Second Issue, Series Two

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Introduction to Oncology Pain Management

Lillie D. Shockney, RN, BS, MAS

In part 2 of our Conquering the Cancer Care Continuum series, the focus is on pain management. Despite dramatic improvements in pharmaceutical agents, as well as surgical procedures designed to help control pain, we still have a long way to go to be successful on behalf of our patients.

I was recently watching a few minutes of an old, black-and-white western movie. A cowboy had been shot by a gunslinger, and as the town doctor attempted to remove the bullet from his chest, another cowboy gave the wounded man a bottle of whiskey to drink and a knife to bite between his teeth. I’m sure back in the day this was how people coped with pain – liquor to numb them and something hard to bite on. This is far from ideal.

Today all patients who enter a hospital environment, whether it be an inpatient unit or a clinic visit with their doctor, are asked to complete a pain measurement tool that provides some expression of whether they are presently in pain, and to what degree. Patients have trouble, however, interpreting what to circle (a happy face or a very sad face) if their pain was bad in the morning but not so bad now because they took a pain pill before coming to see the doctor. Furthermore, is this information actually reviewed by anyone during their visit? Sometimes it is, and sometimes it is not.

Certainly one of the greatest fears expressed by cancer patients is the fear of pain and suffering and the inability to overcome it effectively, fearing they will die while in great pain. Family members, too, commonly respond that their greatest fear is having to witness their loved one in great pain without a way to ease the suffering. Family members fear these will be the final images they witness before their loved one dies.

Many organizations have developed measurement tools and practice guidelines for the purpose of helping providers effectively manage pain associated with cancer and its treatment. The following articles provide you with a wealth of information associated with these tools and guidelines. They also promote that thoughtful care be taken to ensure that all of us address with our cancer patients the pain they are experiencing and implement ways to relieve it. Pain steals away social time, psychological well-being, and physical endurance and can make quality of life virtually absent for some patients. Accurate assessment and adequate treatment for effective pain management need to be priorities for all of us working in the cancer field.

I feel confident you will find these articles thought provoking and containing valuable information that will assist you in reassessing your current patients as well as developing more effective ways to help your future patients have quality of life by having pain effectively managed.

Uncategorized - March 25, 2013

Classifying and Managing Pain in the Oncology Patient

Mrs S is a 58-year-old female who presented to the nurse practitioner complaining of fatigue and mid-thoracic back pain that had become worse in the last few weeks. She works full time as a fourth-grade teacher and cares for her 3 grandchildren every weekend while her daughter works. The youngest [ Read More ]

Uncategorized - March 25, 2013

Clinical Decision Making in Assessing and Treating Cancer Pain

JB is a 57-year-old male who presents to the emergency department complaining of acute left-sided chest pain (8/10 on a numeric pain scale) that has been ongoing for approximately 48 hours following a fall at home. He has taken ibuprofen and acetaminophen with no relief. Chest x-ray reveals 3 fractured [ Read More ]