Ms. Collins was diagnosed with breast cancer four years ago. She immediately underwent surgical removal of her tumor and took anti-cancer medications to ensure the destruction of any remaining cancer cells.
Three months ago, however, Ms. Collins began to experience pain in her left arm. X-rays confirmed that her tumor had recurred and was now invading her bones. Over the last month, her pain has gotten worse and is not responding to standard pain medication. The recurrence of cancer, combined with unremitting pain, has caused Ms. Collins to become severely depressed.
Studies of recent advances in therapies designed to alleviate pain have substantiated the safety of their use in various treatment regimens for people suffering from terminal illness. When we speak of “terminal” illness, or illness that will result in death, we are most often speaking of cancer.
According to the American Cancer Society, about 552,200 Americans are expected to die this year from cancer — this averages out to more than 1,500 people each day. One of every four deaths in this country is from cancer, which is the second leading cause of death, exceeded only by heart disease.
Studies have shown that almost a third of patients are suffering from pain at the time of a cancer diagnosis. If cancer is not adequately treated or if the disease is in its advanced stage, the appropriate treatment of pain becomes a crucially important factor in reducing the suffering attributable to the physical pain of cancer.
In the early stages of cancer, simple medications taken by mouth are the most common treatment for pain. Typically, these include Tylenol, Advil, Motrin or other medications from the so-called nonsteroidal anti-inflammatory medication group.
In cases in which the pain from cancer is more severe, narcotic medications, such as Tylenol 3, Oxycontin, MS Contin, and the Fentanyl patch are very effective and safe treatments. These medications come in various forms and sustained release medications are usually combined with immediate release medications for “breakthrough pain” (increased pain that occurs with activity).
The fear of addiction in people who suffer from cancer is probably unfounded; the most common side effect from narcotic medications is, instead, constipation. Constipation usually is not severe and it subsides after several days. Other than constipation, nausea and drowsiness are other common side effects.
At times, medications other than narcotics are added to treat the cancer pain. This is the case when disease invades other parts of the body, such as nerves and bone. Many different adjunct medications exist, and your doctor will choose proper medication to fit your disease pattern. These medications can also improve your sleep pattern and sense of well-being.
Ms. Collins saw her cancer specialist, who prescribed her morphine pills. The pills almost completely alleviated her pain. She had some drowsiness for the first three days, but reports that the drowsiness has diminished. She is now also much more active. Decreased pain and the ability to enjoy daily activities have resulted in a reduction in her depression. Nevertheless, Ms. Collins continues to see a psychologist to help her deal with her cancer and plan toward her future.
Psychological and family support is crucial in terminal illness. Palliative care services, designed to improve the well-being of people with cancer, can be a big help to the suffering person and their relatives. Alternative therapies for pain, such as biofeedback, relaxation or acupuncture can work when added to a standard treatment regimen.
If all other treatment options fail and pain is still debilitating, interventional (invasive) procedures for pain can be a solution. Complex medical procedures, including intrathecal infusion pumps, nerve blocks or neurosurgical procedures, can alleviate pain and suffering in the terminally ill. Today, pain should not be a major reason for suffering in people with terminal cancer.