Cancer and its treatment cause pain for many patients, whether from the location of a tumor, the tumor spreading to another area such as the bones, or from side effects of chemotherapy, radiation, or surgery.
“Each person is unique in their pain experiences, as well as how they respond to the pain and its medication,” says Dan Gorman, NP, a nurse practitioner in Adult Palliative Care, a division of Dana-Farber’s Department of Psychosocial Oncology and Palliative Care. Gorman and his colleagues provide symptom management support for patients with all diagnoses, at any stage during their treatment. One of the ways they assist patients is through providing pain management medications.
When Should You Seek Pain Medication?
Patients are generally referred to palliative care by their oncologist when over-the-counter medications such as acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Advil) are unable to manage their pain. Some patients may have also tried opioid pain medications as morphine, oxycodone, or dilaudid. Palliative care providers may consider different classes of opioid medications; other, non-opioid pain medications; or pain management options such as palliative radiation, nerve blockers, epidural catheter placements, or steroid injections, says Gorman.
What Should You Expect at Your Appointment?
“When someone comes in for their first appointment, we’ll obtain a thorough history, which includes a full assessment of their pain, what their primary experience has been, if they’ve used pain medication in the past, and if they’ve ever had problems with pain medication before,” Gorman explains.
For cancer patients, palliative care clinicians will take into account medications patients are taking to treat their disease, often consulting with oncologists and palliative pharmacists. Some pain medications, Gorman notes, can cause adverse reactions and side effects when combined with certain cancer treatment protocols. On the other hand, some medications may be able to treat both pain and other cancer side effects, such as neuropathy, so patients should be open with their provider about any concerning cancer side effects. Palliative care clinicians will also consider how both pain and medications may affect patients’ daily function and psychological well-being, taking into account how their quality of life may change with certain prescriptions.
Clinicians also review important safety information with patients. This includes taking medication as prescribed, storing medication safely out of children’s reach, not sharing it with others, and safe disposal of unused medication. Gorman stresses that patients should never take more medication than prescribed. If the prescribed dosage isn’t controlling the pain, patients should tell their provider so adjustments can be made.
Could I Become Addicted to Pain Medications?
Addiction is a common concern of patients, who may be worried that they’ll become dependent on pain killers.
“Any concerns patients have, they should not hesitate to bring up with their provider,” Gorman says. Patients who are concerned about addiction may ask how long they are going to be on the medication, and shouldn’t be embarrassed to share any past addictions with their clinician. Sharing these addictive behaviors upfront can help clinicians better support patients.
In Massachusetts, patients receiving opioid pain medications are required to sign an opioid medication management agreement, which stipulates that providers may ask for urine tests, among other monitoring, to ensure patients are taking medications safely and as prescribed. “It’s a sensitive issue,” Gorman explains. “But we want to make sure we’re having honest conversations with our patients about why they’re taking their medications and the appropriateness of it.”