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Palliative Care Platform

Palliative Care Platform

Symptom Management >Pain

About Pain

Possible causes

  • Cancer pain can be caused by the tumour itself, and includes all kinds of pain induced by it, such as adjacent bone pain and nerve pain
  • The causes of pain can vary, which will be defined by the healthcare professionals
  • Most pain caused by cancer or other conditions can be effectively managed

Common myths and facts about cancer pain

Myths
Facts
Myths:
Cancer causes pain anyway and the patient has to put up with it
Facts:
Pain is not inevitable as most of the cancer pain can be effectively managed
Myths:
Strong opioids are addictive
Facts:
If the patient follows the instructions of the doctor and takes the pain medications appropriately, the chance of addiction is extremely unlikely
Myths:
Pain medications cause major side effects
Facts:
Side effects of pain medications can be prevented and relieved
Myths:
Pain medications treat only the symptoms but not the causes
Facts:
Effective pain management can help improve the physical, psychosocial and spiritual health and enhance the overall quality of life
Myths:
Pain medications should only be used when the pain is intense
Facts:
The pain control will be more effective if the pain medication is taken in a regular and timely manner.
Myths:
Strong pain medications should be reserved for use in later stages of cancer
Facts:
The earlier the pain is managed, the better the effect of pain control
Myths:
Fear that pain of high severity cannot be controlled by medication
Facts:
Pain of different severity levels can all be effectively controlled
Myths:
“Good” patients make no complaints to doctors about pain
Facts:
An honest account of pain helps doctors find out the correct and effective way(s) of pain management

Medical Treatment

  • Pain is a subjective sensation. As long as the patients feel pain or discomfort, healthcare professionals will try their best to offer help
  • Doctors will suggest suitable ways of pain control based on the severity, nature, site and duration of the pain
  • Pain control treatment can be done in hospital or at home. Nurses will evaluate the effect of treatment regularly and discuss with doctors on the adjustment of the analgesic dosage or follow-up treatment when necessary

Common pain medications

Mild analgesics
For patients with mild pain, doctors can prescribe non-opioid pain medications
E.g., paracetamol, NSAID
Medium analgesics
For patients with mild to moderate pain, doctors can prescribe relatively gentle pain medications, such as weak opioids
E.g., Tramadol, Codeine phosphate, Dihydrocodeine Tartrate
Strong analgesics
For patients with moderate to severe pain, doctors can prescribe strong opioids
E.g., Morphine, Oxycodone, Methadone, Fentanyl
Adjuvant analgesics
  • Can effectively control the pain
  • Some strong analgesics may require other specific drugs to achieve significant effects, such as the use of antidepressants or anticonvulsants for neuropathic pain
  • Consult healthcare professionals in case of any questions
Precautions for using medication
  • Follow doctor’s prescription and take the medications regularly; do not consume any alcoholic beverages before and after use of medication to prevent further sides effects of analgesics
  • In case of persistent pain, doctors will prescribe regular pain medications. Patients should follow the prescribed dosage and frequency and should not stop the use or change the dosage on their own. Consult healthcare professionals if necessary
  • In case of any symptoms such as nausea, vomiting, acid reflux, indigestion, constipation, headache, dizziness, rash or shortness of breath after using pain medications, stop using the drug temporarily and contact the healthcare professionals immediately
  • If the conditions of pain fluctuate, doctors may need to prescribe extra pain medications for use where necessary to better manage the pain
  • Observe the effect and its effective duration after medication use. If the pain is alleviated, you can discuss with the doctor to adjust the dosage and frequency of drug use
  • Most of the pain medication(s) may have some side effects. Doctors may prescribe some preventative medicine to manage the side effects
  • Most pain medications are taken orally. If the patient has difficulty swallowing, symptoms of vomiting or drowsiness, pain medications could be administered through subcutaneous injection or absorption through skin
  • Strong opioids have strong pain relieving effects. Doctors will adjust the dosage gradually based on the degree of pain the patients experience. Although there is no limit for the dosage of such medications, a rapid increase in dosage may be harmful. Therefore, patients should never increase or change the dosage on their own
Side effects of opioids

Most of the opioids have limited side effects, and their side effects can be effectively managed.

  • When you first take it, you may experience tiredness and lethargy. These symptoms will mostly disappear in a few days after your body has gotten used to the medicine. If the lethargy is severe, it may be necessary to reduce the dosage or switch to other pain medications
  • They may cause constipation. Therefore, doctors tend to prescribe laxatives at the same time
  • Some patients may feel nausea and vomiting. These symptoms gradually subside in a few days. Doctors may prescribe some anti-vomiting drugs in that transition period

Non-medical Treatment

Patients with fear or anxiety may be more prone to pain. Therefore, they should be given opportunities to channel their thoughts and feelings as much as possible. When the patients feel understood, they will be less anxious or worried.

Apart from medications, there are other ways to relieve pain, including: radiation therapy, physiotherapy, occupational therapy, exercises, relaxation, massage and distraction diversion therapy. Healthcare professionals are happy to provide guidance.

Here are some of the ways for relieving pain :

Physiotherapy

(Please consult physiotherapists for details)

(a) Heat therapy (chronic pain)
  • Heat dilates blood vessels in the affected area(s)
  • relaxes the tense muscles
  • improves blood circulation in the affected area(s)
  • slows down the activity of pain nerves
  • reduces pain
(b) Ice therapy (acute pain)
  • If the patient has inflammation, strain or sprain in the affected area(s) (acute redness, pain, swelling and heat)
  • ice therapy can improve the blood circulation in the affected area(s)
  • avoids swelling
  • slows down the activity of pain nerves
  • reduces pain and swelling

Remarks:

  • 15-20 minutes per therapy session
  • Consult physiotherapist for feasibility if the patient has reduction in sensitivity to heat or cold
(c) Low frequency transcutaneous electrical stimulation
  • Low frequency transcutaneous electrical stimulation can modulate the transmission of pain signal to the brain and reduce the sensation of pain
  • Method: Based on the instructions of physiotherapist, put the electrode pads on the designated trigger point for 15 to 30 minutes
  • To ensure safety, consult your physiotherapist on the application and precautions; do not put on the electrode pads randomly

Consult your physiotherapist in case of any questions.

Relaxation exercise and breathing exercise

Please refer to Caring tips>Home exercise

Change of position

Please refer to Caring tips>Correct posture and transfer methods

Manual massage

Please refer to Caring tips> Hand massage

If you have any questions about the above information or are troubled by pain, consult your healthcare professionals for the most suitable treatment plan.

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