Series Context
This article is one section of the book "How Cancer Pain is Treated: A non-technical guide for patients and their carers". You will find links to the other articles in the series at the bottom of this page. Alternatively, you may download the whole book in various formats HERE. (All downloads are free.)
Disclaimers
This article, written by a senior medical
practitioner with considerable experience in palliative medicine and
hospice care, is offered purely for educational purposes. Nothing in it
should be taken as therapeutic advice for any particular patient.
Mention of any trade (brand) name should not be taken as an endorsement
of the brand or its manufacturer.
Cautions
If you read the articles in this series
carefully, and think about the information in them, in relation to a
particular pain management problem affecting you or someone you love,
you may sometimes be able to think of modifications to the current
treatment which might be expected to improve the situation.
However, it is very dangerous to make changes to a patient's
medication without first discussing them with the prescribing doctor.
The doctor must always know exactly what the patient is taking,
as virtually all medications can cause unwanted side effects and
interact in various ways with other medications.
Importantly, this also applies to "natural", "alternative" or
"complementary" therapies, many of which have significant interactions
with prescribed medications. Therefore, even if you feel that the
current pain management is not optimal, never make any changes without
first discussing them with the doctor.
Introduction
It is bad enough to have an illness which requires a great
deal of tiresome treatment, and which may ultimately prove fatal, but
suffering frequent or constant pain as well makes matters much worse.
Fortunately, however, this extra problem can be managed. Cancer pain can
usually be relieved by quite simple methods, and in the approximately
fifteen percent of cases where these simple treatments are not fully
effective, more complex methods of pain management can be used.
This last point is tremendously important. Although cancer
pain is initially treated in relatively simple ways, as discussed below,
in about fifteen percent of cases these standard treatments are not
effective. However, that does not mean that the pain cannot be relieved.
It simply means that more complex methods of treatment are necessary. Any
patient who is told that nothing more can be done for a pain caused by a
cancer is therefore being misinformed, and should immediately request
referral to a Pain Management or Palliative Care specialist.
In general terms, good pain management involves prevention
(whenever possible), assessment (always), and then either cure or
palliation. When the cause of a pain can be cured, this is obviously the
ideal solution, but when cure is not possible, palliation takes centre
stage. I will give prevention, assessment and palliation their own
headings, below, but I will deal with palliation at greater length, as
it can be very helpful to patients if they and their loved ones
understand how it can be achieved.
Prevention
When it is possible, prevention is always better than cure,
and this has important implications for cancer pain. Of course,
prevention of cancer itself is also important, but that topic is outside
the scope of this series of articles. However, even if a person has a
cancer which cannot be cured, active therapy for that cancer may often
prevent predictable future problems.
For example, surgery to remove a primary bowel cancer can
prevent future problems due to intestinal obstruction, even if secondary
tumours which are already present in other organs mean that cure is
difficult or impossible. Radiotherapy may help to prevent a future
pathological fracture, thus preventing the pain so caused, as well as
avoiding the need for orthopaedic surgery. Excision of a primary cancer
close to the skin may prevent the later development of ulceration and
"fungation" (growing out from the skin in a way reminiscent of a
fungus).
There are many other examples of treatments designed to
prevent a possible future problem, and they should always be considered
by the medical and surgical specialists involved in the patient's care.
From the point of view of the patient, the main thing is to understand
that some recommended treatments may be aimed at prevention of future
symptoms, rather than complete cure of the cancer itself.
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