Running head: CANCER PAIN MANAGEMENT

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Cancer Pain Management Lavon R. Williams University of South Alabama

Running head: CANCER PAIN MANAGEMENT Cancer Pain Management Cancer is rapidly becoming a chronic illness, and an estimated that 10 million individuals in the United States are survivors of cancer (Sun, Borneman, Piper, Koczywas, & Ferrell, 2008). According to 2008, cancer statistics from the American Cancer Society, about

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565,650 people die in the United States from cancer every year. Approximately 1.6 million new cases of cancer are expected to be diagnosed in the United States this year (American Cancer Society, 2012). This is why the health care needs of cancer patients are unique, and many are at risk for developing late or long-term side effects and pain from their primary treatments. These long-term effects may also hinder optimal physical, psychological, and cognitive functioning for patients (Sun et al., 2008). Pain is experienced by 30% to 50% of cancer patients receiving treatment and by 70% to 90% of patients with metastatic or advanced disease. In almost every cancer-related case pain is inadequately managed due to a lack of patient and professional knowledge of optimum management (Sun et al., 2008). This paper will discuss how nurses can help provide adequate pain management in advanced cancer patients. Patient and family needs Support for the patient and family may include education and information, coping skills, counseling and psychotherapy, and family meetings, etc. Patients, as well as their family have psychological needs. Family members’ psychological distress can be as severe as that of the patient. Studies of psychological distress have found that the psychological distress of patients and their family paralleled over time so when you help the family to manage their distress may have a beneficial effect on the distress level of patients (Herschbach, Keller, Knight, Huber, Henrich & Marten-Mittag, 2004).

Running head: CANCER PAIN MANAGEMENT Psychological/Psychosocial/Physical concerns One third of patients with cancer will experience distress which requires evaluation and treatment, patients and their families must cope with the stresses induced by physically

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demanding treatments for the illness and the permanent health impairment and disability, fatigue, and pain that can result (National Cancer Institute, 2012). These effects contribute to emotional distress (guilt, feelings of loss of control, anger, sadness, confusion, and fear) and mental health problems (depression, anxiety and adjustment disorders) and together can lead to substantial social problems, such as the inability to work and reduced income (National Cancer Institute, 2012). Impact of culture/ethnicity on issue Some pain studies show that pain is greatly influenced by cultural factors. Members of some ethnic groups have a higher tolerance for pain than others and can endure increasing levels of a pain stimulus for longer periods (Narayan, 2010). Thus, people of different cultures respond differently to pain for example people from cultures that value stoicism tend to avoid vocalizing with moans or screams when they are in pain. They may strive to keep their faces "masked," trying not to show their pain even by grimacing. They may feel that they'll be perceived as weak if they admit to or show pain, and they may deny having pain when asked. They may prefer to be left alone to bear their pain without bothering others and may have learned to cope without seeking attention or care (Al-Atiyyat, 2009). Nurses need to remember that patients' cultural background can have a big influence on how pain is perceived. Barriers to Care Overcoming barriers to pain management in cancer care is critical to improving quality of life in patients living with cancer but first we must understand the reasons for unrelieved pain

Running head: CANCER PAIN MANAGEMENT symptoms (Ayres, 2012). There are three types of barriers to pain management: patient, professional and system related. Patient-related barriers include reluctance to report pain, attitude about pain and its treatment, and fear of addiction or side effects from medication.

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Professional barriers include lack of knowledge of pain relief, side effect management, poor pain assessment, and fear of patient addiction/tolerance. System-related barriers include access to treatment, inadequate reimbursement and regulatory constraints (Sun et al., 2008). Clinical Evaluation Pain is a common symptom experienced by cancer patients. Inadequate treatment of pain is a serious clinical problem and has been well documented for over 25 years (Elcigil, Maltepe, Esrefgil, & Mutafoglu, 2011). Cancer pain is frequently assessed and treated inadequately. Preventing and managing pain without intolerable side effects from treatment is the goal of care. Because nurses are often the first to hear a patient’s report of pain their ability to perform a comprehensive pain assessment is critical. Tools used to assess pain should cover pain intensity, location, and characteristics, as well as pain-related hindrance with activity (Starck, Sherwood & Adams-McNeill, 2000). Pain assessment tool may include verbal descriptor scales, pain thermometers, numeric rating scales, and facial pain scales (Hanks-Bell, Halvey, & Paice, 2004). Expressions of pain behavior include agitation, confusion, social withdrawal, or apathy. Other signs of pain include the following: facial expressions, vocalization, body movements, changes in interpersonal interactions, changes in activity, or mental status changes (Hanks-Bell, et al., 2004). Management The data obtained from the pain assessment helps form the plan of care, including pharmacologic and nonpharmacologic therapies. Pharmacologic therapies include: non-opioids;

