The pain felt during cancer treatment can be alleviated through a variety of techniques that include psychological, social, spiritual and interventional approaches to pain management. Here, Dr. Sharon Watanabe, the director of the department of symptom control and palliative care at the Cross Cancer Institute in Edmonton, shares some of the strategies she and her team use for pain management.
Q: What does the term pain management encompass?
Pain is a common experience in people who are living with cancer. The goal of pain management is to make pain tolerable and, at the same time, keep any side- effects related to treatment of the pain to a minimum. Pain management doesn’t necessarily mean eliminating pain, but rather trying to control it using various means, so that pain is not interfering with function and quality of life.
Q: Why do patients get referred to your team?
The whole health-care team [of a patient] is involved in managing pain, and not all people who have cancer pain need to see a [symptom control] specialist. The palliative care department at the Cross Cancer Institute is often referred to patients specifically because their pain is not adequately controlled by usual treatments. There can be a misunderstanding about the term palliative care; sometimes it is thought of as being synonymous with end-of-life care, but what we now understand in oncology is that the palliative care approach means trying to optimize quality of life throughout the trajectory of cancer.
Q: So, a patient might be sent to the palliative care department to manage their pain?
Q: How do you determine the root cause of pain in your patients?
There are different sources of pain, and one of the key parts of trying to manage it is to have an understanding of where the pain is coming from. Sometimes, the cancer itself causes injury to the tissue, and that is perceived as pain. Sometimes, the treatment of cancer can cause pain. For example, some chemotherapy drugs are known to affect the nerves that give feeling to the hands and feet, and that can temporarily cause pain. The other type of pain, chronic pain – which is unrelated to cancer – is common in the general population. [Other factors to consider are] if someone is feeling emotionally distressed, more specifically if they’re feeling depressed or anxious, as that can sometimes heighten the sensation of pain.
Q: What are some common methods to manage pain?
If the pain is coming from the cancer itself, cancer treatment can go a long way toward alleviating pain. There are [also] non-drug measures that can help pain. For example, pain that is aggravated by certain positions or movements [is something] a physical or occupational therapist can help with. If there appears to be an emotional component to the pain, then counselling through psychology or spiritual care may also be helpful. There are some procedures like nerve blocks that can help certain types of pain. Then there are drugs. The type of drugs we use depends on how severe the pain is and how the type of pain or nerve pain may respond to specific medication.
Q: What about possibly addictive drugs — how do you decide when to prescribe them?
One common concern raised is that opioids are addicting. It is true that opioids have the potential to lead to an addiction. When we see patients who are candidates for opioid management, we always assess for risk [of addiction]. Many patients will have a very low risk for this occurring, including if they’ve not had addictions to other substances in the past, or if they don’t have mental health issues. Other patients may have a high risk, and that doesn’t preclude the use of opioids, it just means we need to use them in a structured and monitored plan.
Q: What advice would you give family members to help support a loved one dealing with pain management?
Family members can play an important role in pain management. They can help the person to carry out the plan, for example, to stay on track with medications, or record the pain ratings and extra doses in a diary. What they observe of the person’s daily experiences of the pain and its treatment can assist the team in knowing how well the plan is working.