioid Analgesic Side Effects

Digestive Tract Side Effects

Central Nervous System Side Effects

CHAPTER 9

Cancer Pain in Specific Groups

Children and Cancer Pain

Sources of Cancer-Related Pain among Children

Pain Assessment in Children

Managing Cancer Pain in Children

Cancer Pain in the Elderly Person

Pain Assessment in Elderly Patients

Managing Cancer Pain in the Elderly Person

Emotional and Psychological Issues Related to Pain in the Elderly

Treatment Issues for People with a History of Substance Abuse

Culturally Diverse Groups

Impact on Care

Treating Pain in the Person with Advanced Disease

Pain Relief at the End of Life

Treating Severe Pain in Advanced Stages of Cancer

Hospice Care

Palliative Sedation

Conclusion

APPENDIX A

Cancer Pain Drug Information

Nonopioids

Opioids

Adjuvant Analgesics

APPENDIX B

Guidelines for Pain Management

Joint Commission on the Accreditation of Healthcare Organizations

American Pain Society

National Comprehensive Cancer Network

Cancer Pain Treatment Guidelines for Patients

Resources

Glossary

Index

Foreword

by Betty R. Ferrell, PhD, FAAN, Research Scientist City of Hope National Medical Center, Duarte, California

PAIN HAS THE POTENTIAL TO NEGATIVELY AFFECT physical, psychological, social, sexual, and spiritual well-being, as well as upset family members and caregivers. Providing all available pain-relief methods to people with cancer is not only essential for preserving quality of life, it is critical to successful cancer treatment. Patients are better able to tolerate cancer treatment when their pain is alleviated.

The American Cancer Society is dedicated to diminishing suffering from cancer and has focused major efforts—including the publication of the first and revised editions of this book—toward addressing the critical issue of pain management and enhancing quality of life for people facing cancer.

Advances in Understanding Pain

Major advances in cancer prevention, early detection, diagnosis, and treatment have been mirrored by major advances in the understanding and treatment of cancer pain. In 1994, the federal government issued guidelines for the treatment of cancer pain. These initial guidelines, published by the Agency for Health Care Policy and Research, have been reinforced and elaborated upon through major documents from the National Cancer Institute, professional organizations, and consumer groups. All of these groups have consistently agreed that pain negatively affects quality of life—and that, unfortunately, pain is often undertreated.

Partnering to Manage Pain

The successful management of pain requires a partnership between patients and health care professionals. People with cancer and caregivers who are informed about cancer pain will better understand the importance of expressing pain, overcoming fears of addiction and tolerance, exploring appropriate nondrug methods of pain relief, and expecting that all means available are used to provide optimal pain relief. Cancer care professionals can help improve quality of life for people in pain by understanding how to overcome social and cultural barriers, balance side effects of pain-control methods, and assess and treat pain.

The Role of this Book in Pain Control

The American Cancer Society’s Guide to Pain Control was first published in 2001 to inform patients and their families about cancer pain, how to manage it, and how to obtain the best pain-control care possible. The revised edition of this comprehensive resource for patients, families, and health care professionals reflects updated developments in pain control, with an increased focus on practical information for people with cancer. It is essential reading for people with cancer and their family members. This book explains how to take control of cancer pain and how to obtain emotional and social support, and emphasizes that pain can usually be alleviated.

Everyone Has a Right to Pain Relief

Research and advances in clinical practice in the last decade have provided strong evidence that cancer pain is not a necessary part of having cancer, and the majority of people with cancer should expect to experience relief from cancer pain. More and more people are living with cancer, and this population must be able to participate in work, family, and enjoyable activities without being hindered or debilitated by pain. Quality of life must also be preserved for special populations, such as infants and children, the elderly, patients with a history of substance abuse, patients from diverse cultures, and those who are critically ill.

Continuous efforts are being made in the oncology field to better inform health care professionals about the importance of preventing, assessing, and managing pain. Health care professionals should not only strive to prevent pain before it occurs, but continue to learn more about the origins of pain and shape state-of-the-art treatments to treat it. The cooperation between patients and medical professionals is as critical as ever; pain relief can only be achieved through the effective description and assessment of pain.

As our knowledge about cancer pain and how to manage it grow, so do the range of powerful pain-prevention and pain-relief resources at our disposal, including medications, nondrug methods, and complementary therapies. All people with cancer should expect high-quality treatment and care, including a personally tailored pain-relief plan. Pain relief is a basic right and is the foundation for coping with a diagnosis of cancer. Effective pain relief enables patients to focus their energies on fighting cancer and regaining control of their lives.

Introduction

ALTHOUGH PAIN IS ONE OF THE MOST FEARED complications of cancer, many people with cancer do not experience cancer-related pain. In most cases pain can be reduced so a person with cancer can continue most daily activities. Approximately nine out of ten people who have cancer-related pain can get effective pain relief.

Today, many different kinds of medicines and other methods can help relieve pain. With effective pain management, people with cancer pain are free to sleep and eat, enjoy the company of family and friends, and continue with work, hobbies, and other pleasurable activities.

The Impact of Cancer Pain

In general, about two out of every three people with cancer experience pain sometime during their cancer experience. Although cancer pain is often thought of as a crisis that emerges in advanced stages of disease, it may occur at any stage and may be caused by many factors—cancer itself, treatments, or factors unrelated to cancer.

Pain can have a significant impact on both physical and emotional aspects of life. It can cause suffering and reduce physical and social activity, appetite, and sleep. It can weaken the body and make it difficult to follow through with scheduled treatments. Uncontrolled pain negatively affects quality of life, preventing people from working productively, enjoying recreation, or taking pleasure in their usual roles in the family and society.

