Cancer Pain Management with Ann Reiner

Last Editorial Review: 6/3/2004

WebMD Live Events Transcript

Join Ann Reiner, RN, MN, OCN, to discuss strategies for managing cancer pain.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Event_Moderator Welcome to WebMD LIVE! Our guest today is Ann Reiner, RN, MN, OCN, and the topic is 'Cancer Pain Management.' Ann has been an oncology nurse for more than 20 years. She is the program director for cancer services at Oregon Health Sciences University and the co-author of 'The Cancer Experience: Nursing Diagnosis and Management.'  How are you today, Ann?

Ann_Reiner I'm glad today is St. Valentine's Day. It helps take the edge off of a Monday, doesn't it?

Event_Moderator Give us a general overview of cancer pain and how it differs with different types of cancers.

Ann_Reiner Pain is often frequently associated with cancer. Some think the disease itself causes pain . Others think the treatments for cancer cause pain. Many people with cancer do experience pain, but much of that pain can be relieved. It is probably easiest to talk about cancer pain related to the disease itself and pain related to cancer treatment. The majority of patients with cancer experience pain because of the cancer itself. An example is when a tumor within the body grows, takes up space and crowds surrounding organs, tissues and pushes up against nerves. This would be called visceral pain. This can sometimes be the reason an individual goes to the doctor and receives a cancer diagnosis. Pain can also be a result from the treatment for cancer. The most common treatment modalities include surgery, chemotherapy, and radiation therapy. A common side effect from surgery is pain. Chemotherapy and radiation therapy do not directly cause pain, but the side effects of these treatments can initiate the pain experience. Many people are not surprised to learn surgery causes pain. They rely on analgesic medications to manage the pain. This kind of pain can also be classified as acute pain. Post-operative pain is considered short-lived. As one's body heals, the pain diminishes. There are some exceptions to this generalization. There are some post-surgical pain syndromes that can create a chronic pain experience. An example would be a post operative frozen shoulder. It is difficult to completely alleviate this pain. Thus, the pain becomes chronic. You can see that the main difference between acute and chronic pain is the duration of time. Many clinicians call pain acute if it lasts less than 1-3 months. Beyond three months, it is considered chronic pain. These definitions are applied to non cancer pain as well. However, as I mentioned previously, there are some pain experiences that are unique to cancer treatment. Chemotherapy is generally not painful. If a patient received intravenous (via a vein) chemotherapy and does not have a permanent catheter, then the immediate pain experience comes from the needle stick. Again, this is not unique to cancer therapy. There are side effects of certain chemotherapies that can create pain experiences. An example is the development of mouth sores, or mucositis. Chemotherapy has a detrimental effect on fast growing cells. Cancer cells, in general, are fast growing. However, so are the cells within one's mouth and gastrointestinal tract. As a result of some types of chemo, sores within the buccal cavity. It affects a patient's ability to eat, to swallow. This pain is considered acute pain, as the affected non cancer cells reproduce quickly and new cells take their place. When the chemotherapy stops, so does the pain. The pain can be managed with straightforward self care measures. However, there are some chemotherapies that can create a chronic pain syndrome.

Event_Moderator Do you encourage alternative therapies for dealing with cancer pain, and how effective are they?

Ann_Reiner To answer that question, it's important to first look at the many dimensions of the a pain experience. Oncology nursing research has documented the following dimensions to pain: 1. somatic-characteristics such as onset and duration of pain. 2. sensory- the intensity or pattern of pain. 3. behavioral- the communication a patient uses to describe his/her pain, pain behaviors, sleep patterns. 4.- cognitive- the meaning of pain, coping strategies 5. affective- the moods created from the pain experience, such as anger, anxiety or depression and finally 6.socio-cultural dimensions- there are gender and ethnic specific qualities to the expression of pain. When you imagine all these factors affecting a person's pain experience, it makes sense to me that there must be many types of interventions to help the person manage the pain. So, yes, there are some non-pharmacological pain relief methods that can be very effective. Guided Imagery is an example. This can create a distraction from the pain, especially pain associated with a procedure. Acupucture has been identified as helpful in managing cancer pain. There has been quite an explosion of knowledge about cancer pain management over the last decade. The information is available and endorsed by organizations such as the World Health Organization. The problem has been in the dissemination and application of the knowledge. For example, healthcare professionals are concerned about the side effects of analgesics, most commonly addiction from narcotics. Research has shown that very few cancer patients become addicted to pain medications. In fact, it has been shown that a patient with chronic cancer pain can become tolerant to a particular does of pain medications. Therefore, for the medications to continue working, the dose must be increased. The patient saying "i need more pain medication does not mean the patient is becoming addicted. At time, there is a reluctance on a patient's part to admit to the pain for many reasons. "I don't want to disappoint / bother the doctor." There is a perception that increased pain means the treatment is not working or that the cancer is returning. Patients have concerns about becoming addicted and becoming tolerant to the medication, so when the pain increases, the medication won't work. All these misconceptions can be clarified with knowledge and a good assessment of the patient's pain experience by the healthcare provider. The patient and family members can also provide information. Unmanaged cancer pain affects a patient's and family's quality of life, in a negative way. With a thorough assessment, knowledge of medications, and a willingness to try various methods of pain relief, a patient's pain can often be managed well. Thanks for your attention.

Event_Moderator We've reached the end of our show. Our guest today has been Nurse Ann Reiner. Thanks so much, Ann, for being our guest today! This has been an extremely informative show. You're welcome to come back any time!

Ann_Reiner Thank you.

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