HER2 Support Group Forums - View Single Post - ~Pain Medication~What Do You Use For Extreme Pain??

dlaxague · 12-01-2008, 11:32 AM

Marie, do you have access to providers who specialize in pain management? Some are called palliative care specialists or simply pain specialists. They are really good at what they do and work hard to effectively relieve pain (which is probably the easier part) while keeping side effects tolerable. This can require some finesse and patience, not to mention knowledge and experience. It's usually not the forte' (nor the interest) of regular oncs or PCP's.

Morphine comes in a myriad of ways and routes. Fentanyl too - it's similar to a short-acting morphine although there are ways to get it in more steady doses also (like patches or pumps). Some prefer Dilaudid (less nausea perhaps if that's an issue). Then there are the neuropathy drugs that can be a big help in relieving pain, plus the NSAID's that work well with narcotics so that 1+1 might equal 3 or 4.

I'm sure that you know that as you move up into the heavier-duty drugs, you need to be extra vigilant and proactive about keeping those bowels moving. Constipation from narcotics can be kinda like fatigue from chemo - there just should be stronger words to describe the phenomenons. Everyone has their favorites for dealing with this so Ed can pick and choose but be sure he's paying close attention. The pill that I hear mentioned most often is senokot, preferably generic as it's quite pricey.

Most people with pain issues find a baseline rate that keeps "the usual" pain under control, and they stay on that round the clock, not just as needed. Then they have a plan for something quick for breakthrough pain. If conditions are changing rapidly, it can mean frequent consults (often by phone) with the provider. Much better to stay on top of pain than to try to catch up once it's escalated.

As for pain r/t treatment - haven't I read that there can be a flare of pain as a treatment begins to kill cancer cells?

Good luck, will you let us know how this goes?

Debbie Laxague

12-01-2008, 11:32 AM	#4
dlaxague Senior Member Join Date: May 2006 Posts: 221	pain specialists Marie, do you have access to providers who specialize in pain management? Some are called palliative care specialists or simply pain specialists. They are really good at what they do and work hard to effectively relieve pain (which is probably the easier part) while keeping side effects tolerable. This can require some finesse and patience, not to mention knowledge and experience. It's usually not the forte' (nor the interest) of regular oncs or PCP's. Morphine comes in a myriad of ways and routes. Fentanyl too - it's similar to a short-acting morphine although there are ways to get it in more steady doses also (like patches or pumps). Some prefer Dilaudid (less nausea perhaps if that's an issue). Then there are the neuropathy drugs that can be a big help in relieving pain, plus the NSAID's that work well with narcotics so that 1+1 might equal 3 or 4. I'm sure that you know that as you move up into the heavier-duty drugs, you need to be extra vigilant and proactive about keeping those bowels moving. Constipation from narcotics can be kinda like fatigue from chemo - there just should be stronger words to describe the phenomenons. Everyone has their favorites for dealing with this so Ed can pick and choose but be sure he's paying close attention. The pill that I hear mentioned most often is senokot, preferably generic as it's quite pricey. Most people with pain issues find a baseline rate that keeps "the usual" pain under control, and they stay on that round the clock, not just as needed. Then they have a plan for something quick for breakthrough pain. If conditions are changing rapidly, it can mean frequent consults (often by phone) with the provider. Much better to stay on top of pain than to try to catch up once it's escalated. As for pain r/t treatment - haven't I read that there can be a flare of pain as a treatment begins to kill cancer cells? Good luck, will you let us know how this goes? Debbie Laxague __________________ 3/01 ~ Age 49, occult primary announced by large axillary node found by my husband. Multiple CBE's, mammogram, U/S could not find anything in the breast. Axillary node biopsy - pathology said + for "mets above diaphragm, probably breast". 4/01 ~ Bilateral mastectomies (LMRM, R simple) - 1.2cm IDC was found at pathology. 5 of 11 axillary nodes positive, largest = 6cm. Stage IIIA ERPR 5%/1% (re-done later at Baylor, both negative at zero). HER2neu positive by IHC and FISH (8.89). Lymphovascular invasion, grade 3, 8/9 modified SBR. TX: Control of arm of NSABP B-31's adjuvant Herceptin trial (no Herceptin): A/C x 4 and Taxol x 4 q3weeks, then rads. Arimidex for two years, stopped after second patholgy opinion.