American Cancer Society's Guide to Pain Control
Understanding and Managing Cancer Pain 2nd Edition
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Published by
American Cancer Society
Health Promotions
1599 Clifton Road NE
Atlanta, Georgia 30329, USA
© 2004 American Cancer Society
All rights reserved. Without limiting the rights under copyright reserved above, no part of this
publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any
form or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the
prior written permission of the publisher.
Printed in the United States of America
Cover designed by Jill Dible
5 4 3 2 1 04 05 06 07 08
Library of Congress Cataloging-in-Publication Data
American Cancer Society’s guide to pain control : understanding and managing cancer pain.— Rev.
ed.
p. cm.
Previous ed. has subtitle: Powerful methods to overcome cancer pain.
Includes bibliographical references and index.
ISBN 0-944235-52-2 (pbk. : alk. paper)
1. Cancer pain. 2. cancer pain—Treatment. I. Title: Guide to pain control. II. American Cancer
Society.
RC262.A645 2004
616’.0472—dc22
2003025526
Brief Contents
CHAPTER 1
Understanding Cancer Pain
CHAPTER 2
Coping with the Emotional and Social Impact of Cancer Pain
CHAPTER 3
Achieving Effective Pain Control
CHAPTER 4
Describing and Measuring Your Pain
CHAPTER 5
Pain Relief through Medication
CHAPTER 6
Other Medical Approaches to Pain Management
CHAPTER 7
Complementary Nondrug Treatments
CHAPTER 8
Managing Side Effects of Opioids
CHAPTER 9
Cancer Pain in Specific Groups
EDITOR
Amy Brittain
MANAGING EDITOR
Gianna Marsella, MA
BOOK PUBLISHING MANAGER
Candace Magee
DIRECTOR,PUBLISHING
Diane Scott-Lichter,MA
DIRECT CHANNELS
ANAGING DIRECTOR
Chuck Westbrook
EDITORIAL REVIEW
Terri Ades, MS, APRN-BC, AOCN
Director of Cancer Information
American Cancer Society
Atlanta, Georgia
Betty R. Ferrell, PhD, FAAN
Research Scientist
City of Hope National Medical Center
Duarte, California
A Note to the Reader
The information contained in this book is not intended as medical advice
and should not be relied upon as a substitute for talking with your doctor.
This information may not address all possible actions, precautions, side
effects, or interactions. All matters regarding your health require the
supervision of a medical doctor who is familiar with your medical needs.
For more information, contact your American Cancer Society at 800-ACS-
2345 or http://www.cancer.org.
Contents
Foreword by Betty R. Ferrell, PhD, FAAN
Advances in Understanding Pain
Partnering to Manage Paini
The Role of this Book in Pain Control
Everyone Has a Right to Pain Relief
Introduction
The Impact of Cancer Pain
Cancer Pain Is Undertreated
Methods of Pain Control
What You Can Do
How to Use This Book
About the American Cancer Society
Acknowledgments
CHAPTER 1
Understanding Cancer Pain
What Is Cancer?
What Is Pain?
Types of Pain
Acute Pain
Chronic Pain
Breakthrough Pain
Nociceptive Pain
Neuropathic Pain
Factors that Influence Pain
Causes of Pain
Diagnostic Procedures
Cancer Treatment
Tumor-Related Pain
Pain Due to Other Causes
Help is on the Way
CHAPTER 2
Coping with the Emotional and Social Impact of Cancer Pain
Pain’s Impact on Quality of Life
Measuring Quality of Life
Common Feelings about Cancer and Cancer Pain
Factors that Affect Feelings about Pain
Individual Reactions to Pain
Pain and Depression
Pain and Anxiety
The Impact of Pain on Relationships
Support from Friends and Family
Asking for Help
When to Seek Counseling
Finding Support
Support Groups
Individual Therapy
Family Therapy
Choosing a Counselor
Why Do Some People Need Help and Others Don’t?
Will Insurance Pay for Counseling and Therapy Services?
CHAPTER 3
Achieving Effective Pain Control
Myths and Misconceptions about Cancer Pain
Myth 1: People Become Addicted to Pain Medications
Myth 2: Taking Too Much Pain Medication Will over Time Decrease
Its Effectiveness
Myth 3: Pain Is a Normal Part of Having Cancer
Myth 4: Pain Means that the Cancer Is Growing
Myth 5: Pain Can’t Be Treated
Myth 6: Doctors Don’t Understand Pain
Myth 7: Good Patients Don’t Complain
Myth 8: Focusing on the Pain May Be a Distraction from Treating
the Cance
Myth 9: People Should Be Able to “Tough it Out”
Myth 10: Pain Medications Cause Unpleasant Side Effects
The Importance of Communication
Communicating with Your Health Care Team
Communicating with Caregivers
Barriers to Communication
Language Barriers
Cultural Background
Pain Is Subjective
Limited Knowledge and Time
When to Seek Additional Help
CHAPTER 4
Describing and Measuring Your Pain
The “Language” of Pain
Talking about Your Pain
Talking with Family Members and Caregivers about Pain
Talking with Your Health Care Team about Pain
How Pain Is Measured
The Initial Pain Assessment
Preparing for a Pain Assessment
When the Person with Cancer Is Unable to Discuss Pain
Tools for Rating Your Pain
Numeric Scales
Word Scales
The Faces Scale
Color Scales
The Brief Pain Inventory
What to Do after the Initial Pain Assessment
Your Pain Treatment Plan
Communicating about Pain and Pain Relief
The Pain Log
Assessment for Recurrence of Pain
CHAPTER 5
Pain Relief through Medication
Determining Pain Medication(s) Appropriate for You
Types of Medications Used to Control Cancer Pain
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Acetaminophen
Opioids
Other Types of Pain Medications
Adjuvant Medicines
Methods Used for Drug Delivery
Oral
Transmucosal
Sublingual
Transdermal (Skin Patch)
Rectal Suppositories
Injections
Patient-Controlled Analgesia (PCA)
Managing Your Drug Therapy Program
Controlling Breakthrough Pain
Tolerance, Dependence, and Addiction
Drug Tolerance
Drug Dependence
Psychological Dependence and Addiction
Changing Your Pain Medicine or Drug Therapy Plan
Pain Records, Charts, and Logs
What to Include in a Pain Record
CHAPTER 6
Other Medical Approaches to Pain Management
Palliative Therapy for Pain Control
Palliative Radiation Therapy
Palliative Chemotherapy
Hormonal Therapy
Bisphosphonate Therapy
Palliative Surgery
Nerve Blocks
Temporary Nerve Blocks
Permanent Nerve Blocks
Side Effects of Nerve Blocks
Location of Nerve Blocks
Spinal Opioid Infusion
Neurosurgery
CHAPTER 7
Complementary Nondrug Treatments
What Are Complementary Nondrug Treatments?
