 When she has pains and spasms, it's difficult because every pothole or little riffle in the road that you hit just reverberates through her body and causes pain. A lot of times you're limited to what you can do because of the pain. A lot of things I couldn't do with the pain was really cutting my grass and do things to my house like I wanted to. Arthur Moten couldn't work around the house. Mary Boyd was restricted in her daily activities. For Carolyn Jones, a simple car ride was unbearable. Cancer pain has many causes and can affect people in different ways. But these patients were able to have their pain controlled with effective pain management. The bottom line is that patients don't need to suffer with pain. If it can't be controlled with simple oral medications, we have a whole host of other medicines and procedures and approaches that can make just about every patient comfortable. This is a 61 year old woman with a diagnosis of metastatic breast cancer. Pain management requires a team of doctors, nurses, pharmacists and social workers all working together to keep a patient's pain under control. But the most important member of this pain control team is you, the patient. Hi, Dr. Grusson. Pain is nothing that the doctor can feel, it's nothing the doctor can measure. I had this pain behind my right rib cage and in my shoulder. The patient can feel it, the patient knows how much discomfort they have and if they don't communicate that to the person who's taken care of them, the person who's taken care of them is not going to be able to do the kind of job they should. It's been almost a week since I've seen you last. Why don't you catch me up to date and tell me how you've been doing for the last week? Well actually the pain has much improved. The first step in pain control is communicating how much pain you are experiencing. The best way to do this is just by talking with your doctor or nurse. We want to get lots of information about how the pain is affecting almost every aspect of their life and then from there try to figure out what it is we can suggest or have the patient do that would try to make the pain better, that it's more tolerable, that they can get through the day a little bit easier. Using the scale that you've used before with no pain here, the worst pain imaginable here, where would you put it right now? At this moment I would go all the way over to no pain. You may be asked to describe your pain using a scale from 0 to 10. This tells your doctor or nurse how bad your pain is and it provides a baseline to measure the effectiveness of your treatment plan. Often that seems almost too simple, you know, how much pain do you have? But that tells the health care provider something very important. If we give some medicine, does it slide down to a 4 which is not much better or does it slide down to a 0 or a 1 and how long does it stay there? If we know how long it stays there or how far down the pain rating goes we can figure out how we should adjust the medicines a little bit in order to be able to do even a better job. The pain medicine would doubt taking 260 milligrams three times a day. Another important way to communicate how you are feeling is to keep a diary of your pain. This helps your doctor or nurse determine how effectively your pain is being controlled. I'm going to be putting together stuff for starting your IV. In some cases treating the cause of the pain with chemotherapy, surgery, and radiation can help relieve the pain. Arthur Moten found that after a week of chemotherapy his cancer pain improved. I notice around but the fourth to fifth day I start feeling a lot of relief. I start cutting my own grass, I start cleaning my car and I start doing a lot of the things I wasn't able to do at first. But in most cases treating the cancer alone does not relieve the pain so you'll have to treat the pain as well. The most common way in which pain can be successfully controlled is with the use of pain medications and for most patients they only need to use oral medications to control their pain. Pain control is a process of finding the right drug or combination of drugs that's right for you. Your pain control team will work with you to keep your level of pain as low as possible at all times. There are really three different groups of medications that can be used. One group of medications is used for what we would consider mild pain. They're medications that patients may be familiar with being able to actually get just in the pharmacy without a prescription, things such as Tylenol and Motrin. Once that no longer works there is a progression to medications that we use for more severe pain and these are medications like morphine or what they're also called opiates. There's a third group of medications as well. A good example is drugs that are used to treat epilepsy can also be very effective in treating certain types of cancer pain. Many patients worry about taking certain types of pain medicines like morphine because they're concerned about becoming addicted but when used to treat cancer pain addiction is very rare. There's been research done that shows that only about one in 10,000 patients will ever become addicted as a result of taking pain medications for pain control and that's the key. We always try to remind our patients to ask themselves if you didn't have pain would you be taking these pain medicines and universally their reply is always no of course not. In fact sometimes your pain is enough you need to think about