Pain in Pancreatic Cancer Can Be Controlled

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The management of pain for patients with pancreatic cancer is one of the most important aspects of their care. Pain is a common symptom that can be successfully controlled. The best management of pain is aggressive therapy with constant assessment. The patient with pancreatic cancer who is experiencing pain can maintain his/her quality of life.

A patient’s report concerning his/her pain should always be the primary source of information that health care providers use to assess and control pain successfully. 

The goals of pancreatic cancer pain management are to control pain, prevent or minimize side effects and to enhance quality of life. The goals of the health care provider are to understand the causes of the pain, perform a comprehensive assessment, select the most appropriate drug/medication and nondrug interventions, and evaluate the patient’s response to these treatments.

Comprehensive Pain Assessment
Assessment of pain intensity

• Onset: When did it start? How often does it occur?
  
• Location: Where is it?
  
• Quality: What does it feel like? (stabbing, shooting, cramping, dull, aching)
  
• Intensity: What is the intensity of the current pain?
  
  
  1. Numerical rating scale: On a scale of 0 to 10, with 0 being no pain and 10 the worst pain imaginable, the patient needs to select a number between 0 and 10 that best describes how intense the pain feels. When is it most intense? When is it better?
     
  2. Verbal descriptor scale: The patient needs to indicate if he or she is in pain. If so, is the pain mild, moderate, or severe?

Aggravating and relieving factors: What makes the pain better or worse?

• Previous treatment: What treatments were used in the past and how successful were they?
  
• Relief with current treatment: Is relief of pain complete, almost complete, partial, very little, none?
  
• Side effects of current treatment: Is the patient experiencing any side effects to current treatment?
  
• Assess other factors that influence the management of pain.

Effect of pain on patient and family members/significant others.

• Meaning of pain to patient and family/significant others.
  
• Usual coping strategies for pain and other stressors.
  
• Mood states.
  
• Effect of pain on sleep and fatigue.
  
• Concern about addiction and side effects of medication.
  
• Concern about costs of treatment.

Treatments
The use of opioids (or narcotics, the strongest pain relievers available) is the main way to treat pain from pancreatic cancer. Other types of medicines used to relieve pain that are not opioids are: acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). At times, medicines called adjuvant analgesics are also used. These are medicines used for purposes other than the treatment of pain but help in relieving pain in some situations.

Types of Opioids Recommended for Pain of Pancreatic Cancer*
codeine
hydrocodone (Vicodin®, Vicoprofen®)
hydromorphone (Dilaudid®)
Tramadol (Ultram®)
Ultracet (Tramadol & Acetaminophen)
Ultram®
Vioxx® (nonsteroidal anti-inflammatory drug (NSAID))
levorphanol (Levo-Dromoran®)
morphine (Kadian®, MSIR®, MS Contin®, Oramorph-SR®)
oxycodone (Roxicodone®, OxyIR®, OxyContin®, Percodan®)
Esgic Plus-Generic (BUTALBITAL)
fentanyl (Duragesic®, Actiq®)
methadone (Dolophine®)
Fioricet (generic Butalbital)
Butalbital APAP w/Caffeine
Celebrex
Imitrex

MSIR=morphine sulfate immediate release
MS Contin=morphine sulfate sustained release
Oramorph-SR=morphine sulfate sustained release
Roxicodone=oxycodone immediate release
OxyIR=oxycodone immediate release
OxyContin=oxycodone sustained release
Percodan=oxycodone and immediate release

*Opioids are available only by prescription

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