Cancer Pain Treatment Guidelines Now Available for Patients (dateline May 3, 2001)
The National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS) have published new cancer patient treatment guidelines for patients to help them understand that cancer pain can be effectively treated. More than 50% of cancer patients must cope with pain on a daily basis and of these patients, more than 30% suffer moderate to severe pain. Patients often do not realize that most cancer pain can be controlled with medicines or other therapies.
Cancer pain can occur for several reasons. Sometimes, the pain is a result of the tumor itself. Other times, pain occurs when cancer has spread into soft tissues (such as the muscle or connective tissue) or into organs or bones. Pain can also be a result of a nerve injury or from a tumor putting pressure on a nerve. Cancer treatments (such as surgery, chemotherapy, or radiation) can also cause pain.
Many patients are hesitant about taking medications for controlling pain because they are afraid they will become addicted to them, said Robert C. Young, MD, President of Fox Chase Cancer Center in Philadelphia, Pennsylvania and president-elect of the American Cancer Society, at a recent ACS/NCCN news conference in New York. However, very few cancer patients develop an addiction to pain medication. According to Dr. Young, one study showed that only 4 of 11,000 patients treated for pain relief developed an addiction to the medication. Dr. Young also cited another study in which 550 patients were treated for 40 days with opiods (a type of pain medication). None of the patients became addicted to the medication.
The new ACS/NCCN cancer pain treatment guidelines explain what causes cancer pain, the obstacles involved in finding relief from pain, how physicians assess pain, how cancer pain is treated, and more. The guidelines are written specifically for patients and can be obtained through the NCCN or the ACS (see the resources section below for more information on how to obtain the NCCN treatment guidelines).
The treatment guidelines explain that cancer pain is assessed with a variety of tools in addition to physical examination and an analysis of the patients medical history. These assessment tools include:
- Numerical pain scale: Patients identify the extent of their pain on a scale from 0 to 10, 0 being no pain and 10 being the worst pain imaginable.
- Visual analog scale: Patients are given a scale that consists of straight line with the left end of the line representing no pain and the right end of the line representing the worst pain; they are asked to mark where their pain falls).
- Categorical pain: Patients describe their pain as none, mild, moderate, or severe.
- Pain faces scale: Patients are given a serious of faces with different expressions and asked which face best describes their pain.
After a patients pain is thoroughly assessed, his or her cancer team will develop a treatment plan. Medications are the most common method of treating cancer pain. Categories of medicines that may be used include:
- Non-opiods: These medicines are used for mild pain or combined with other medicines to provide greater pain relief. Examples include acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen).
- Opiods: These medicines provide the strongest pain relief and are available by prescription only. Opiods are classified as weak (for mild or moderate pain) and strong (for severe pain).
- Examples include codeine, fentanyl, hydrocodone, hydromorphone, levorphanol.
- Adjuvant analgesics: These medicines have multiple purposes but can be effective for relieving pain. Examples include antidepressants, anticonvulsants, steroids, local anesthetics.
Besides drug therapies, other methods for relieving cancer pain include surgery, radiation therapy, chemotherapy, nerve blocks, or non-medical therapies (including massage, relaxation, distraction, hypnosis, physical therapy, imagery, heat and cold therapy, positioning for comfort, coping skills, emotional support, and counseling).
Cancer patients who are experiencing pain should not assume that pain is a necessary part of treatment. Pain can be treated in most cases. Often, physicians will refer patients with severe pain to pain management facilities or to other physicians who specialize in pain treatment.
Additional Resources and References
- The National Comprehensive Cancer Network (NCCN)/American Cancer Society new cancer pain treatment guidelines for patients may be obtained by calling the NCCN at 1.888.909.NCCN or the American Cancer Society at 1.800.ACS.2345. Guidelines may also be viewed or downloaded from the NCCN website at http://www.nccn.org/
- The April 3, 2001 American Cancer Society News Today report, "New Cancer Pain Treatment Guidelines Announced," is available at http://www2.cancer.org/zine/index.cfm?sc=001&fn=001_04032001_0