One distinct, uniquely personal symptom unifies almost all patients with cancer: pain. It can be as wildly varied and different as each patient it affects. It can be acute, sudden experiences of pain, or the symptoms can be chronic and perpetual.
Patients undergoing the treatments associated with cancer often suffer varying degrees of pain through their cancer journeys, which leads to significant physical and psychosocial burdens. This can decrease their quality of life and potentially impact their overall outcomes. A 2015 National Comprehensive Cancer Network report suggested that the evidence suggests a clear link between improved survival outcomes and adequate symptom management.
Oncology nurses spend more time with their patients than any other medical professional on the cancer care team. Patients report their symptoms, seek advice, and rely on the expert knowledge and care of their nurses. Through proper education and dedicated symptom management resources, oncology nurse can be equipped to face the challenges of mitigating pain in their patients.
Pain in Patients with Cancer
According to studies, anywhere from 20%–75% of patients with cancer report experiencing pain at the time of diagnosis. It’s often categorized as acute, chronic, breakthrough, or refractory. It can be nociceptive (i.e., injury caused to the tissue) or neuropathic (i.e., damage to the peripheral or central nervous system).
Patients will react differently to differing types of pain management techniques. Individualizing and tailoring pain management is crucial for oncology nurses and the healthcare team. Patient education and shared decision making are key as well. Developing a pain management plan with patients can help to outline the process and ensure that everyone is on the same page.
Because pain is one of the most commonly reported symptoms for patients with cancer, ONS developed evidence-based resources for nurses to apply in practice.
Assessing Pain and Choosing the Right Intervention
Identifying the type of pain and its potential origin is a crucial step when helping patients. According to the National Cancer Institute’s healthcare professional cancer pain information, several points of information should be identified prior to selecting the appropriate intervention.
- Is the pain acute or chronic?
- Is it secondary to cancer, cancer treatment, other causes, or a combination?
- Is it somatic, visceral, neuropathic, or mixed?
- Does it have an incidental component?
- Is breakthrough pain involved?
ONS has links to nurse-focused assessment tools for cancer-related symptoms, including PROMIS and the Brief Pain Inventory for assessing pain.
Once a patient has been fully assessed, interventions must be selected based on efficacy and safety. ONS experts and project teams have evaluated the literature and research studies to identify the evidence surrounding interventions to combat pain. ONS’s Putting Evidence Into Practice web resource provides a detailed overview of interventions that oncology nurses can use to help manage patients’ pain based on their individual needs.
Discussing Opioids With Patients in Pain
Opioid treatments may be a good choice for patients experiencing pain. However, as news continues to emerge of the U.S. opioid epidemic, patients may be wary of undesirable effects like addiction, abuse, constipation, and more. It’s crucial that oncology nurses address these concerns with their patients and close any educational gaps concerning the intricacies of pain management, especially as it pertains to opioids.
It’s known that opioids—although extremely effective at combatting pain symptoms—bind the brain’s limbic system and can produce reward responses. For many, this leads to dependence and drug-seeking behaviors. This response, coupled with the need to increase dosing levels in patients with intense pain, can lead to additiona issues like chemical coping. Providers should be aware of these potential effects to plan accordingly.
Ultimately, patients with cancer require access to opioids—as well as other pain mitigating strategies—to effectively manage cancer-related pain. Since this patient population faces a unique symptom profile, ONS continues to develop new resources for oncology nurses everywhere. ONS is actively advocating on a national level for proper access to pain management strategies, especially as the country continues to address the growing opioid epidemic.