no addiction because you're only looking for that pain to relieve from that particular thing that you're taking it for. Once your pain has been brought under control it's important that you stay on a regular schedule of taking the medications your doctor has prescribed. Patients who are put on scheduled medications really keep maintain better pain control. Once they go off of their schedule and they don't take their medications on a scheduled basis then their pain comes back and it takes much more medication to eventually get their pain back under control again. There may be times when you're more active and need a little extra help. Your doctor will prescribe additional doses of medication to help you enjoy the things you like to do that may cause you pain. The things that I would just do moderately I could do a whole lot better, a whole lot longer and so I was told not to overdo it and if I found myself overdoing I would take a little pain pill or a little morphine, a little Percocet, not that much but just to keep the pain under control. Hi, Chiefs of the Catholicities. Yes, Mrs. Pace, how are you today? I have a prescription here for you for oxycodone tablets. Unfortunately, side effects often accompany the use of some medications used for treating cancer pain. And have you taken this medication before? Yes, I have. And did you have problems with it? Yes, I did. Okay, why don't you wait for a few minutes and we'll sit down and talk about it. But these side effects can almost always be treated with either other medications or changes in diet. You mentioned that you had had a problem when you took the oxycodone before. Tell me what the problem was. When I took it I got really sick in my stomach. What we do oftentimes is give patients other medications to prevent them from being sick to their stomach. Your pharmacist can assist you by answering any questions you might have about a particular medication or its side effects. Most pain medications are taken as a pill or liquid by mouth. But sometimes it may be necessary to find other means in which to deliver the pain medication. Rectal suppositories can be used for patients who can't swallow tablets. Then we can move on up to things like giving some of the pain medications into a vein or IV, as it's commonly called. It can also be injected into a muscle or simply just by sliding a needle in under the skin and giving it just underneath the skin. All of these methods are also very effective in managing cancer pain. One very safe and effective way of managing pain is with a patient-controlled analgesia or PCA pump. This pump can be used to give medication into a vein under the skin or into the spine. When patients feel pain they simply press a button to receive a dose of medicine. This allows a patient to have greater control over their pain management either in the hospital or at home. Controlling cancer pain often goes beyond the use of medications and treatments. You have to learn all over again how to live because you're not able to get around, you're not able to do the things you used to do before. So you have to learn how to live all over again. While drugs can help reduce physical pain, you still need to address the pain you may be feeling emotionally. Your outlook on life can affect the way you feel both mentally and physically. The social work role in the pain control for patients and for families is that of the person who can listen to their feelings to listen to what it's like to be in pain for an extended period of time. There are a variety of what we call non-pharmacologic, non-medication treatments for pain. Perhaps the most common is relaxation. When I walk in a room I'm the person who comes in with no needles, no medicine, and actually no magic either. I come to listen to people from my heart to their heart to understand where their feelings come from. Sometimes simply enjoying an activity alone or with a friend or spouse can help you focus your attention away from your pain and put you more at ease. One of the things I think that has also helped her on pain is family and especially the grandchildren. When they come she can seem to stand a lot more pain. So when family comes or people, some of our friends come to visit, that's really been very beneficial. You, the patient, have an important role in controlling your pain. Communicating your feelings openly with your medical team, staying on a schedule of pain treatment, and letting your doctor or nurse know when something isn't working are key to keeping your pain under control. If you're taking a medicine and it's not working for you, you have to speak up because you don't, the doctor can't help you if you don't help yourself. You have to let him know how it's affecting you, it's not working for you or if it is working for you, how it's working for you. You have to work that out and you have to sit down and be able to talk to your doctor about that. Trying to see that she'll go right, you got first preference. Whatever the cause of your pain, whether from cancer or its treatment, you can rest assured that pain does not have to take control of your life. No matter the severity, it can almost always be treated effectively. There is really no reason for patients to suffer with pain when they've got their tumor. Pain doesn't do anything positive for a patient who's trying to enjoy their family and their activities at the same time. It can be controlled, you just have to be patient and try different things and see what helps.