P

pain management in cancer The ability to
improve comfort and provide relief from PAINand
related symptoms that cancer and cancer treat-
ment may cause. Many people worry about the
potential for their cancer to cause pain. However,
the broad spectrum of available ANALGESIC MEDICA-
TIONS and other methods provide numerous
options to manage, and often entirely relieve, pain
due to cancer.

Causes of Pain in Cancer
Pain in cancer arises from either the cancer or
from treatments for the cancer. Cancerous tumors
can cause pain when they invade tissues and dis-
rupt the nerves. Sometimes cancer can also invade
NERVEtissue, also causing pain. Damage to struc-
tures, such as may occur when cancer invades and
destroys tissues and organs, causes the cells of
those structures to release numerous CYTOKINES
(biochemicals that activate various components of
the IMMUNE RESPONSE). Among these cytokines are
substances that stimulate nociceptors, specialized
molecules in peripheral neurons that send pain
signals to the CENTRAL NERVOUS SYSTEM. RADIATION
THERAPYis often effective for pain relief in such sit-
uations, as it can shrink the tumor so it no longer
pressures nerves and other structures. Sometimes
surgery to remove part of the tumor also provides
relief.
SURGERY FOR CANCERis most often the cause of
treatment-related pain. Sometimes surgery for
cancer is extensive, and the recovery period can
be lengthy and challenging. Most people are eager
to recuperate and return to their normal activities
as quickly as possible. They may feel taking anal-
gesic medications prolongs their recovery or may
fear that taking narcotic medications, the strongest
pain relievers, will result in ADDICTION. Neither is

true. It may be necessary to take analgesic medica-

tions regularly and for an extended time after

major cancer surgery to effectively manage the

pain. This is important because adequate pain

relief not only provides comfort but also allows

the body to heal. Protracted pain is emotionally

and physically stressful in ways that interfere with

HEALINGand QUALITY OF LIFE.

Analgesic Medications for Pain Relief

Over-the-counter analgesic medications such as

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

and acetaminophen often provide relief from mild

to moderate discomfort and pain. Prescription

NSAIDs and narcotic medications may be neces-

sary for moderate to significant pain. Dependence

and addiction are very seldom concerns in people

who are taking narcotic pain relievers for such

levels of pain. As well, there is little risk for over-

dose, another major concern.

Though there is a ceiling effect with NSAIDs (a

point beyond which increasing the dose does not

provide any greater pain relief), this is not the case

with opioid analgesics. The body seems able to

accommodate the effects narcotics have on the

respiratory cycle when the narcotics are necessary

to relieve high levels of pain. However, opioid

pain relievers do impair judgment and thought

processes enough to make activities such as driv-

ing hazardous and ill-advised.

Palliative Treatments for Pain Relief

Radiation therapy and surgery are often options

for palliative treatment for pain resulting from

cancer. These treatments reduce the size of

tumors, relieving their pressure on surrounding

tissues. The relief may extend months to years,

depending on the cancer. There is no discomfort

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