The Prostate NetPain Management for Patients and Caregivers

Biren Saraiya MDThe Cancer Institute of New Jersey

Question for audience

• What concerns do you have about pain control?1. My doctor does not think pain is important2. My doctor is too busy to talk about symptoms including pain3. If I talk about my pain, my doctors will not treat my cancer 4. Doctors will not be able to control pain5. Pain medications will make me an addict6. Pain medications will make me “loopy”7. Pain is inevitable

Key Points• Pain control is desirable and achievable• There are many choices for pain therapy– Oral medications– Intravenous medications– Patches– Radiation/surgery

• Pain control requires frequent reassessment, adapting to needs and management of side effects

Goals of Care

• In Cancer treatment, there are two goals:– Cure the cancer– Palliative the symptoms (prolong quality of life)

• In either setting, optimal pain control is desired

Pain Therapeutics

• Pharmacological– NSAIDS (ibuprofen)– Acetaminophen (tylenol)– Antidepressants – Anti-seizure medications– Opioids• Short acting (Oxycodone, hydromorphone)• Long acting (oxycontin, MS Contin, Methadone)

Pain Therapeutics• Pharmacological (different delivery systems)– Pain pumps– Patches (lidocaine, fentanyl)

• Non pharmacological– Radiation, Surgery– Exercise, Heat/Cold– Quadramet

Understanding Opioids

• Works well for different types of pain• Not concerned about addiction• Most side effects (nausea, vomiting, drowsiness etc.)

last only few hours to days• Exception is constipation

• When need to increase medication dose, increase in PERCENTAGES, not absolute numbers

• dosing should be based on desired and achieved pain control (mild, moderate, severe)• Changes should be in percentages, not absolute numbers

Professional Help

• Pain Management Specialists– Anesthesiologists–Medical Doctors

• Palliative Care Specialists–Medical Doctors who also specialize in symptom

management