Introduction to Cancer Pain
Introduction to Cancer Pain

How some Native cancer patients have described their pain

 

"My pain sometimes felt like a spider jumping or moving on a web that radiated through my body. Wherever the spider was, was where my pain was most intense.” 

NACR pain focus group, San Diego, 2001

Mary Nance

“Sometimes my pain feels like lightning.”

NACR pain focus group, San Diego, 2001

"My pain feels like fire burning.”

NACR pain focus group, San Diego, 2001

What is Pain?

  • Pain is whatever you say is painful, happening whenever and wherever you say it does
  • There are many different kinds of pain
  • It may be an unpleasant feeling/ hurting
  • It may feel sharp, dull, burning, numbing, or shooting
  • It may not be much of a problem or may be a big problem
  • It may last a short time (acute) or a long time (chronic)
  • Pain is related to both the area that is hurt and how your brain deals with the signals/ symptoms of pain from this area
  • Each person reacts to pain differently (some will experience more pain than others even when the cause of the pain is the same)
  • Each person reacts to a specific pain medication/drug different (some will have a lot of pain relief; others will have only a little pain relief with the same type and dose of the pain drug)
  • Sundance and similar traditional ceremonies may include an offering of flesh, but this type of pain is very sacred and not the same as pain that may occur with cancer or cancer treatments.

Traditional ways of thinking about pain

  • Pain as a path

Your path with pain changes as you go through your cancer experience. As illustrated in Barb Christensens drawing, the path has a lot of twists and turns and personal adjustments as you learn to cope with pain.

  • Pain as part of the Medicine Wheel or Circle of Life
    • The physical pain is usually a temporary part of our lives while we go through our cancer experience. Most of us can find good ways to deal with pain and get back into balance.


Overall Goal of Pain Relief

  • The main goal of pain relief is to decrease the effect of your pain on your comfort, lifestyle, and quality of life
  • Methods to treat your pain may not totally get rid of your pain, but should make it so that you can do the things you want to.
  • If you have pain, it is always important to tell your provider.

Why is pain relief important?

  • Pain puts stress on the mind, body and spirit
  • Pain interferes with life activities such as sleep, relationships and enjoyment of life
  • Pain may interfere with cancer treatment
  • Traditional Indian Medicine says that the body should not hurt. Pain tells us something is wrong or not in balance.
  • Helping you understand your pain may help you get the pain relief you need to improve your ability to function and enjoy daily living.

How common is cancer pain?

  • Surgical pain is common
  • 1/3 of people getting chemotherapy have pain
  • At least 2/3 of people with advanced cancer have pain
  • Those with breast and prostate cancer are most likely to have pain as opposed to those with other types of cancer
  • Pain may be the first sign of cancer.
  • Pain is likely to occur if there is a delay in getting cancer diagnosis and treatment
  • American Indians and Alaska Natives frequently deny that they are having any pain (even if pain exists).
  • American Indians and Alaska Natives are usually under-treated for pain.

Ways to think about pain

  • Body Location where the pain is located such as low back pain
  • Duration - how long the pain lasts (acute, chronic)
  • Cause - what caused the pain such as injury or cancer
  • Severity/Intensity - how bad the pain is (0-10 scale)

Important Definitions about Pain

Pain Threshold

  • The time at which something is felt as painful
  • Your pain threshold is when you feel something as painful
  • It is different for each person (some people feel pain more easily than others)
  • Having pain for a long time (chronic pain) does not lead to decreased feelings of pain (just because you have pain for a long time, doesnt mean that you dont feel it or will feel it less)

Pain Tolerance

  • Your tolerance is how much pain you can put up with before you want relief from it.
  • It is different from person to person (some can take much more pain than others).
  • A common myth is that if you can put up with a lot of pain then you are able to tolerate even more pain in the future. Having pain or feeling a lot of pain does not help you to better deal with any pain you may have in the future.

Drug Tolerance

  • After you take your pain medicine for a while, you may need more of it to get the same pain relief (this is called drug tolerance).
  • If your disease has not gotten worse, you usually will not need to take more of the medicine to get the same pain relief.
  • You may have tolerance to the side effects (nausea, sleepiness) of your pain medicine.
  • Tolerance to side effects is common. It is helpful as you should have fewer problems.
  • Tolerance also occurs if you are taking traditional medicines such as teas.

Physical Dependence

  • Physical dependence is NOT addiction.
  • It is when your body is used to having the narcotic pain medicine because you have been taking it for awhile.
  • When the narcotic pain drug is stopped suddenly, you have withdrawal symptoms (shaking, aches, sweating).
  • The symptoms will be less if the dose of narcotic is slowly lowered once your pain has gotten less or gone away.
  • It is common with many drugs (if you quickly stop your blood pressure medicine, your blood pressure may go very high, even higher than it was before you started the medicine).

Addiction and Substance Dependence

  • A psychological dependence (feeling a high when taking the drug); not a physical need (having pain)
  • There is no medical need for the drug
  • The person has a loss of control, wants or needs the drug even if getting the drug is dangerous or illegal

Differences between a person which chronic pain and one who is an addict:

Person with Chronic Pain Person who is an Addict
Takes pain medication when supposed to Takes pain medicine when desires, even if has no pain
When have side effects, usually decreases does of pain medicine Continues or even increases pain medicines even if has bad side effects
Taking pain medicines ease pain and improve QOL Taking pain medicines may decrease QOL
Has concerns about physical problems causing pain Unaware or denies any problems leading to taking pain medicines
Follows directions for taking pain medicines as planned with provider Doesnt follow directions for taking pain medicine (medicine may not have been ordered by the provider)
Often has medicine left over because doesnt take all that is ordered (due to concern about taking too much, not having enough if need it or side effects) Has no leftover medicines; often runs out before next prescription is due to be filled; often has stories about lost/ stolen medicines

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