Cancer and pain: It's okay to ask for help

Unfortunately, pain in cancer patients is very common and affects most aspects of an individual’s life. But would it surprise you to know that cancer pain is severely under-treated in patients?

Research shows this could be for a number of reasons:

• As doctors, we sometimes focus all our energy on treating the disease and lose sight of controlling the pain along the way
• Patients often fail to talk to their doctors about their pain, falsely believing that some amount of suffering “goes with the territory”
• Patients and doctors are often hesitant to use morphine and other opiods for pain control, fearing addiction, when in reality patients being treated for cancer rarely form such an addiction.

The good news is, we believe 90% of chronic cancer pain can be treated with drug AND non-drug therapies. Source.

First and foremost, you are the only one who knows what your pain feels like. How you communicate your pain is the single most important factor in treating it.

This means, you must work with your care team to explain what is bothering you and exactly how it is bothering you. I recommend keeping a pain journal to help track anything that may be causing your discomfort. Controlling your pain is vital in maintaining your strength, emotionally and physically.

Pain can affect:

• Your sleep quality and your ability to perform daily activities
• Your mood and coping abilities
• Your relationships with others around you, including your social support system
• Your spiritual or religious beliefs

If you experience a new onset of pain, or sudden change of your chronic pain, call or see your doctor immediately.

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You don't have to put up with cancer-related fatigue

Fatigue is a common problem and also one of the most distressing symptoms associated with cancer and its treatment, yet it has been consistently under-reported. Many patients believe that feeling weak, tired or exhausted is a necessary evil when your body is fighting cancer. Cancer-related fatigue profoundly affects the quality of life of patients and their families through physical, psychosocial, and economic/occupational aspects.

The most important factors contributing to cancer-related fatigue are:

• treatment with chemotherapy or radiation therapy (RT)
• anemia
• pain
• lack of exercise
• sleep disturbance
• poor nutrition
• emotional distress

Anemia is the most common reversible cause of cancer-related fatigue, particularly among patients receiving chemotherapy. Treatment includes red blood cell (RBC) transfusion, or using erythropoietin stimulating agent such as procrit.

Pain: Pain in cancer patients is also considered under-reported. If you are in pain talk with your doctor, it could be contributing to your cancer-related fatigue.

Lack of exercise: To avoid fatigue, cancer patients often are advised to rest and down-regulate their daily activities. However, because inactivity can induce muscular wasting, prolonged rest can lead to further loss of physical strength and endurance. Although you may not think so, physical exercise training programs can increase your functional capacity, leading to reduced effort in performing usual activities and a decreased sense of fatigue. Again, talk with your doctor to develop a program that is right for you.

Emotional distress and sleep disturbance: Sleep disturbance associated with fatigue is often difficult to treat and manage. It may be influenced by numerous factors including daytime naps, depression, anxiety, medication, sleep interruption because of nocturia or hot flashes, and evening food and/or beverage intake. Cognitive-behavioral therapy and stress reduction may help insomnia and sleep disorders.

Poor nutrition: One of the most common side effects of cancer is a change or loss of appetite which results in fatigue. However, your body has never needed proper nutrition more. It may be helpful to keep a journal of what you are eating. When you speak with your doctor next you can go through it together and make sure your diet is providing your body with all the essential nutrients it needs.

Medication:Psychostimulants (methylphenidate, dexmethylphenidate, or modafinil) and antidepressants may be useful if the above methods do not improve fatigue.

If you are suffering from cancer-related fatigue don’t just assume that being exhausted “goes with the territory.” Talk with your doctor to develop a plan and get you functioning at your best level.