Get a Second Life
July 22, 2010
An Effective Complement to the Pap Smear
July 22, 2010
HPV Vaccination Recommendations
July 22, 2010
Resources
July 21, 2010
A Study of Dietary Prudence
November 18, 2009 – Kathy LaTour
Debt Collection: Playing Fair
July 21, 2010
Fast Facts: John Plumb Sr.
July 21, 2010
Bearing the Bankruptcy Burden
July 21, 2010 – Teresa McUsic
Debt-Fighting Strategies
July 21, 2010 – Teresa McUsic
What to Watch For
July 20, 2010 – Debra Wood, RN
Web Exclusive: Possible Barriers to Palliative Care
March 10, 2008 – The American Cancer Society
Recommended Resources
March 10, 2008 – Elizabeth Whittington
Doctors in Training
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Now That I'm An Adult
March 10, 2008 – Claudia Craemer-Meihsner as told to Eric Ness
For When It Hurts
March 10, 2008 – Joanne Kenen
Cancer Around the World
March 10, 2008 – Jo Cavallo
Making a Difference
March 10, 2008 – Jo Cavallo
The High-Risk Crowd
March 10, 2008 – Elizabeth Whittington
Risk Factors: Close to Home
March 10, 2008 – Nicole LeBrasseur, PhD
What's Behind the Screen?
March 10, 2008 – Nicole LeBrasseur, PhD
Long-Distance Lifesavers
March 10, 2008 – Marc Silver
Intimacy Issues
March 10, 2008 – Curtis Pesmen
Protecting Yourself
March 10, 2008 – Katy Human
Schools Get Schooled on Parents with Cancer
March 10, 2008 – Erik Ness
DES Exposure: Questions and Answers
March 10, 2008 – The American Cancer Society
Are Public Awareness Campaigns Effective?
March 10, 2008 – Lacey Meyer
The New Specialty in Cancer Care
March 10, 2008 – Joanne Kenen
Below the Surface
March 10, 2008 – Nicole LeBrasseur, PhD
Another Deafening Silence
March 10, 2008 – Betty Ferrell, PhD, RN
How Out-of-Towners Stay in the Loop
March 10, 2008 – Marc Silver
Are Minorities Benefiting From Prevention Priority?
March 10, 2008 – Jo Cavallo
Marriage and Cancer?
March 10, 2008 – Curtis Pesmen
On the Defensive
March 10, 2008 – Katy Human
Breast Cancer & Lung Cancer
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When the Ordinary Becomes the Ideal
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Straight Talk
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Dieting Away Cancer?
March 10, 2008 – Lena Huang
Message from the Publisher
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More Radiation in Less Time
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Letters from Our Readers
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Friend in Need: Chemo Duck
March 10, 2008 – Elizabeth Whittington
www.cancer.gov/bcrisktool
March 10, 2008 – Elizabeth Whittington
Breast Cancer Risk May be Overstated in BRCA Carriers
March 10, 2008 – Elizabeth Whittington
Q&A: Predicting Breast Cancer Recurrence
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Journeys Through Cancer: Art of Healing & Hope
March 10, 2008 – Elizabeth Whittington
Cancer on $5 a Day (*chemo not included): How Humor Got Me Through the Toughest Journey of My Life
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Exploring the Origin of Childhood Leukemia
March 10, 2008 – Elizabeth Whittington
We Can Weekend
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Seventies Musicians Linked by Cancer
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Insurance for Clinical Trial Care a State-by-State Battle
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Get a Second Life
July 22, 2010
An Effective Complement to the Pap Smear
July 22, 2010
HPV Vaccination Recommendations
July 22, 2010
A Shot at Prevention
February 04, 2008 – Don Vaughan
Prevention in America
February 04, 2008 – Lovell Jones
Resources
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Reel-Life Cancer
February 04, 2008 – Lacey Meyer
Voices
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Defining Perceptions
February 04, 2008 – Debu Tripathy, MD
A Study of Dietary Prudence
November 18, 2009 – Kathy LaTour
Gastronomical Distress
February 04, 2008 – Claudia Boynton
Debt Collection: Playing Fair
July 21, 2010
Fast Facts: John Plumb Sr.
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Snippets
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Snippets
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Bearing the Bankruptcy Burden
July 21, 2010 – Teresa McUsic
Debt-Fighting Strategies
July 21, 2010 – Teresa McUsic
What to Watch For
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Here We Go Again
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Snippets
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Shining Light on Detection
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Preparing for the Breast Cancer Paradigm Shift
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Diagnosis: Critical Mass
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Snippets
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The Healing Zone
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Surviving With A Plumb
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Letters
February 04, 2008
Figurative Testimonials
February 04, 2008 – Karen Belfer
Relay for (Second) Life
February 04, 2008 – John V. Wood
Shouldering Debt
February 04, 2008 – Teresa McUsic
Heart & Lung Watch
February 04, 2008 – Debra Wood, RN
Web Exclusive: Possible Barriers to Palliative Care
March 10, 2008 – The American Cancer Society
Recommended Resources
March 10, 2008 – Elizabeth Whittington
Doctors in Training
March 10, 2008 – Joanne Kenen
Now That I'm An Adult
March 10, 2008 – Claudia Craemer-Meihsner as told to Eric Ness
Currently Viewing
For When It Hurts
March 10, 2008 – Joanne Kenen
Making a Difference
March 10, 2008 – Jo Cavallo
The High-Risk Crowd
March 10, 2008 – Elizabeth Whittington
Risk Factors: Close to Home
March 10, 2008 – Nicole LeBrasseur, PhD
What's Behind the Screen?
March 10, 2008 – Nicole LeBrasseur, PhD
Long-Distance Lifesavers
March 10, 2008 – Marc Silver
Intimacy Issues
March 10, 2008 – Curtis Pesmen
Protecting Yourself
March 10, 2008 – Katy Human
Schools Get Schooled on Parents with Cancer
March 10, 2008 – Erik Ness
DES Exposure: Questions and Answers
March 10, 2008 – The American Cancer Society
Are Public Awareness Campaigns Effective?
March 10, 2008 – Lacey Meyer
The New Specialty in Cancer Care
March 10, 2008 – Joanne Kenen
Below the Surface
March 10, 2008 – Nicole LeBrasseur, PhD
Another Deafening Silence
March 10, 2008 – Betty Ferrell, PhD, RN
How Out-of-Towners Stay in the Loop
March 10, 2008 – Marc Silver
Are Minorities Benefiting From Prevention Priority?
March 10, 2008 – Jo Cavallo
Marriage and Cancer?
March 10, 2008 – Curtis Pesmen
On the Defensive
March 10, 2008 – Katy Human
Breast Cancer & Lung Cancer
March 10, 2008 – Elizabeth Whittington
When the Ordinary Becomes the Ideal
March 10, 2008 – Linn Kurkjian
Straight Talk
March 10, 2008 – Erik Ness
Dieting Away Cancer?
March 10, 2008 – Lena Huang
Message from the Publisher
March 10, 2008 – Susan McClure
More Radiation in Less Time
March 10, 2008 – Laura Beil
Letters from Our Readers
March 10, 2008
Friend in Need: Chemo Duck
March 10, 2008 – Elizabeth Whittington
www.cancer.gov/bcrisktool
March 10, 2008 – Elizabeth Whittington
Breast Cancer Risk May be Overstated in BRCA Carriers
March 10, 2008 – Elizabeth Whittington
Q&A: Predicting Breast Cancer Recurrence
March 10, 2008 – Len Lichtenfeld, MD
Journeys Through Cancer: Art of Healing & Hope
March 10, 2008 – Elizabeth Whittington
Cancer on $5 a Day (*chemo not included): How Humor Got Me Through the Toughest Journey of My Life
March 10, 2008 – Kathy LaTour
Exploring the Origin of Childhood Leukemia
March 10, 2008 – Elizabeth Whittington
We Can Weekend
March 10, 2008 – Elizabeth Whittington
Seventies Musicians Linked by Cancer
March 10, 2008 – Elizabeth Whittington
Insurance for Clinical Trial Care a State-by-State Battle
March 10, 2008 – Elizabeth Whittington

