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.)
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.
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.
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.
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.