Running head: CANCER PAIN MANAGEMENT

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opioids, nerve blocks and adjunct drugs. Non-pharmacologic therapies include various physical, cognitive-behavioral and emotional therapies for both acute and persistent pain (Starck et al., 2000). Advance Practice Nurses (APNs) and other health care providers should make appropriate referrals for pain which cannot be managed by traditional means. As members of interdisciplinary teams (IDT) involved in patient care, education & training, management, and research, nurses are in a pivotal position to improve cancer pain assessment and management (Starck, et al., 2000). Advance Practice Specific Role Functions APNs are vital members within the health care team who deliver high-quality, evidencebased interventions to patients who are experiencing unrelieved pain from advanced illnesses like cancer by reducing discomfort and promoting quality of life. The APNs are prepared to identify, support, and make the appropriate referrals that address the patient’s pain management needs (Kuebler, 2003). As a Nurse Leader, APNs mentor and empower other IDT members in providing effective pain assessment and management. As Nurse Educators, APNs educate other disciplines regarding pain and symptom management. As clinicians, we utilize appropriate techniques to assess, evaluate and manage pain as mentioned above. APNs work together with other members of the IDT to create and implement a comprehensive treatment plan for meeting the needs of the patient and family (Matzo & Sherman, 2010). Summary Managing cancer pain during advance disease states can be complex. Unrelieved pain has significant functional, cognitive, emotional, and societal consequences. Pain can markedly impact the quality of an individual’s life, increase vulnerability in certain populations, and create

Running head: CANCER PAIN MANAGEMENT reliance on healthcare providers to access for adequate pain management (Hanks-Bell, et al., 2004). APNs and other nurses play a crucial role in pain management process but first we have

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to overcome barriers which hinder effective pain management. There are a variety of tools used to assess pain and the accuracy of pain management. Pharmacological and non-pharmacological interventions are used to treat pain. APNs, with advanced knowledge, skills and understanding of the multiple needs of the patient and their family, can promote an empathetic and focused care, and is an asset to the interdisciplinary team (Kuebler, 2003).

Running head: CANCER PAIN MANAGEMENT Reference Al-Atiyyat, N. M. H. (2009). Cultural diversity and cancer pain. Journal of Hospice and Palliative Nursing, 11(3), 154-164. Retrieved from http://www.nursingcenter.com/prodev/ce_article.asp?tid=864763 American Cancer Society. (2012). Cancer facts & figures 2012. Retrieved from

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http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/docum ent/acspc-031941.pdf Ayres, E. (2012). Managing chronic pain in older adults: 6 steps to overcoming medication barriers. Chronic Pain Perspectives, 61(9), S16-S21. Retrieved from http://chronicpainperspectives.com/Article.aspx?aid=176&t=Managing-chronic-pain-inolder-adults%3a-6-steps-to-overcoming-medication-barriers Elcigil, A., Maltepe, H., Eşrefgil, G. & Mutafoglu, K. (2011). Nurses' perceived barriers to assessment and management of pain in a University Hospital. Journal of Pediatric Hematology/Oncology, 33, S33–S38. doi: 10.1097/MPH.0b013e3182121bef Hanks-Bell, M., Halvey, K. & Paice, J. A. (2004). Pain assessment and management in aging. Online Journal of Issue in Nursing, 9(3). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/ OJIN/TableofContents/Volume92004/No3Sept04/ArticlePreviousTopic/PainAssessmenta ndManagementinAging.aspx Herschbach, P., Keller, M., Knight, L., Huber, T., Henrich, B. & Marten-Mittag, B. (2004). Psychological problems of cancer patients: a cancer distress screening with a cancerspecific questionnaire. British Journal of Cancer, 91(3), 504-511. doi: 10.1038/sj.bjc.6601986

Running head: CANCER PAIN MANAGEMENT Kuebler, K. K. (2003). The palliative care advanced practice nurse. Journal of Palliative Medicine, 6(5), 707-714. Retrieved from www.aahpm.org/pdf/pcapn.pdf Matzo, M. & Sherman D. W. (Ed.). (2010). Palliative care nursing quality care to the end of life. New York, NY: Springer Narayan, M. C. (2010). Culture's effects on pain assessment and management. American Journal of Nursing, 110(4), 38-47. Retrieved from http://www.nursingcenter.com/prodev/ce_article.asp?tid=998868 National Cancer Institute. (2012). The caregiver’s quality of life. Retrieved from http://www.cancer.gov/cancertopics/pdq/supportivecare/caregivers/patient/page4 Sun, V., Borneman, T., Piper, B., Koczywas, M., & Ferrell, B. (2008). Barriers to pain assessment and management of cancer survivorship. Journal of Cancer Survivor, 2(1), 65-71. dio: 10.1007/s11764-008-0047-0

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