Control the pain both before and after it hurts
By Elaine Wacholtz, PhD
For Troy Mikell and his wife, Tami, it is business as usual - but it has not always been that way. They work as a team running T & T Transportation Services, LLC , their freight brokerage business. Eighteen months ago, however, life was very different for Troy, who was recovering from bladder cancer. The pain imposed upon him by the disease proved to be both a blessing and a burden, but learning how to manage that pain led to better healing and quicker recovery.
It all started on a Friday in the summer of 2004 during an appointment with his urologist who "reassured Tami and me that the blood I had noticed in my urine had a non-cancerous cause," explained Troy. Contrary to that reassurance, "we learned on the following Sunday that biopsies had revealed stage III cancer (transitional cell carcinoma) of the left ureter," added Tami.
After surgery removed the cancerous section of the left ureter on June 3, 2004, the urologist considered immunotherapy to guard against the possible spread of the cancer to the bladder, but test results convinced his physician that there was no sign of the disease.
Troy began to notice pain in his left hip that was tolerable at first but became so unbearable that by October, Troy could no longer sleep at night. "The pain in my hip was more of the sharp, stabbing feeling," explained Troy, "and it radiated into my leg. I’d spend part of every night in the recliner because I was more comfortable that way than when I was in bed, lying flat."
That pain turned out to be a blessing in disguise, because it signaled what was the spread of cancer that Troy was convinced he had already beaten, motivating him to seek treatment once again. Troy would come to learn more about the pain and how to manage it as his cancer was being treated.
What is cancer pain?
Pain is one of the most common, most feared symptoms associated with cancer. Despite the fact that medical science has a straightforward, almost clinical, definition of pain, the reality is that the experience of pain can be highly subjective. In fact, not all patients with cancer even experience pain. Dr. Mark Axness, director of Pain Management and Anesthesiology Services at Cancer Treatment Centers of America (CTCA), estimates that 75 to 80 percent of patients with cancer experience pain consistently across all stages.
About 25 percent of cancer-related pain is caused by the treatments themselves, such as surgery, chemotherapy, radiation therapy, and immunotherapy, according to Ann Berger, MD , manager of Pain and Palliative Care Service in the National Institutes of Health Clinical Center. Troy is among the many patients (nearly 90 percent) who have to deal with such pain. "The muscles in my legs were so burned from radiation treatments at my first treatment center," he said. "I couldn’t get around. I had to use a wheelchair."
"Most of the pain Troy experienced early on was bone pain in his femur (thigh bone) and acetabulum (where the three components of the pelvis meet) and some soft tissue involvement," explained Dr. Axness. "While radiation and chemotherapy treated the cancer and alleviated the bone pain, the radiation burns (soft tissue necrosis) in the groin and legs were another source of pain."
How do you manage cancer pain?
Most people are able to find relief through appropriate pain management. Today, many large hospitals and specialized facilities have clinics devoted exclusively to managing cancer pain. At these facilities, cancer pain is managed with a number of treatment approaches: pharmacologic and anesthetic treatments, nonpharmacologic treatments, and medical procedures, often times a combination of approaches is used. The goal is to help patients deal with their pain so that they can better navigate the experience of cancer treatments, speed their way on the road to recovery and improve their quality of life.
The most effective pain management programs incorporate three critical components that occur on a cyclical basis: assessment of pain, therapeutic analgesic regimen, and integration of pain treatment with other therapies.
Assessment of Pain. Pain changes over time, therefore, managing pain requires ongoing evaluation. Pain scales, usually numbered from one to 10, help physicians and patients communicate about the intensity of the pain. Pain scales provide baselines while other methods, such as the McGill Pain Questionnaire, provide snapshots of what is going on with the patient. Both methods help assess how the pain is changing from visit to visit. "On the day I arrived at CTCA, my pain was an eight or a nine," says Troy. "After my first visit, I felt much less pain with the scale reading a two or a three; by the time I started radiation and chemotherapy, I was pretty well out of pain. My pain had not been addressed as thoroughly at my previous treatment program. With my pain under control, I began to believe I could beat this disease."
Therapeutic Analgesic Regimen. An analgesic is something that alleviates pain without making the patient drowsy or sleepy. Opioids - drugs that mimic the effect of opiates like morphine - are the mainstay of cancer pain management. However, both the World Health Organization and the Agency for Health Care Policy and Research recommend the use of adjuvant analgesics, which amplify the effect of other anti-pain drugs. The use of adjuvant analgesics have been linked to a decrease in opioid use, which is good because of the discomforts and risks of addiction related to the side effects of opioids.
Other Therapies. Those include nonpharmacological (or drug) treatments and medical procedures. Nonpharmacological treatments may be used during all phases of cancer management and can result in a decrease in the need for drugs and their side effects. Medical procedures involve removal or reduction of the underlying cancer and can also provide pain relief. Sometimes, however, the procedures themselves become a source of pain.
How important is pain management to the treatment of cancer?
Unmanaged cancer pain can slow healing and recovery from the disease and treatment, because over time the exhaustion of pain causes patients to feel fatigue, anger, depression, worry, and stress. As patients become increasingly unable to sleep and eat properly, their immune systems are threatened and their minds are not able to think clearly and make the best treatment decisions. Besides speeding healing and recovery from disease, pain management restores functionality in the lives of patients with cancer during and after treatment and improves their sense of well-being and quality of life.
"With the dramatic advances that have taken place in pain management over the last 25 years, excellent pain control is possible and some patients can expect normal functionality during treatment, even patients with advanced-stage cancer," says Dr. Axness. In spite of the daunting side effects of stage IV bladder cancer, a rigorous chemotherapy and radiation therapy regimen, and a twice-weekly, 300-mile round trip commute for outpatient treatment, Troy was able to maintain business-as-usual status in the family freight brokerage business, "I could [stay in touch with my] business anywhere in the hospital. I was able to maintain my income," recalled Troy.
More importantly, he was able to maintain his role as a father. "I would drive home on Wednesday, spend the evening with my two kids [Christopher, then age 9; Chelsi, then age 4] to keep their home life as normal as possible, drive back on Thursday for treatments on Thursday and Friday and back home again on Friday for the weekend," added Troy.
As Troy looks back over the last four years, he notes that many things helped him get through his fight with cancer. He appreciates the support he has received from Tami, their children, their two families, their friends, their church, and the hospital staff who treated him. Tami’s support reminds him of the way they run their freight brokerage business, as a team: "From day one, she was right there with me the whole time no matter what I was doing - every appointment, chemotherapy session - even with us having two kids and running our own business."
Tami sees their spirituality as another pillar of support for them. "I am very strong in my faith and Troy is, too," she said.
Troy offers up what helped him recover from the disease - pain management. People would tell him at the hospital while he was confronted by the cancer pain: "They would say ‘You have to have your pain under control. You have to stop the pain before your body can start healing.’"
This article is from the summer edition of Cancer Fighter Thrive Magazine. To learn more or subscribe, please visit cfthrive.com.
