Pain management in cancer patients is a challenge for healthcare professionals. It is one of the vital signs and is considered a fifth vital sign.As(temperature, pulse, respiration, blood pressure, and pain). Pain intensity varies from patient to patient based on the disease’s nature, such as patients with solid tumors experiencing more pain than patients with blood cancer. Pain management is an important part of palliative care. However, it is important to make the patient comfortable and pain-free. This may improve the quality of life of the patient. Patients with pain have very disturbed lives.
How does pain impact a patient’s life?
Pain is a disturbing factor affecting a patient’s quality of life. Patients with pain have disturbed physical, emotional, and psychological health. The following are some symptoms a patient experiences.
Physical disturbances/effects:
Disturbed Sleep Pattern: Patients experiencing pain have disturbed sleep patterns, leading to irritability, fatigue, and exhaustion.
Decreased Mobility: Patients with pain cannot move freely as pain usually increases /aggravates with movements. Secondly, patients using painkillers make the patient drowsy which also leads to decrease patient’s mobility.
Unable to perform daily activities: Patient with pain become dependent on others for their activities which they could not perform by themselves.
Decreased Oral intake: In most cases, patients with pain cannot eat which leads to malnutrition, and lethargy due to lower levels of energy. This further leads to weight loss, dehydration, and other health problems such as constipation.
Emotional effects:
Patient with chronic pain suffers from the following emotional disturbances
Stress and anxiety: Stress and anxiety are most common in patients with pain.it is due to long-term effects of pain such as disturbed sleep, limited movement, low energy levels, fatigue, and inability to perform activities of daily living.
Hopelessness: Patients with cancer become hopeless due to increased pain as most of the time the pain indicates the progression of the disease. So, increased or continuous pain decreases the patient’s hope for survival.
Decreased self-esteem: A patient with pain cannot perform his/her daily living activities independently. Being dependent on others for self-care and other activities of daily living leads a person to decreased self-esteem and low confidence levels.
Social isolation: Patients with pain usually try to avoid voices and talks and want to avoid people around them or avoid large gatherings and try to rest peacefully. This leads to social isolation.
What are the different types of pain in cancer patients?
Nociceptive pain: This type of pain is caused by the damage to the organ due to the spread of cancer OR inflammation due to damage.in character, it can be sharp or aching.it is usually localized to the site of organ damage. Usually, it occurs due to nerve damage in the insulted site. In simple words, nociceptive pain is caused by surgery, inflammations, or infections. Furthermore, infections such as abscesses or cellulitis lead to nociceptive pain.
Visceral pain: visceral pain is associated with organs internal organs such as the heart, stomach, liver, gallbladder, etc. Visceral pain is usually dull and deep and always associated with vomit and nausea.
Neuropathic pain: This type of pain occurs due to damaged nerve endings at the site of the tumor or maybe some medications used to treat cancer.
How pain is assessed in patients?
Pain is assessed by medical professionals by different methods depending on the patient’s condition.
Verbal numeric pain scale: Patients who are fully oriented and can verbalize and understand the languages are assessed by verbal numeric scale.it is usually rated on a scale from 0 —10. Zero means no pain 1 to 3 means mild 4 to 6 is moderate and 7 to 10 means severe.
What are the characteristics of pain?
Pain is characterized in patients with pain with the following.
Sharp, throbbing, dull, radiating
What is the intensity of pain?
Mild Pain:
Mild pain when there is no need for any intervention such as painkillers. This level of pain can be managed by non-pharmacological methods such as mind diversion therapies and deep breathing exercises. Patients can carry out their activities of dialing living with mild pain.
Moderate Pain:
Moderate pain is greater than mild pain and rated as 4 to 6 on a verbal numeric scale. This level of pain needs medications and can be managed with low-severity medications. Such as non-opioid analgesics and NSAIDs (Non-steroidal anti-inflammatory drugs). However, non-pharmacological therapies can also be implemented along with pain medications. This level of pain slightly limits the patient’s mobility and activities of daily living and is slightly dependent upon others for care.
Severe Pain:
Severe pain is rated as 7 to 10 on a verbal numeric scale. These types of pain need strong analgesics such as opioids such as morphine or pethidine. This level of pain completely restricts the patient’s activities and almost dependent upon others for care and other activities.
What are the associated symptoms in a patient with pain?
Patients suffering from pain may have the following symptoms
Irritability
Nausea
Vomiting
Fatigue
Lethargy due to medications being used
High blood pressure, high pulse
Decrease appetite
Sleep disturbances
How pain is controlled in cancer patients?
In patients especially cancer patients’ pain is controlled by following methods/measures
Pharmacological:
In the pharmacological method, strong painkillers are used to control pain, medication is always used and starts from lower efficacy to stronger if not responding to lower efficacy medicine. Medications include opioid and non-opioid drugs.
Non-pharmacological:-
pharmacological measures are the ways through which pain is controlled without using medications. These therapies are
Massage
Meditation
Imaginary guided
Acupuncture
Deep breathing exercises
Icing: applying cold packs to the pain site
Applying heat to the pain site
Radiation for pain relief:
Radiations used for pain relief are called palliative radiation. The purpose of radiation therapy is to shrink a tumor that exerts pressure and pain to site organs presses nerves and tissues and or any skin lesion that grows larger and causes pain if the cancer has spread to bones, and bones radiation shrinks tumor lesions. Therefore, radiation therapy is used for pain relief in cancer patients.
Surgery in cancer patients for pain relief:
Surgical procedures to remove tumors are also used to relieve pain. If the tumor is of larger size radiation or chemotherapy is given first to shrink the tumor or cancerous lesion.
Palliative chemotherapy:
In cancer patients with severe pain, chemotherapy is also used to control the patient’s pain. This also works as radiation works by shrinking the size of the tumor that presses the nerves and nearby tissues.
What are the risks associated with pain medications?
Pain medications used for longer have some associated risk factors as below.
Drug dependency or addiction:
There is a very strong relationship between painkillers especially opioids and drug dependency. People who use medications for pain relief become addicted and want to take medications regularly in the absence of pain. Their body demands the medication and the patient may have a strong urge. So; it is necessary to give the drug to the patient in a controlled environment and controlled doses.
Some side effects:
Most pain medications have some toxicity which sometimes may have effects on organs such as kidney damage; and liver. Secondly, pain medications have an impact on the central nervous system and gastrointestinal. Symptoms associated with the brain are lethargy, sleepiness, unable to communicate words properly, and sometimes irritability. However, the patient’s expedited symptoms in the gastrointestinal system are constipation, nausea, and vomiting.
So, pain is a crucial part of cancer treatment that cannot be ignored. Its safe management is very important to keep a cancer patient comfortable. Treatment modalities used in pain management are pharmacological, non-pharmacological, surgery, chemotherapy, and radiation therapy. So, patients suffering from cancer must be assessed for pain all the time.
