Improving pain management in cancer patients

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Improving pain management in cancer patients


Pain is often the most feared aspect of cancer. Therefore, pain management is an ongoing and important issue, which concerns many patients and health professionals alike. Many misbeliefs from health professionals and patients, such as "pain is an unmanageable and inevitable feature of advanced cancer" or "opioids cause addiction" have led, and are still leading to ineffective pain management that causes unnecessary suffering and reduces quality of life. Recent advances in the understanding of pain and pain management are shifting the trend from unnecessary suffering and reduced quality of life to effectively controlling pain in up to 90% of cancer patients. New treatment options that have been developed to control pain effectively do not only include new technologies and advances in pharmacology but also ways of caring for the cancer patient and changes in the whole health care sector. Some major breakthroughs in pain management such as controlled release morphine and patient controlled analgesia pumps have replaced outdated and less effective methods of pain management. Furthermore, many alternative measures of controlling pain in cancer patients, such as acupuncture, massage and relaxation have proven to be helpful as adjuncts to therapy in pain control. Such alternative measures have been known for many years and today feature as a major come back in pain management. Due to a broader knowledge, innovative treatment options and advances in technology, new ways in dealing with patients with cancer pain emerged and had an immense impact on nursing practice that turned the biomedical model of health care to a more holistic model. This conference paper will give an insight in the new technologies and treatment options that are available in cancer pain management and will compare those to the outdated strategies used previously. Furthermore, the paper will research the dangerous misbeliefs in cancer pain management and explore how recent changes in treatment and technology affected those beliefs to benefit the patient and the whole health care sector.


Pain is a common symptom for cancer patients and one of the most feared consequences for patients and their families (Oncology Nursing Society, 2004). Cancer pain evolves as a result of the disease or disease-related treatment and causes significant physical and psychosocial burdens, which markedly influence the patient's quality of life (Hawthorn, Aranda & Webb, 1996). Every person has the right to optimal pain relief that includes culturally appropriate and sensitive assessment, intervention and management. Although, effective control of cancer pain was a remote goal 30 years ago due to a lack of knowledge, skills, technology and many misbeliefs, today, cancer pain can be controlled effectively in up to 90 % of patients, provided that appropriate knowledge and skills are implemented and misbeliefs questioned (Canadian Association of Nursing in Oncology, 1999).

Since nurses have more frequent contact with patients than any other health care professional, they are in a prime position to offer effective and current pain relief for the patient with cancer (Hawthorn, Aranda & Webb, 1996). However, advances in knowledge of cancer pain, pharmacology, technology and new treatment options bring along many new challenges for the nursing profession. It is the aim of this conference paper to explore the impact that the new advances in cancer pain management have on the nursing profession and consequently on the patient. The conference paper will compare the old techniques, treatments and beliefs about pain management that nurses possessed decades ago with the recent ones and show how new advances can benefit the patient. It is outside the scope of this paper to explain in depth the scientific issues of treatment devises, medications and technical advances.

Historical aspects of pain management

Historically, pain was seen as an emotion rather than a sensation that was experienced by the heart and not the brain (Meldrum, 2003). During the Reformation, pain was seen as punishment and considered synonymous with wrongdoing (Matteliano, 2003). As a result of those pain theories, caregivers were unwilling or unable to give adequate analgesia for pain relief and patients suffered needlessly.

More recently, in 1965, Melzack and Wall proposed the gate control theory, which showed that the central nervous system plays a major role in the pain experience and therefore, pain is not only a physical symptom occurring in response to disease, it can have significant emotional and psychological components as well (Hawthorn, Aranda & Webb, 1996). The patient's perception of the physical component of pain is now thought to be influenced by the patient's previous experiences about pain, cultural issues, current environment and own beliefs and values (Crisp & Taylor, 2001).

Pain in today's society is seen as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage" (International Association of the Study of Pain, 2004). Therefore, pain is not only experienced on a physical level such as intensity, location and quality but also with emotional feelings such as anxiety, frustration and depression. Pain is a multidimensional phenomenon and many health care professionals today adapt a more practical definition from McCaffery's that states "pain is what the patient says it is and exists when the patient says it does" (Tollison, Satterthwaite & Tollison, 2002).
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Advances in pain assessment and their influence on nursing practice

Since health care professionals are aware of the importance of pain management because it influences a patient's quality of life drastically, they shifted their primary care goal from cure and survival in cancer patients to supportive care that includes pain management, promoting comfort and maintaining the quality of life (Crisp & Taylor, 2001). This shift impacted on nursing greatly, since adequate and on-going pain assessment, implementation of the prescribed pain management plan and evaluation of the patient's responses to the implemented interventions, play a major role in ...

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