Some types of cancer pain may be dull, and some may be aching or sharp. Cancer pain can range from mild to severe. And it is more likely occur as cancer advances to terminal stages. The World Health Organization has developed a three-tiered "analgesic ladder" that is often used to control cancer pain with medications, according to the National Cancer Institute.
Mild Pain Treated with Milder Drugs
The first step on the cancer pain ladder is for patients with mild pain. The best route for pain control in these patients are acetaminophen or a nonsteroidal anti-inflammatory, or NSAID, drugs. These include over-the-counter drugs such as aspirin, ibuprofen and naproxen sodium, or prescription NSAID drugs. These drugs should be taken according to guidelines. However, many of these drugs cause digestive problems and other side effects. Moreover, they often fail to control pain that rises as cancer advances. The World Health Organization guidelines call for a quick jump to step two in the cancer pain ladder, with doctors sometimes skipping step one altogether.
Opioids Added as Pain Increases to Moderate Levels
At step two on the cancer pain ladder, doctors add an opioid that is used for moderate pain. Opioids include codeine, hydrocodone, dihydrocodeine, oxycodone, propoxyphene or tramadol. Patients may continue to receive milder drugs such as acetaminophen or an NSAID. Doctors believe the continued treatment of a patient's cancer may help relieve pain. One possible source of the pain is chemicals that tumors release, which can be treated with chemotherapy, radiation or surgery.
Tough Pain Gets Tough Drugs
When cancer pain intensifies, doctors often rely on strong opioids such as morphine, oxycodone, hydromorphone, methadone, levorphanol or fentanyl. These drugs can be taken orally, by injection or through a patch. Morphine is the drug most often used to control severe cancer pain, according to the National Cancer Institute. However, the institute says that patients could develop tolerance for morphine and need a different drug. Other approaches can include nerve blocks to prevent pain from traveling to the brain.
Barriers to Pain Control in Cancer Patients
There are many barriers to pain control in cancer patients, the National Cancer Institute says. Doctors sometimes lack knowledge of pain management or poorly assess pain. They can have concerns about regulation of controlled substances and worry about a patient getting addicted. They often want to avoid side effects or to keep a patient from developing tolerance to pain medications. Sometimes patients present barriers to pain control. They may be reluctant to report pain, concerned about distracting doctors from treatment, fearful that pain means the cancer is worse, worried about not being a good patient, and fearful of addiction or side effects from pain medications.
Flexibility Key to Cancer Pain Control
The National Cancer Institute says that pain control hinges on flexibility. As the cancer progresses, doctors and patients must be willing to change methods of managing pain. Patients should be asked regularly about pain. A pain assessment should be conducted and include discussion about common symptoms experienced by cancer patients and possible treatments. It is important to ask patients to identify their most troublesome symptoms. Doctors should take seriously reports by patients and family about pain and what relieves it. By doing this, patients and families feel empowered to control the course of the cancer treatment as much as possible.
