Health (A weekly column prepared by Dr. Balwant Singh’s Hospital Inc.)
By Dr Amit Verma, MD (Anaesthesiology)
The term terminal cancer means that the cancer in a patient has progressed to such a stage that cure is not possible with the currently available modalities of treatment, and the patient is literally waiting for the last day of his life. The biggest challenge for most of the terminally ill cancer patients is not accepting the inevitable, but the fear of pain that lies ahead. Pain is inevitable and will follow sooner or later in 75% of patients with terminal cancer. This article is intended to give an insight about cancer pain and what can be done to reduce it.
Cancer pain is a complex subjective phenomenon with some psychological element to it. It is mainly caused by the tumour growing locally and destroying the nearby structures, or by the distant spread of the cancer (metastasis) to the other organs. Cancer treatment with chemotherapy, radiotherapy or surgery adds to the pain. A lot can be done in the present medical world to decrease the suffering of a person who has recently been told of the harsh reality of untreatable cancer.
The treatment options are plenty. They are hardly ever all available in a single place, even in the so-called developed world. The ideal way is to remove the source of the pain, through surgery, chemotherapy, radiation or some other form of treatment. If that cannot be done, pain medications can usually control the pain.
Objective: Freedom from pain
Pain medication can often be taken orally, so it’s easy to use. Medication may come in tablet form, or it may be made to dissolve quickly in your mouth. However, if you are unable to take medications orally, they may also be taken through the vein, rectally or through the skin using a patch.
Specialised treatment, such as nerve blocks, also may be applicable. Nerve blocks are local anaesthetics that are injected around or into a nerve, which prevents pain messages from reaching the brain.
Unfortunately, cancer pain is often under-treated. There are many factors behind that, some of which include:
Physician’s knowledge – One factor has to do with a doctor’s knowledge and ability to treat and recognize pain. Some doctors and other health care professionals may not specifically ask about pain, which should be a normal part of every cancer patient’s visit. Cancer patients should be asked if they have any pain. If they are, the doctor should stop there and deal with the issue. Some doctors don’t know enough about proper pain treatment. If this is the case, your doctor might refer you to a pain specialist. Other doctors may be concerned about prescribing pain medications because these drugs can be abused. However, people in pain are very unlikely to abuse pain medications.
Patient reluctance – A second factor might be a patient’s own reluctance. Some people might not want to ‘bother’ their doctors with the information, or they may fear that their cancer is getting worse. They might feel that because they have cancer, they’re supposed to have pain and should be able to deal with it. That simply isn’t true.
Fear of addiction – Another factor might be a person’s fear of becoming addicted to the pain medications. This is something that we know doesn’t typically happen if you take medications for pain. If you take them when you’re not in pain or to get high, then, yes, you can get addicted. But the risk of addiction for people who take pain medications in an appropriate fashion for pain is very low, so this shouldn’t be a concern.
Fear of side effects – Some people fear the side effects of pain medications. Many are afraid of being sleepy, unable to communicate with family and friends, acting strangely, or being seen as dependent on medications. People are also sometimes afraid that taking morphine may shorten their life. There is no evidence of any of these things happening if the medication is dosed appropriately. Although strong pain medications can cause drowsiness when you first take them, that side effect usually goes away with steady dosing.
Medication is the cornerstone of cancer pain treatment, and its use is aimed at providing the greatest pain relief possible with the fewest number of side effects. Medications used for cancer pain are selected by your doctor to meet the pain needs you have. A few things to follow on a pain clinic visit:
1. Don’t accept pain as inevitable.
2. Make sure your doctor understands the severity of your pain.
3. Insist on morphine if pain persists.
4. Enjoy proper pain relief without worrying about addiction or danger.
5. The right prescription for you is that which relieves pain throughout the day and night without unacceptable side effects.
The care of terminally ill patients with severe pain should provide treatment that permits these patients to close their lives with dignity and purpose. Effective pain relief in cancer patients is an art which needs a physician’s understanding of the dynamics of the cancer pain, a lot of tolerance and cooperation of patients and last but not the least, emotional support by the relatives, friends and family members.
