NEW YORK--The fear that pain may signal advancing disease often stops
patients from telling their physicians about it and getting relief,
Nessa Coyle, RN, MS, director of palliative care, Memorial
Sloan-Kettering Cancer Center, said in a talk to cancer patients at
Cancer Care, Inc. headquarters.
One of the biggest misconceptions, she said, and one that patients
may share with some physicians, is that aggressive pain management
only occurs at the end of life. "Palliative care is important
throughout the course of the disease," Ms. Coyle said. "That
is a message which really has not yet been widely integrated into
oncology practice. If it had been, people would be less fearful of
aggressively managing symptoms."
Patients may also be afraid that if their physician treats the pain,
he or she will stop focusing on curative treatment. But pain control
is an integral part of cancer treatment, she stressed.
"This is a very important message to get across to cancer
patients and to their relatives and friends," she said.
"Unless you control the pain, its going to interfere with
the treatment, with the patients immune system, and with their
ability to participate in activities they enjoy."
At Sloan-Kettering, Ms. Coyle said, patients are asked when they are
admitted if they have had persistent pain, if they have received
treatment for it, and if they were satisfied with the treatment.
Once admitted, they are asked twice a day, in the morning and
afternoon, if they have pain, the level of the pain on a scale of 0
to 10, and if the drugs they are getting provide relief. "Unless
you have these ongoing questions," Ms. Coyle said, "patients
sometimes slip through the cracks because they dont like to
talk about their pain."
Patients should also be asked what they think their pain means, she
said, to sort out the misconceptions. "They may think their pain
is associated with ongoing disease when actually it is associated
with the treatment--or they may think their pain is never going to
get better when, in fact, the pain can be controlled."
Putting Up a Stop Sign
Patients should be instructed on the specific steps to take when pain
occurs. Ms. Coyle advises her patients to think of a stop sign.
"It says, Stop. Ive had this pain before, and I know what
I do. I take my medication. I sit down. I do focused deep breathing,
and if the pain does not decrease by 50% (with oral medication) in
half an hour, I take another rescue dose. If the pain has not
decreased in half an hour, I take another rescue dose, and I call my
resource person--whoever that may be, a pain nurse or physician."
Patients can use their individuality to develop imagery that will
help them manage pain, Ms. Coyle said. "When the pain is
escalating, they put the stop sign up. They take the rescue
medication. They sit down or lie down, do focused breathing, and then
they use the imagery."
A nurse or social worker who is skilled in this process can help the
patient develop the imagery that is right for them, Ms. Coyle
suggested. They can also make an audio tape to get the patient
started using the imagery at home.
Imagery at Work to Control Pain
Nessa Coyle, RN, MS, of Memorial Sloan-Kettering, offered two
One patient was an artist who had a burning component to his pain and
Her second example was a young person who loved cars. He would take
As the rescue dose took effect, he visualized the speedometer going
Pain and Suffering Not the Same
While medications can ease patients pain, they may continue to
suffer, Ms. Coyle said, noting that there is a difference between
pain and suffering. "It is the self that suffers," she
said. "Suffering is very individualized. The amount of distress
can be totally unrelated to the pain. It is related to what is
important to the individual and how their life has been altered by
the disease process."
Since cancer affects the family support network, that can be part of
the suffering people go through too, because the familys
lifestyle has also been changed, she noted. "Thats all
part of the suffering. And suffering for each of us is very
different," Ms. Coyle said.