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    Coping With Pain During and After Cancer

    All of us look forward to our treatments ending. We think that that we will have an uneventful return to normal life. But for some cancer patients, they suffer from pain after treatment as a late side-effect of their cancer treatment.


    The causes of chronic pain are as varied as are the diagnoses. These are the leading causes of pain in cancer survivors. Chemotherapy-induced peripheral neuropathy Pain after head and neck cancers Post-mastectomy pain
    Oncologists estimate that about one-third of their patients suffer from chronic pain after treatment. More patients are surviving cancer for longer times. Many survivors are well past the 10-year mark. Improving the quality of life through more effective pain management has become a higher priority now. Some of the long-term side effects, including pain, appear long after treatment ends.
    Where do cancer survivors fit in the opioid epidemic?
    A recent study by Duke University shows that cancer patients are ten times less likely to die of an opioid overdose than the general population. The researchers studied anonymous death certificates from the National Center for Health Statistics. Death certificates contain a single cause of death and up to 20 contributing factors along with demographic information. They looked at death certificates from 2006 to 2016.
    The results were definitive. Cancer patients are much less likely to die from an opioid overdose. 895 opioid-related deaths in cancer patients versus 193,000 in the general population. .66 per 100,000 people in the cancer populations versus 8.97 per 100,000 in the general population.
    Almost half of the opioid-related cancer deaths occurred in just two kinds of cancer — lung and gastrointestinal cancer. The other cancer diagnoses linked to opioid-related deaths were head and neck (12 percent), blood cancers (11 percent) and genitourinary (10 percent).
    Access to opioids has been reduced over the last few years as the opioid deaths continue to rise. Reduced access to pain medication affects cancer patients today. Walmart’s new opioid policy is just one example of how cancer patients and cancer survivors are adversely impacted. Walmart and other pharmacy chains now fill enough opioid for 7 days. Yet cancer patients undergo complex surgeries that the general population will never face. Most cancer patients need pain medication after surgery for several weeks.
    What’s Being Done to Help Pain in Cancer Survivors?
    Oncologists, surgeons and radiology oncologists are all exploring ways to effectively treat patients’ cancers while reducing the possibility of long-term pain.
    Newer surgical techniques help many patients. For example, more lumpectomies and less aggressive mastectomies reduce the risk of post-mastectomy pain syndrome (PMPS). PMPS may cause nerve endings to misfire for no reason, causing mild to severe pain.
    Use of other medications (instead of pain medications) for chemo-induced peripheral neuropathy. These medications include anti-epileptic drugs, anti-seizure medications and antidepressants.
    More effective use of pain medication, upfront, can reduce the need for extended physical therapy. Breast cancer surgery may cause adhesive capsulitis, a condition known as frozen shoulder. Frozen shoulder can be completely cured with physical therapy — but patients can’t effectively do the physical therapy without adequate pain relief. 


    What problems do we need to address specifically for cancer patients?
    Unfortunately, laws are a “one-size fits all” band-aid solution. Cancer patients may not get the pain relief that they desperately need to heal. Poorer patients (both in urban and rural areas) are especially at risk. The new laws create barriers for writing and filling prescriptions. Patients who lack transportation may be unable to travel back to a surgeon’s office to obtain another prescription for pain medication after colorectal, lung or other major surgery.
    Lung cancer patients are particularly at risk of suffering shortness of breath because access to morphine and other opioids is so tightly controlled. These substances help relieve the “breathlessness” caused by the removal of a lung or a lobe of a lung.
    Alternatives aren’t always well understood by oncologists and other physicians, insurance companies or our elected and government officials. Many alternative methods of pain relief like acupuncture, yoga and medical marijuana face prejudice and lack of acceptance. Lack of insurance coverage for these alternative methods of pain control limit which patients even have access to alternative pain-relief methods. Even milligram dosages are limited — methadone used to be available in 40 mg. tablets — now it is only available in 5 and 10 mg. tablets.
    Complementary Treatments That May Help
    Many complementary treatments exist. Some alternative treatments work for some people but not for others. Many patients find that adding complementary treatments to conventional medicine provides the best pain relief.
    Acupuncture. Acupuncture is an ancient Chinese method of inserting needles into precise locations. Modern science believes “needling” these points stimulates the nervous system to release chemicals into our muscles, spinal cord and brain.
    Biofeedback. This technique helps teach a patient to gain voluntary control over a normally automatic bodily function, like our heart rate. Biofeedback can help chronic pain, headaches, high blood pressure and even urinary incontinence.
    Massage. Massage comes in many forms. It can help relieve spasms, cramping and nerve pain. Massage enhances sleep, relieves anxiety and reduces fatigue. 


    Mind + Body. Meditation, hypnosis, and mindfulness are forms of mind + body where we learn to channel negative thoughts into more positive feelings. Mind + body is often combined with other complementary practices.
    Tai Chi . This ancient Chinese martial arts technique is gaining a following among older adults as a low-to-moderate exercise to increase balance and flexibility. Cancer survivors with chemo-induced peripheral neuropathy (CIPN) learn to use their entire body when exercising. They regain their confidence by reducing the risk of falls.
    The use of repurposed drugs helps peripheral neuropathy too. Older antidepressant drugs called tricyclics may provide excellent pain relief for nerve pain. These drugs include amitriptyline, imipramine, clomipramine, desipramine, and nortriptyline. They are inexpensive and are usually well tolerated. Anti-seizure medications sometimes work. Finding the one that works for you may take some trial-and-error, but many cancer survivors find relief using repurposed drugs.
    Don’t forget about over-the-counter pain relievers. Many of these provide powerful pain relief when used for specific types of pain. Nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen and Naproxen are good for inflammation, joint pain and bone pain. Frozen joints and general stiffness respond well to NSAIDs. Just remember to take with food to avoid stomach upset.
    Acetaminophen. This is a powerful pain reliever that is sometimes unappreciated. Be sure to follow dosing directions to avoid liver damage. Topical and local analgesics. Lidocaine patches and creams, peppermint oil and OTC gels get high marks from some patients. They work on nerve pain and joint pain.
    Don’t give up if your chronic pain robs you of quality of life. Schedule an appointment with your oncologist or primary care physician specifically to discuss pain management.


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