Are you having any pain. These are most likely the first words from a registered nurse to an oncology patient. Pain is a concept that creates many challenges for medical professionals. In a review of patients with cancer, pain was reported in 33% of patients after treatment to cure cancer, 59% of patients given anti-cancer treatment with the aim of either curative or palliative treatment, 64% of patients having advanced, metastatic or terminal cancer and 53% of patients with all stages of the disease (Chapman, 2012a). Pain management is a common reason an oncology patient is admitted as an inpatient to a hospital. Nurses are at the forefront of assessing and managing pain to achieve adequate therapy. However, in order to reach this outcome, nurses need to understand the types and causes of pain, assessment tools, non-pharmacological treatment and action of pain medications (Casey, 2011). Nursing staff and other medical professionals need to act as patient advocates when dealing with pain so that symptoms can be managed. Nevertheless, within the healthcare system, the prevalence of pain is increasing and pain is a complex issue that is not always well understood or managed by healthcare professionals and patients (Shaw, 2006).
Nurses are constantly faced with managing pain and need to develop skills to identify when pain is not adequately controlled in order to make recommendations to alleviate a patient’s pain. Unfortunately, there are many times when both nurses and physicians are not well educated in pain management and are not successful in decreasing an individual’s pain level. Regardless of the variety of treatment options, cancer pain is not always effectively managed due to several barriers that include poor assessment, insufficient knowledge about pain and treatment and specific concerns about dependence, tolerance, addiction and drug-related side effects (Chapman, 2012b). In addition, many medical professionals hold inappropriate beliefs and attitudes toward pain management, which can affect providing pain relief for patients (Naylor, 2003). Some practitioners are fearful of prescribing or administering pain medications at a high level that might be required due to a patient’s tolerance. This creates many challenges in providing adequate pain control for patients that are able to verbalize their pain, as well as those patients who are not able to verbally express their pain levels.
Pain is a significant concept in oncology nursing. Physicians and nurses working with this population need to be experts in pain management. It is critical for medical professionals to understand the different types of pain that oncology patients can experience. There are several pain management treatments available and not every medication will work effectively for a patient. It is important for nurses to recognize differences so that patients can be effectively managed. When pain is not adequately controlled, patients can become withdrawn and unable to focus on important aspects of their quality of life including activities of daily living and sexual and social relationships (Chapman, 2012a). In addition, mood, sleep patterns, cognition and existential beliefs can be affected (Chapman, 2012a).
There are several types of pain that an oncology patient can experience. The most common types of pain are chronic pain, acute pain and breakthrough pain. Chronic pain is a constant pain. Acute pain can last anywhere from a few days to a few months and typically resolves when the underlying condition is treated (Chapman, 2012). Breakthrough pain happens briefly with moderate-to-severe flare-ups that occur even when a patient is taking long acting pain medication to address their chronic pain (Kedziera, 1998). Understanding these types of pain is pivotal to determine medications to be prescribed and implement non-pharmacological therapies. When medical staff understands the causes and types of cancer pain, they can individualize pain management strategies in order to improve the quality of patient care as well as provide sufficient pain relief (Chapman, 2012a).