Even if cancer treatment is successful, you may still need to find relief from persistent pain.(MARTIN POOLE/ISTOCKPHOTO/HEALTH)Cancer, a scary enough diagnosis in itself, often brings on unexpected pain that, left untreated, can get in the way of successfully treating the original cancer. Here two patients share their stories.
When diagnosed with advanced ovarian cancer, 59-year-old Barbara Chance, of Glendale, Ariz., was not expecting to later feel numbness and pain in her feet and hands. But two bouts of chemotherapy later, she ended up with neuropathypainful nerve damage in her fingers and feet.
"Sometimes at night if I'm lying down and I turn over, these pains will start shooting through my feet," says Chance. "It can get quite bad."
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Standing became so painful that Chance left her job at a pharmacy and went on disability. She had been prescribed Neurontin for day-to-day relief of nerve damage pain and occasionally took Dilaudid, an opioid, to alleviate more intense pain spikes. Both medications helped, but when she told a neurologist what she was taking, Chance says his frosty attitude shocked her. He told her that he thought the Dilaudid might be causing her additional pain, but she also sensed that he thought she had become addicted to it.
"He asked me if I take it every day and I said, 'Sometimes I do, I might take it four days in row.' He didn't want to hear my side of it at all," says Chance. "That doctor believed nothing in pain management. He upset me so badly that I was crying."
To prove the neurologist wrong, Chance stopped taking the Dilaudid for several months. But proving that point was more painful than it was worth in the end. Luckily, Chance found a new neurologist who was more open to the pain management that worked for her. He told her the Dilaudid was fine if it worked and switched her from Neurontin to Lyrica, which has reduced not only her everyday pain but also the frequency with which she reaches for the Dilaudid.
Next Page: If one doctor doesn't have the answer, keep looking [ pagebreak ]If one doctor doesn't have the answer, keep looking
When Ann Dosch, 58, of Millersville, Pa., had an exploratory lumpectomy in March 2007, she discovered that she had breast cancer and was treated with another lumpectomy followed by radiation therapy. But when the pain around her incision wouldn't go away and started spreading to her collarbone and shoulder, her surgeon shrugged it off, "He said physical therapy was not going to help me and said 'I don't know why you are having this pain.' I thought, 'I'm never going back to you ever again,'" says Dosch.
Her next stop was the radiation oncologist, who told her that she might have to live with the pain for a couple of years and to take Extra Strength Tylenol. But the pain was getting worse and the Tylenol didn't help.
Dosch got a third opinion from her medical oncologist and this time she found the answer she was looking for, "She told me physical therapy might help. And I was so happy. We both decided it certainly wouldn't hurt." Dosch's doctor also wrote her a prescription for Neurontin.
Dosch held off taking the drug and went to a physical therapist who applied small amounts of pressure to the areas that were hurting her, and gave her exercises to release tightness in the region of her pain. After just one visit, Dosch felt some relief, "I left the first session wanting to cry," says Dosch, "because I felt so relieved that somebody was helping me."
Physician education is catching up
Eugenie Obbens, MD, acting chief of the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center in New York City, blames doctors' neglect of this issue on education, but she believes understanding about the problem is growing.
"Until 10 or 15 years ago there was very little education in oncology textbooks about cancer pain," says Dr. Obbens. "Now there are a lot more books available, more lectures have been given at conferences, pain management is usually covered, there's more action in the hospitals. It's now strongly recommended that each hospital have a pain specialist. Pain has become more visible."
Find a pain specialist
"There are a growing number of pain specialists who have more and more methods to treat pain, like interrupting pain signals," says Timothy Moynihan, MD, a medical oncologist at the Mayo Clinic in Rochester, Minn. "Talk to your oncologist about referring you to a pain clinic; most of the major cancer centers will have them. It takes many, many people to treat pain," says Dr. Moynihan.