Oncology patientscanraise some questions about chronic pain and cancer
- I have a lot of pain despite treatment by my oncologist. What else can the Pain Management Clinic do for me?
Cancer pain is very complex. Especially as the disease progresses as there are usually various types of pain occurring at the same time. Your pain is our main concern and therefore we have experience managing the very unusual medications used by oncologists. We also have the ability to apply techniques that reduce pain levels up to the very advanced stages of disease to help preserve quality of life.
- How we can do for a patient whose cancer has advanced too far for chemotherapy?
Particularly in the later stages of the disease, when the patient has only a few weeks left, the presence or absence of pain is very important. Hence techniques such as epidural blocks, nerve blocks, epidurals or intrathecal infusions of analgesics can be applied to help the patient live better. There is also evidence that good pain management in expert hands can prolong survival in addition to the quality of life.
- Is the Pain Management Clinic appropriate only for the later stages of cancer?
When pain management is proving difficult it is advisable to seek the assistance of the Pain Management Clinic regardless of how far along your disease is.Â We help patients by providing our services to the other medical departments at Centro Medico Teknon. The ideal situation for cancer patients would involve us working closely with the oncology service so that as they apply the appropriate therapies to reduce tumor size the Pain Management Clinic makes sure that the pain of these procedures is diminished or prevented entirely.
- Does morphine use cause addiction?
Do not confuse the terms dependence, addiction and tolerance.
Tolerance implies the need for increased doses to achieve the same therapeutic effect. This happens with morphine but does not usually lead to problems because, first, there is no roof, every time we increase the dose the desired effect increases with it. Secondly, there is also a tolerance for side effects, so that as time goes on side effects such as nausea and sleepiness disappear.
Physical dependence means that if we interrupt treatment a number of unpleasant symptoms can appear suddenly which we call "withdrawal syndrome." This can be solved by re-administering the medication or by using tranquilizers.
Psychological dependence is what is usually called addiction. Psychological dependence only happens when morphine is used to achieve a mental state different from normal. Among people with chronic pain with or without cancer the occurrence of addiction is less than 0.2%.
- Why do I need more morphine every time?
As explained above, this may be due to morphine tolerance itself or also due to the progression of the disease.
- If I start taking morphine will I ever be able to stop?
In the same way that pain treatment can progress to stronger and stronger doses as pain increases, weaker and weaker doses can be used as it decreases until the pain is gone and drugs are no longer needed. Halting morphine dependence is a well-documented and a relatively simple process.
- If I start taking morphine and I suffered from a lot of nausea. Does that mean I can not take any type of opiate?
Reactions to different opiates (morphine, methadone, fentanyl, buprenorphine, oxycodone, tramadol, and codeine) differ per person and depend on the number and type of nerve receptors we have for them. So a bad experience with one type should not discourage the possible use of others.
- Are there other opiates besides morphine?
As already mentioned there are other drugs that are derived from opium or are synthetic that interact with the Mu and Kappa receptors of the brain like morphine does. The most commonly used among them are fentanyl, buprenorphine, methadone, tramadol and codeine. At present they can be administered by oral, transdermal, transmucosal oral, intravenous and epidural methods. Their effects can be both fast and brief or slow and lasting (up to 72h). Various types can be combined to handle acute pain and chronic pain at the same time or individually.
- Practical tips for transdermal opiates
Always read the directions before using any medication. Special care should be taken of the skin at the application site as the patches can cause skin irritation. It is also important to note that the speed with which the drug passes from the patch to the skin and into the blood, depends on the temperature of the skin. So be careful in a fever situation as there is a risk of overdose.
Medication patches do not have a localized effect, the drug enters the bloodstream through the skin and is effective all through the body.
- I have unrelieved rheumatic pain. Can opiates only be used for cancer pain?
TIt is becoming more common that when pain is severe it is treated with potent medication irrespective of the origins of the pain. There has been considerable field work and studies that support the use of opiates in patients with non cancer chronic pain and found no more complications nor higher incidences of addiction to that found in cancer patients.
Adequate control and an ongoing relationship between doctor and patient virtually eliminate addiction related problems.
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