How Complementary Nondrug Treatments Can Help Control Pain
Access to Complementary Nondrug Treatments
Complementary Nondrug Methods
Acupuncture
Biofeedback
Distraction
Exercise
Humor Therapy
Hypnosis
Imagery and Visualization
Meditation
Music Therapy
Psychotherapy/Counseling
Relaxation
Skin Stimulation
Spirituality and Prayer
Transcutaneous Electrical Nerve Stimulation (TENS)
Yoga
CHAPTER 8
Managing Side Effects of Opioids
Opioid Analgesic Side Effects
Digestive Tract Side Effects
Central Nervous System Side Effects
CHAPTER 9
Cancer Pain in Specific Groups
Children and Cancer Pain
Sources of Cancer-Related Pain among Children
Pain Assessment in Children
Managing Cancer Pain in Children
Cancer Pain in the Elderly Person
Pain Assessment in Elderly Patients
Managing Cancer Pain in the Elderly Person
Emotional and Psychological Issues Related to Pain in the Elderly
Treatment Issues for People with a History of Substance Abuse
Culturally Diverse Groups
Impact on Care
Treating Pain in the Person with Advanced Disease
Pain Relief at the End of Life
Treating Severe Pain in Advanced Stages of Cancer
Hospice Care
Palliative Sedation
Conclusion
APPENDIX A
Cancer Pain Drug Information
Nonopioids
Opioids
Adjuvant Analgesics
APPENDIX B
Guidelines for Pain Management
Joint Commission on the Accreditation of Healthcare Organizations
American Pain Society
National Comprehensive Cancer Network
Cancer Pain Treatment Guidelines for Patients
Resources
Glossary
Index
Foreword
by Betty R. Ferrell, PhD, FAAN, Research Scientist City of Hope National Medical Center,
Duarte, California
PAIN HAS THE POTENTIAL TO NEGATIVELY AFFECT physical, psychological, social,
sexual, and spiritual well-being, as well as upset family members and
caregivers. Providing all available pain-relief methods to people with cancer
is not only essential for preserving quality of life, it is critical to successful
cancer treatment. Patients are better able to tolerate cancer treatment when
their pain is alleviated.
The American Cancer Society is dedicated to diminishing suffering from
cancer and has focused major efforts—including the publication of the first
and revised editions of this book—toward addressing the critical issue of
pain management and enhancing quality of life for people facing cancer.
Advances in Understanding Pain
Major advances in cancer prevention, early detection, diagnosis, and
treatment have been mirrored by major advances in the understanding and
treatment of cancer pain. In 1994, the federal government issued guidelines
for the treatment of cancer pain. These initial guidelines, published by the
Agency for Health Care Policy and Research, have been reinforced and
elaborated upon through major documents from the National Cancer
Institute, professional organizations, and consumer groups. All of these
groups have consistently agreed that pain negatively affects quality of life—
and that, unfortunately, pain is often undertreated.
Partnering to Manage Pain
The successful management of pain requires a partnership between patients
and health care professionals. People with cancer and caregivers who are
informed about cancer pain will better understand the importance of
expressing pain, overcoming fears of addiction and tolerance, exploring
appropriate nondrug methods of pain relief, and expecting that all means
available are used to provide optimal pain relief. Cancer care professionals
can help improve quality of life for people in pain by understanding how to
overcome social and cultural barriers, balance side effects of pain-control
methods, and assess and treat pain.
The Role of this Book in Pain Control
The American Cancer Society’s Guide to Pain Control was first published in
2001 to inform patients and their families about cancer pain, how to manage
it, and how to obtain the best pain-control care possible. The revised edition
of this comprehensive resource for patients, families, and health care
professionals reflects updated developments in pain control, with an
increased focus on practical information for people with cancer. It is
essential reading for people with cancer and their family members. This
book explains how to take control of cancer pain and how to obtain
emotional and social support, and emphasizes that pain can usually be
alleviated.
Everyone Has a Right to Pain Relief
Research and advances in clinical practice in the last decade have provided
strong evidence that cancer pain is not a necessary part of having cancer,
and the majority of people with cancer should expect to experience relief
from cancer pain. More and more people are living with cancer, and this
population must be able to participate in work, family, and enjoyable
activities without being hindered or debilitated by pain. Quality of life must
also be preserved for special populations, such as infants and children, the
elderly, patients with a history of substance abuse, patients from diverse
cultures, and those who are critically ill.
Continuous efforts are being made in the oncology field to better inform
health care professionals about the importance of preventing, assessing, and
managing pain. Health care professionals should not only strive to prevent
pain before it occurs, but continue to learn more about the origins of pain
and shape state-of-the-art treatments to treat it. The cooperation between
