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Cancer Pain Management
An estimated 1.1 million Americans currently suffer from cancer pain. For many, the most frightening part of having cancer is the threat of pain. Today people with cancer can be confident that pain is treatable and does not necessarily occur in all cases. If pain does occur, doctors at the Pain Center can keep the problem controlled through medication and anesthesia.
The Pain Center at Cedars-Sinai Medical Center is at the leading edge of cancer pain-relief technology. Having access to advanced equipment and up-to-the-minute techniques and medical procedures allows our team of specialists to find the exact source of the pain and determine the best way to ease patients' suffering.
Pain can be related to the cancer itself or to the treatments needed to combat it. Causes of pain may include:
- A tumor may press on an organ or body part
- Tiny cancer cells may get inside the bones and cause pain
- Sometimes a cancerous nerve can spread pain wherever it travels in the body, making the patient hurt in places away from the cancerous area (known as referred pain)
- Chemotherapy can cause numbness, tingling or pain -- usually in the feet, legs or hands
- Radiation can cause affected areas to become hardened
- Narcotic pain medicine may result in severe constipation
- Surgery to remove a tumor may itself be a cause of pain
Often doctors find pain hard to assess because it is highly subjective. That is, one patient may describe his or her pain as severe, while another experiencing the same degree of pain may describe it as mild. Patients also tend to downplay the pain they experience when they visit their doctor because they are focused on what is happening at the moment, they do not want to seem like a complainer or because cultural differences come into play. It is important that patients report all aspects of pain as honestly and fully as possible so that doctors can determine the best treatment methods.
How Cancer-Related Pain Is Assessed
Pain specialists take into consideration:
- Severity. Doctors commonly ask patients to rate pain on a 1 to 10 scale
- Time factors. How often, for how long and what time of day does pain occur
- Location. In one place or several, in a large area or small
- Quality. Stabbing, burning or crushing
- Modifers. Movement or activities that make the pain better or worse
Cancer Pain Treatment Options
In most cases, pain specialists follow what is called the "pain ladder" when planning treatments for cancer patients. The first rung on the ladder is analgesic medication - from over-the-counter types, such as aspirin and ibuprofen, to stronger drugs known as NSAIDS. If these do not relieve the pain, still stronger medications containing codeine or morphine are given. If even further relief is needed, the doctor goes up another rung on the ladder, which is to give higher doses of the strongest medications.
All medications come in a variety of forms, including pills, liquids, suppositories, shots and even skin patches that can be worn for several days. Unfortunately, pain medications can cause some patients to experience unpleasant side effects, like nausea, drowsiness and constipation.
Non-medicine treatments are sometimes added to the pain-relieving process. They include a technique called transcutaneous electrical nerve stimulation(TENS), which sends small, non-painful electrical bursts to areas of the skin. Anesthesiologists sometimes inject a numbing medication directly into the nerve that leads to the pain area.
Medical Team Approach
All individuals who seek relief at the Pain Center at Cedars-Sinai greatly benefit by having available to them the collective knowledge and experience of an entire team of specialists. After the results of all medical tests, examinations and analyses are compiled, the doctor consults with specialists from various areas of medicine to develop a treatment plan tailored to the specific needs of the patient.
The doctors who are on staff at the Pain Center are all board-certified with training and experience in invasive pain management. Other team members are care providers who have completed extensive pain management training. They include professionals involved in internal medicine, physical medicine, psychiatry, dentistry, behavioral medicine, physical therapy, and chiropractic.
Considered a key member of the Pain Center team, the patient's referring doctor is consulted regularly and kept informed of the patient's treatment and progress.