Cancer pain management

The pain of cancer is usually constant. A person with well-managed pain has an improved quality of life. They are likely to sleep better and have more energy during the day. Being as active as possible also reduces the risk of ailments like pneumonia, blood clots and bedsores, which are associated with immobility. The foundation of cancer pain management is regular medication, including paracetamol and opioid drugs, chosen to suit individual patients and to minimise side effects. Drug combinations to gain maximum benefit are common. Radiotherapy, surgery, hormone therapy and chemotherapy - if successful in reducing tumour size - may also relieve pain. Other techniques that may be helpful include relaxation therapies and acupuncture.

The drug regimen is determined by the pain
The pain experienced influences the choice of drugs and their use. Some of the factors that influence the treatment choices include:

• The location of the pain
• The severity of the pain
• The type of pain - such as sharp, tingling or aching
• Whether the pain is persistent, or comes and goes
• What activities or events make the pain worse
• What activities or events make the pain better
• The current medications
• Whether or not the current medications ease the pain to an appreciable degree
• The impact the pain has on lifestyle, such as poor quality of sleep or loss of appetite.

A range of medications
Some people respond better to certain pain-killing drugs than others, so treatment is always individually tailored. Pain relief can be provided by a range of medications, including:

• Aspirin-like drugs - these medications are used for bone pain, and pain caused by inflammation (such as pleurisy). Some people experience stomach problems, such as indigestion and bleeding, with this type of medication. Aspirin itself is generally avoided, because it is too hard on the stomach if taken regularly.
• Paracetamol - this drug is important in cancer pain control. It is usually well tolerated, doesn’t affect the stomach and won’t thin the blood. It is helpful to reduce fevers and relieve bone pain, and is often used along with opioids.
• Opioids - such as codeine and morphine. Some of the possible side effects can include nausea, vomiting, drowsiness and constipation. There is no danger of addiction if taken for pain relief purposes. There are several newer opioids available, so that one can usually be found to suit any individual. Many patients worry about taking opioids, because they are afraid to become addicted or think they should wait until they are very ill before they use these drugs. Evidence shows that it is far better to find a suitable opioid and use it regularly from the time when your pain becomes constant. This makes it easier to maintain the activities and interests you enjoy.

The different forms of medication
Pain-killing medication can be administered in different ways, including:

• Tablets or syrups - these can be taken by mouth and are simple to use. However, if nausea or vomiting is a problem, tablets or syrups may not be practical.
• Injections - injections into the skin are painless, effective and quick acting. Continuous infusions under the skin may be set up and maintained at home, using a small portable pump.
• Intravenous injections - drugs are administered directly to the bloodstream via a slender tube (catheter) inserted into a vein. The pain relief is more rapid than tablets, syrups or regular injections, but it is inconvenient for long term administration for patients who are at home.
• Spinal injections - drugs are administered though a small catheter in the back (epidural catheter). This procedure must be performed by an anaesthetist. Generally, this type of pain relief is offered when other methods fail.