Magazine article American Nurse Today

Managing Chronic Pain in Cancer Survivors: Thorough Assessment Is the First Step in Pain Management for These Patients

Magazine article American Nurse Today

Managing Chronic Pain in Cancer Survivors: Thorough Assessment Is the First Step in Pain Management for These Patients

Article excerpt

CANCER SURVIVORS, who are at a higher risk of chronic pain than the general population, require detailed assessment to help identify the cause of their pain. That assessment is the first step in developing a comprehensive treatment plan that controls your patient's pain, improves quality of life, and increases functional status with minimal risks and adverse effects.

Definitions are important

First, let's define some terms. Cancer survivors, can be defined in two ways:

1. someone who has completed treatment and shows no evidence of disease

2. someone at any point on the spectrum from diagnosis to death. Pain can be categorized as acute, chronic, neuropathic, visceral, or somatic. It can be described as stabbing, throbbing, aching, cramping, and squeezing. (See Defining pain.)

No matter how it's described or defined, the experience of pain is unique to each person and can be complicated by emotional, physical, psychosocial, and spiritual issues.

This article focuses on cancer survivors who show no evidence of disease but are experiencing chronic pain.

Risk for undertreatment

Various factors can put cancer survivors at risk for undertreatment and influence how they experience pain. Everything from emotional and spiritual distress to age, race, ethnicity, gender, and social support can impact pain assessment, perception, and management.

Patients at especially high risk of undertreatment include the elderly, children, minorities, and those who are active drug abusers or have a history of drug abuse. Older patients, for example, can be at a higher risk of an incomplete or difficult pain assessment because of barriers such as memory or hearing loss, confusion, or fear of being a burden. Studies have shown that elderly men, in particular, are more likely to be stoic in their expression of pain, which may require you to be more creative in your pain assessment.

Ethnic, racial, and cultural minorities face a risk of underassessment and undertreatment because of language barriers or a lack of trust in the healthcare team. Provider bias can also create barriers to pain management.

Patients may be reluctant to report pain if they recognize it as a possible sign of cancer recurrence. Cost and availability of treatment also create barriers to care, as can a lack of social support to help with tasks such as transportation and medication administration.

Cognitive barriers can lead to a patient misunderstanding the illness or the source of the pain. And feeling a loss of control or of being abandoned by God can intensify the pain experience, as can depression and anxiety.

In some cases, a patient may be undertreated due to the clinician's lack of pain management education or a reluctance to prescribe opioids.

Possible pain sources

If your patient complains of new acute pain, this might indicate a cancer recurrence and should be promptly assessed. If the pain is severe and uncontrolled, your patient may require emergency medical treatment.

However, many cancer survivors experience chronic pain, and your knowledge of cancer pain syndromes helps identify the cause of pain, and in turn can help determine the best treatment. Cancer and its treatment can be debilitating, which also may contribute to pain syndromes and loss of functional ability.

* Surgery may contribute to chronic pain syndromes. For example, 20% to 30% of patients have chronic neuropathic pain in the chest wall after mastectomy. Many patients also experience chronic neuropathic or somatic pain after thoracotomy. In addition, procedures that result in adhesions, lymphedema, nerve damage, or other complications can contribute to ongoing pain in cancer survivors.

* Radiation can cause chronic pain related to the location of radiation therapy. For example, brachial plexus damage during radiation can cause ongoing neuropathic pain called brachial plexopathy. …

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