Table of Contents

Chapter 8: Managing Bone Metastases and Pain

d. Managing Pain

Although pain can oftentimes be relieved by treating the bone metastases with radiation, bisphosphonates, or other bone-targeted therapies, you might still need additional pain medications.

There are three general rules of pain management that you should always keep in mind.

1. Don’t try to be too tough or act "macho". Cancer can be painful, and there’s no benefit in acting stoic and pretending it doesn’t affect you. Untreated pain takes a toll on the body, forcing it to expend a lot of energy fighting it. There are plenty of very effective pain medications available, and using them will allow you to feel better and stay stronger.

2. There might be a very simple solution to your pain. Don’t assume that you can’t get pain relief unless you’re completely doped up. Remember, the goal of pain management is to keep your body strong so you can fight your disease. Some very simple and easy to take oral medications might be enough to ease your pain and help you get back on track.

3. Don’t worry about becoming addicted to pain medication. The most common reason that doctors are afraid to prescribe strong pain medications and that people are afraid to take them is fear of addiction. But that’s mostly because people don’t understand the differences between addiction, physical dependence, and tolerance.

Addiction is a psychological and behavioral syndrome in which there is continual or increasing use of a drug despite negative physical, psychological, or social consequences. In fact, taking pain medications so that you can spend your days feeling healthier and stronger would seem to be exactly the opposite of addictive behavior.

On the other hand, both physical dependence and tolerance are possible, so you and your doctors should take them into consideration as you start and stop different pain medications.

If you are physically dependent upon a drug, your body will not know how to cope with its loss if you stop it or lower the dose too rapidly, and you will show symptoms of withdrawal. This is why doses of strong pain medications are usually tapered before stopping, meaning that your doctors will give you a gradual lowering of the dose over time so that your body will learn to adapt and adjust to its loss.

If you use a certain drug for a long period of time, you can build up a tolerance to it, to the point where the drug is no longer effective. Slowly increasing the doses over time can help to avoid the onset of tolerance, but that’s only a temporary measure, and you’ll likely have to switch to a medication that works in a slightly different manner before you can find relief.

Keep in mind that if you have a history of drug addiction or drug abuse, you should tell your doctors as soon as possible. It won’t keep you from getting any pain medication, but it will ensure that your doctors monitor your responses to your medication more closely so you don’t get too physically dependent or build up a tolerance too quickly. In addition, it is likely that you will need higher doses of the medication to gain the full benefit and overcome your tolerance to the medication.

If your doctors seem unwilling or unsure of how to treat your pain, seek out the opinion of a pain specialist. There are dozens of different types of medications available, some designed specifically to treat long-term pain and some designed specifically to treat brief pain flares. If you find no relief from oral or intravenous drugs, there are also a number of minor surgical procedures that can be done to help you find relief.

Keep in mind that every pain medication, like all other medications, has its own set of side effects. Constipation is the most common side effect of pain medication use; so common, in fact, that it is not a question of if you will be constipated, but rather a question of when you will get constipated. If you use pain medications on a regular basis, even as little as once a day, you will need to start on an aggressive bowel regimen with stool softeners, laxatives, or other therapies to prevent constipation and the problems that can result from it if not treated effectively.

Other side effects can include nausea and vomiting, sleepiness, and confusion. Most of these start to fade as your body builds up tolerance to the drug, but be sure to discuss the side effects with your doctor so you can know what to expect and how to deal with it.

Remember, your goal is to stay as strong and healthy as possible so you can fight your disease. It might take some time to figure out how to effectively treat your pain, but if you work with your team of doctors and nurses, together you will find the treatment path that’s right for you.