Dealing with the Inevitable
One of the most dreaded effects of cancer is pain, which provides a unique problem for medical professionals. The prevalence of Cancer-related pain is common; it affects around 75% of people with advanced cancer. When cancer patients express pain, 40–50% say it is moderate to severe, and another 20–30% say it is terrible. Physical and psychological disabilities brought on by pain can negatively affect a patient's quality of life. Loss of hope, the anxiety of the disease deteriorating or advancing, rejection of treatment plans, loss of pleasure of family or social duties, interruption of productive work, and suicidal thoughts in specific individuals are all possible psychological side effects of cancer pain.
Pain associated with cancer is a complex phenomenon composed of multiple dimensions: physiologic, sensory, affective, cognitive, behavioural, and sociocultural. Much is known about the physiologic components of cancer pain, but less emphasis is given to other dimensions of the pain experience. The physiologic component of cancer pain encompasses the organic aetiology of pain, including bone metastasis, nerve compression, and tissue or organ infiltration. In addition, the type of pain experienced (acute versus chronic, tumour or treatment, or unrelated to cancer) and the pattern of the pain (transient, intermittent, or continuous) contribute to the physiological component.
The sensory component of pain includes the location of the pain, its intensity, and how the pain feels to the individual. The area affects how the patient responds to physical and psychological pain. Multiple sites of pain may increase the intensity of response. The intensity of pain is subjective and may be influenced by pain threshold, cultural expectations of how one responds to pain, and other factors such as fatigue, insomnia, and lack of sleep. According to some experts, cancer patients associate growing pain with the deterioration of their condition. After going through this module's recorded tutorials, my understanding of patients living with cancer pain has improved substantially.
Managing patients suffering from cancer pain is very challenging. This requires professionalism and empathy. This has led to several changes in my management of patients with cancer pain. Take-home messages are the following:
1. Inadequate assessment of patients with cancer-induced pain is one of the most reported factors in the undertreatment of cancer pain.
2. The assessment of these patients should include a detailed pain history and structured pain assessment tool, such as the visual analogue scale or numerical rating scale.
3. The impact on the patient's life of the pain should also be explored, in addition to previous analgesic use and the patient's choice.
4. Where appropriate, an examination may be carried out to identify sources of pain. Investigations must be considered in the context of the patient's condition; only those likely to alter management should be performed, and in patients nearing the end of life, only if the pain may be due to a reversible cause