For When It Hurts

Pain management options for patients.

BY Joanne Kenen
PUBLISHED March 10, 2008

Oncologists can and do treat cancer pain, but patients with severe, intractable, or chronic pain should seek help from a palliative care team, pain specialist, or interventional anesthesiologist. Sometimes a psychologist or social worker may also become involved because emotions, stress, and coping styles play a role in pain, says Ann Berger, MD, an oncologist and palliative care physician in Bethesda, Maryland, and the author of Healing Pain.

Specialists have many techniques they can recommend, ranging from heat packs and acupuncture to surgically implanted drug delivery pumps and precision nerve blocks. Pain may be caused by the tumor itself or by treatment, including radiation, chemotherapy, or surgery, that has caused nerve damage or other painful side effects.

Medication is almost always part of pain management, and some patients may need two drug regimens, one around-the-clock medication to stay in front of chronic pain and one fast-acting medication to counter sudden and intense episodes of breakthrough pain.

Sometimes doctors use a cocktail of drugs, including non-narcotic medications that can act synergistically, or they “rotate” opiates, switching from one to another if a patient develops tolerance. The goal is to keep pain under control so patients can concentrate on fighting their cancer, not their symptoms.

“We usually start with an opioid the patient has used before and found effective, without significant side effects,” says Janet Abrahm, MD, of Dana-Farber Cancer Institute in Boston. “If they’ve taken oxycodone after a wisdom tooth extraction, for example, or morphine after surgery, we’ll start with that. Since each person is unique, we may have to try a variety of opioids to find the one that is most effective with the fewest side effects, or that comes in a form that the patient prefers—a patch, for example, rather than pills that deliver eight or 12 hours’ worth of drug.”

When necessary, Dr. Abrahm says they work with insurance plans to make sure the patient will be able to get the right drugs, but that’s usually not a barrier for cancer pain.

One of the biggest barriers to pain control comes not from the doctors or insurers, but from “opiophobic” patients who are reluctant to take powerful painkillers that have social stigma. Some clinicians and researchers report increased concern about addiction in elderly patients and by ethnic minorities, a concern experts say is misplaced. It is extremely rare for a cancer patient to develop an addiction to a narcotic or opiate that is correctly prescribed (unless they have a history of substance abuse), says Dr. Berger.

Patients may also shun drugs that make them drowsy, but the sleepiness side effect usually wears off within a few days. Other side effects, such as constipation, can be controlled with their own remedies. Whatever the issue, patients should talk to their doctor about solutions or alternatives.

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