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The Prostate Net
Pain management for patients and
caregivers
Biren Saraiya MD
The Cancer Institute of New Jersey
ARS
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
– Palliate the symptoms (prolong quality of life)
• In either setting, optimal pain control is
desired
Pain
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S
U
C
K
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Pain
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Subjective
Underreported
Compromises function
Control requires Knowledgeable patient and
clinician
• Side effects need to be addressed
Pain Therapeutics
• Non pharmacological
– Heat/Cold
– Exercise
– Radiation, Surgery
• Pharmacological
– Delivered differently
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Oral
Intravenously
Nerve block
Patches (lidocaine, fentanyl)
Pain Therapeutics
• Pharmacological
– NSAIDS (ibuprofen)
– Acetaminophen (tylenol)
– Opioids
• Short acting (Oxycodone, hydromorphone)
• Long acting (oxycontin, MS Contin, Methadone)
– Antidepressants
– Anti-seizure medications
Understanding Opioids
• Works well for different types of pain
• Concern for addiction low
• 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
• Changes should be in percentages, not absolute
numbers
Being advocate for yourself
• Establish a goal with your treatment team for
pain control
• Ensure the treatment team meets the goal
• If goals not met, ask for help
– Pain Management Specialists
• Anesthesiologists
• Medical Doctors
– Palliative Care Specialists
• Medical Doctors who also specialize in symptom
management