Symptom Specific Services

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Pain
• Will I experience pain?
• What causes pain?
• What are the goals at Continuum Cancer Centers of New York for treating pain?
• How can I get pain relief?
• Types of pain medicine
• How is pain medicine given?
• What is breakthrough pain?
• Reducing pain without drugs
• Can Radiation Oncology help with pain
• What are common concerns for patients who experience cancer pain?
• How can I benefit from the specialized services of the Department of Pain Medicine?
• How to evaluate and describe your own pain
• Other useful tips

How can I get pain relief?
Your pain is unique and it will be treated individually and uniquely. What works for one person may not work for the next. Pain is treated through the use of drug therapies or medications.

Different treatments exist for different types of pain. Before we describe this further, it's important to remember:

• You may be taking several medications at the same time. Be sure you understand when and how to take them, and report any side effects.

• If one medication isn't helping, changes in the dosage can be made. Or you and your doctor can explore other medications in place of one that isn't helping.

• No medication, not even aspirin, should be taken without your doctor or nurse knowing.

• The pain control plan created by you and your doctor should be one that you can easily follow. If you are having trouble getting or taking the medication, talk with your doctor. If there is any reason you cannot follow your plan, your medications and the schedules for taking them can be adjusted to fit your lifestyle.

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Types of Pain Medicine
For mild or low-level pain, acetaminophen and other nonsteroidal anti-inflammatory (NSAIDS) medications are recommended. These medications include aspirin and ibuprofen; most are available without a prescription. NSAIDS, used alone, have a limit to their pain-relieving effect, which is known as a ceiling; taking a higher dose than specified will not bring about greater pain relief and is not recommended.

Although aspirin is an excellent pain reliever, it is not usually given to people receiving radiation or chemotherapy. Even though these medications are sold over the counter, you still need to be monitored by your medical team for any side effects that could occur with long-term use.

For moderate to severe pain, you may need an opioid, also called a narcotic, which requires a prescription. Morphine, Fentanyl, Hydromorphone, Oxycodone and codeine are all opioids. They can be taken by mouth (pill or liquid), through a patch on the body (similar to nicotine patches), in suppository form, or by injection.

Unlike NSAIDS, opioids do not have a ceiling. Your doctor can increase the dose of these medications as much as it takes to relieve your pain. The dosage can always be increased, which means there is never a time when medication cannot treat your pain.

One of the main obstacles to opioid use is constipation. The effect of opiates on bowel function is so consistent that most experts recommend administering Senokot-S (senna and docusate sodium) on a scheduled basis rather than when necessary. For information about how to minimize and treat constipation, please see diarrhea and constipation.

Sometimes your doctor will prescribe non-opioids along with opioids. Many people have the misconception that medications such as morphine lead to addiction. Studies have shown that this is not the case.

Pain caused by swelling or inflammation is often treated with steroids. Examples of steroids are Prednisone and Dexamethasone. Prescriptions are necessary for these medications and it is important to carefully follow the directions for taking them. Do not stop taking these medications without letting your doctor know, as the dosage must be decreased on a schedule over time before you can stop taking them.

Anti-depressants may be prescribed to relieve symptoms such as the burning and tingling that occurs from nerve pain. Amitriptyline and Imipramine are examples of antidepressants. These medications are commonly prescribed to relieve these symptoms. Taking anti-depressants does not mean that you are depressed or unable to cope.

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How is pain medication given?
There are several ways, or “routes of administration” that medication can be given. If one does not work well, another route may be used. According to experts in cancer pain, 85 percent to 95 percent of cancer pain can be effectively relieved using oral medications. The other 5 percent to 15 percent of patients may need to use a different route of administration, and/or see a specialist to relieve pain. Your doctor will work with you to decide the route that may work best, and the schedule that will meet your needs.

Taking medication by mouth is generally the most convenient and inexpensive method. Oral medications come in tablet, capsule and liquid forms. Most people can be treated with oral medications. If you have problems swallowing, or problems with nausea and vomiting, your doctor may prescribe your medications to be taken through either the rectal or transdermal (under the skin) route.

Medications administered rectally are in the form of a suppository, which dissolves from the heat of your body and releases medication. This route is not useful if you have diarrhea or rectal pain, or if you have difficulty placing the suppository.

Only two pain medications are currently available using the transdermal route. One is Duragesic, a fentanyl patch that attaches to the skin and allows medicine to flow into the skin over time. The other is Lidocaine, a local anesthetic that can be placed over the involved skin or nerve tract close to the area of pain.

Medications can also be delivered into a muscle or a vein, which is called the parenteral route. Medicine can be delivered into:

1) A muscle (intramuscular or IM injections)

2) Under the skin (subcutaneously or Sub-Q)

3) A vein (intravenously or IV)

4) The spinal fluid (intraspinal)

5) Chambers in the brain, called ventricles (intraventricular). This is a relatively new route, but it is becoming more common.

You may also use a parenteral system called Patient-Controlled Analgesia (PCA). This system allows you to control how much pain medicine you receive. PCA may be dispensed through oral, intravenous, subcutaneous and intraspinal routes. When dispensed through a parenteral route, a special pump is used, and a predetermined dose is given in a steady infusion. You may give yourself an extra dose (bolus) if you are experiencing breakthrough pain (see below), or adjust the medication if it would help you engage more comfortably in a physical activity or treatment. Your doctor will evaluate whether you are a good candidate to use this method at home.

Medications are generally prescribed around the clock to help keep your pain from building up. You may take medications every three, four, eight, 12 or 24 hours. You should discuss a plan with your doctor and decide what schedule of medications works best for you.

There are many options from which you and your doctor can to choose when trying to control pain. If one is not working, speak with your doctor about alternative treatment methods.

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