The psychological effects of cancer pain can also be devastating. An inability to meet financial, employment, and interpersonal demands can create a heavy burden. People with cancer may lose hope when pain occurs because they think pain signals the progression of disease. Chronic, severe, or unrelieved pain can lead to depression, and depression or anxiety can lower a person’s tolerance for pain and make the pain feel even worse.

Cancer Pain Is Undertreated

The inadequate treatment of cancer pain causes needless suffering. Although a variety of treatment methods exist to relieve cancer pain, research shows that it is still undertreated.

Even though treatments exist that can significantly reduce cancer pain and improve the quality of life of patients and their families, enormous barriers persist that can prevent these treatments from being adequately and appropriately applied. Patients’ and health professionals’ lack of knowledge about the appropriate use of treatments is a major barrier. Myths and misconceptions about pain, addiction, and tolerance may make patients reluctant to ask for or use pain medication and may make health professionals reluctant to prescribe pain medications. Health care professionals often lack knowledge about how to assess pain (that is, understand if the patient is having pain, and if so, how much pain, what type of pain, and its location or cause) and adequately treat pain. Fear of disciplinary action by licensing boards and criminal prosecution by drug enforcement agencies also hinders professionals from prescribing appropriate medicines and/or doses to relieve pain.

Pain control is still considered a secondary issue rather than a central element of appropriate cancer care. Until recently, hospitals and health care systems did not have practice standards for pain control (see Appendix B on page 201 for more information about guidelines for pain management). Health insurance companies do not adequately reimburse for pain medications, and this restricts patients’ access to needed pain control. Further, because of societal and cultural barriers, patients often do not feel comfortable raising concerns about cancer pain. These barriers also inhibit doctors and nurses from appropriately and adequately prescribing pain medications and deter patients from using them.

Methods of Pain Control

Cancer pain can be treated in a variety of ways. One of the most effective methods of pain control is the use of medicines, or drug therapy. Nondrug therapies may also help manage pain, including applying heat or cold, massage, transcutaneous electrical nerve stimulation (TENS), exercise, immobilization (e.g., bracing a joint), nerve blocks and nervous system surgery, and acupuncture.

Pain relief can also be achieved by reducing a person’s reaction to pain. People can learn skills such as relaxation, imagery, meditation, distraction, biofeedback, hypnosis, and other techniques to increase their ability to cope with pain and remain as active as possible. These complementary nondrug methods can also help people cope with the emotional and psychological impact of pain on their quality of life and well-being, both of which can be significantly affected by pain.

What You Can Do

The first step in pain control is to identify and express the pain. If your doctor does not bring up the subject of pain, it is up to you to make your pain known. The cornerstone of effective pain management is a thorough pain assessment. What you tell your health care team about your pain and how you describe your pain help form the pain assessment. You can help by describing your experience of pain in as much detail as possible. Only you can describe the nature of your pain to your health care team, including:

the location

what it feels like

how long it lasts

when it started

the intensity or how severe it is

what makes it better and what makes it worse

Recording and reporting the effects of your pain and how it impacts your ability to function every day will also help with the evaluation. Your doctor will use your information along with a detailed history, physical examination, psychosocial assessment, and the results of any diagnostic studies to determine the treatment options that are best for you.

How to Use This Book

The American Cancer Society’s Guide to Pain Control is a comprehensive guide that will help you understand the complex issues involved in dealing with cancer pain. The goal of this book is to help people affected by cancer pain:

learn about pain

overcome the barriers to pain treatment

communicate with members of the health care team, including describing pain accurately

manage pain and related side effects

cope with the related emotional and social concerns

find helpful resources in the community and across the country

This book will walk you through the important issues and details related to pain control, from diagnosis throughout your cancer experience. You’ll discover how to achieve acceptable pain control and how to understand the optimal balance between pain relief and side effects of pain medication. As you read, you’ll learn about how cancer pain and its treatment affect your body, your emotions, your relationships with others, and your life in general. We encourage you to evaluate the information here and talk with your health care team to determine how best to treat your pain. Remember that you have a right to receive appropriate treatment for pain control.

About the American Cancer Society

Represented in more than 3,400 communities throughout the country and Puerto Rico, the American Cancer Society is a nonprofit health organization dedicated to eliminating cancer as a major health problem. This book is just one example of the many ways the American Cancer Society seeks to fulfill its mission: to save lives and diminish suffering from cancer through research, education, advocacy, and service.

The Society is the largest private source of cancer research dollars in the U.S. Approximately two million Americans volunteer their time to the Society to work to conquer cancer. To contact the American Cancer Society, call 800-ACS-2345 or visit our web site at http://www.cancer.org.

Acknowledgments

Many people helped shape this edition of the American Cancer Society’s Guide to Pain Control by providing us with valuable feedback on the first edition of this text:

Terri Ades, MS, APRN-BC, AOCN; Claudia Barnes, RN, BSN, CHPN; Debbie Bruins; Melinda Burns; Patrick J. Coyne, MSN, APRN, BC-PCM; Sherryll Crutcher; June Dahl, PhD; Doreen Donahue, OSW-C; Pat Dooley, RNC, BSN, MHSA; Wendy J. Evans, RN, MSN, AOCN; Betty R. Ferrell, PhD, FAAN; Walter B. Forman, MD, FACP, CMD; Michele E. Gaguski, MSN, RN, AOCN, APN-C; Lisa L. Hansen;