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Pain Therapies

Managing a rose's thorms

Pain Mangement

Taking Charge

Pain and its under-treatment is a major public health problem facing cancer survivors in the United States. Over eight and one half million people in the United States have had cancer, and more than 70% of them have experienced pain from the disease. Unrelieved pain causes needless suffering and destroys quality of life. But this doesn't have to happen. Nearly all cancer pain can be relieved.

Often it is the patient's description of how the pain feels that provides pain management specialists with their best clue about its cause. A wide variety of available therapies include:

Non-steroidal anti-inflammatory drugs (NSAIDS)
Aspirin, ibuprofen, acetaminophen, etc. NSAIDS are used for mild to moderate pain. They work by blocking the cyclooxygenase enzymes (COX-1 and COX-2) that lead to inflammation. They may be used alone or in combination with opioids, depending on the patient's level of pain. Even though these drugs are commonly used, they must be taken with caution as they can interfere with blood clotting, may cause gastrointestinal ulcers and may impact on kidney function.

Opioids (narcotics)
Opioids are used for moderate to severe pain and should be taken with a stool softener. They work by suppressing the incoming messages of pain to the central nervous system. They provide the cornerstone for pain treatment in most cancer patients. While there has been a lot of bad press about Oxycontin and other potentially addictive opioids in recent months, Edwards maintains that, with proper monitoring, these drugs can be safe and effective. "We keep track of our patients," she says. "Oxycontin can be a good drug for cancer pain. Unfortunately, recent publicity may make it hard for some patients to get. Also, some patients may not feel comfortable using it due to the fear factor." Side effects like mental confusion, sleepiness, itching and urinary problems either wear off or can be offset.

Anticonvulsants
Neurontin and other drugs can help calm over-sensitized nerves. Because Neurontin has a very low side effect profile, it is used commonly for neuropathic pain. Other anticonvulsants, such as Tegretol or Dilantin, are also used but need to be monitored more closely for potential side effects like lowered blood counts or changes in liver function.

Tricyclic antidepressants
Amitriptyline, Nortriptyline, Desipramine and other antidepressants can be extremely useful in treating neuropathic pain. They augment the ability of the patient's own body to reduce pain. Possible side effects include sleepiness, dry mouth and constipation.

Our 2001 Fall/Winter Newsletter was devoted to the topic of pain management. Please join us and receive this publication for a year!