Pain Management

Dr Sunita Goel
Managing Cancer Pain
Here are some common concerns people have about pain medicine and the facts about them

Concern: I will become "hooked" or addicted to pain medicine
Fact: Studies show that getting "hooked" or addicted to pain medicine is very rare.
Concern: If I take too much medicine, it will stop working.
Fact: The medicine will not stop working, but some times your body will get used to the medicine. This is called tolerance. Tolerance is not usually a problem with Cancer pain treatment, because the amount of medicine can be changed or other medicines can be added. Cancer pain can be relieved; so do not deny yourself pain relief now.
Concern: I can only take medicine or other treatments when I have severe pain.
Fact: You should not wait until the pain becomes severe to take your medicine. Pain is much easier to control when is mild than when it is severe.
Concern: If I complain too much, I am not being a good patient.
Fact: Controlling your pain is an important part of your care. Tell your doctor or nurse if you have pain, if your pain is getting worse, or if you are taking pain medicine and it is not working. Tell them if you are having side effects to the pain medicine. They can help you to get relief from your pain and control or eliminate the side effects.

Non-Opioids: (NSAIDS, Acetaminophen), useful for bone pain, soft tissue pain, dysmennorhoea.
Opioids: Effective for most pain types including cancer pains. Morphine is the most commonly used agent.
Adjuvant analgesics:(antidepressants, anticonvulsants, corticosteroid, local anesthetics). Effective for pain caused due to involvement of nervous system.

ACUPUNCTURE : Ancient Chinese medical technique involving stimulation of specific skin location by a variety of methods. Example: Needle insertion at acupuncture point.
Art therapy: Use of creative arts to modify pain and mood. Example: having children use arts and craft as a means to express feelings/concerns about their pain and its treatment.

Behavioral management: Use of operant and classical conditioning methods to manage pain related disability. Examples: Rewarding a child's efforts to increase activities and comply with treatments; desensitizing a child to aversive aspects of medical treatment.

Breathing: Modulation of breathing to increase sensation of relaxation and exercises to distract the child from pain. Example: Deep breaths, "blowing away pain".

Biofeedback: Provision of auditory and/or visual feedback related changes in involuntary bodily responses to assist with the modification of these responses. Examples: Heart rate, galvanic skin response (GSR), hand temperature, and electromyography (EMG).

Cold therapy: Use of cold to provide local analgesia, typically for acute pain. Examples: Ice massage, vapocoolant sprays, cold packs.

Cognitive therapy: Modification of cognitions that exacerbate pain and mood. Examples: Reducing negative, "catastrophizing cognitions", increasing the child's positive self- statements about his/her abilities to cope.

Distractions: Use of any variety of methods that absorb the child's attention methods to reduce the child's focus on pain and pain treatment. Examples: bubble blowing, singing, videogames, party blowers, pinwheels.

Education: Providing age appropriate information to children about their pain, and the methods used to treat pain. Example: Explaining to a school age child that they can rub the injection site "close to the pain gate" before and after the shot.

Exercise: Prescribed activities to increase the child's functional capacities and reverse any pain related deconditioning. Examples: stretching, strengthening, flexibility, aerobic and range of motion exercises.

Heat Therapy: Use of heat to relieve muscle spasm, joint stiffness and increase local metabolism. Example: Hot packs, hydrotherapy, ultrasound.

Hypnosis: Induction of an altered state of consciousness, wherein the child is suggestible to alterations of sensation and perception. Examples: the child with CPRS may imagine herself turning off a pain switch to reduce sensation in an affected limb.

Massage and touch: Application of touch or force to soft tissues, usually without causing movement or change in joint position. Examples: Rubbing the site of a needle injection, stroking/ kneading sore muscles.

Mental imagery: A multi-sensory representation of experience. Examples: Having children imagine themselves in a pleasant place doing some thing they really like to do, involving as many senses as possible in the image.

Music therapy: Use of music to modify mood and distract the child from pain. Examples: having the child sing a song or listen to favorite music.

Play therapy: Use of play to desensitize or educate a child about their plan and painful medical procedures. Examples: Play with medical props supervised by a play therapist or child life specialist.

Relaxation: Techniques that reduce the stress response and produce feelings of mental calmness, usually involving a repetitive stimulus. Examples: Progressive muscle relaxation, meditation, autogenics.

TENS: Use of electrical stimulation that can be applied to the skin at different rates and intensities, to relieve pain. Examples: Positioning of TENS unit over muscle in spasm.

Pain Management Pain Management 08/01/2015
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