Mr. A middle aged man who is diagnosed with Stage IV lung cancer (his cancer has transferred or metastasized already to his bones) came to my clinic. He was very unpleasant, did not smile at all, had a stooped posture, hair unkempt and clothes crumpled. The first thing he said to me when he sat down was this: “Doctor, I want to die. I am just abiding by my relatives’ wishes which is why I’m here. If it were up to me, I would not see you at all. I don’t think there is anything you can do”.
Another patient, Mrs. B, an elderly woman, who was previously well, developed back pain, difficulty of breathing and weight loss over a span of 2 months. Upon examination, she was also discovered to have lung cancer. When I saw her, she looked very very weak, she had very poor appetite, she was very irritable towards her relatives and they were complaining to me about their difficult in adapting to her recent behavior.
Those were not isolated cases. These kinds of reactions and complaints are very very common among cancer patients. Relatives often complain that the patients become difficult to deal with. Ninety-nine percent of the time, the reason why they react in such a manner is because they are in severe, excruciating pain.
Pain and Cancer
A large majority of patients with cancer will experience pain at some point in the course of their illness. Almost one third of patients with pain will experience severe pain. Most of these patients are those with advanced stage disease.
The causes of pain may be any or a combination of the following:
- 1. The Cancer itself
– The tumor can compress other structures such as bone and nerves.
– Cancer can obstruct blood vessels that supply blood to other organs
– The tumor can release chemicals that can make pain nerves more sensitive to pain
- 2. Side-effects of treatment or procedures
– Chemotherapy can cause mouth sores that can produce pain
– Surgical procedures such as biopsies or mastectomies
– Other treatment related procedures such as blood extractions
Effects of Cancer Pain
All of us know that nobody wants to experience pain because it is extremely unpleasant. However, the effects of pain go beyond this unpleasant sensation. Pain affects the overall quality of a patient’s life. It not only affects the individual afflicted with pain but the entire family or those people around him. These effects include:
– Lack of appetite
– Inability to sleep
– Irritability, behavioural changes, depression
– Inability to carry out tasks
– Shortened period of survival
– Loss of joy in living
– Family misunderstandings
– Feelings of isolation
No Need to Suffer
The next time I saw Mr. A, he had a smile on his face and greeted me when I entered the clinic. He was seated upright, his face shaven and it took me a while to recognize him. He spoke calmly and told me how grateful he was since he started taking the pain medications. He regained his appetite and was able to sleep at night without the need to give additional medications to put him to sleep. He felt well-rested after a very very long time. He never said he wanted to die anymore.
The next time I saw Mrs. B, she was sound asleep and the relatives greeted me with a smile and a lot of gratitude. They said that it was the first time that she was able to sleep very soundly after a long while.
These and countless patients need not suffer from pain anymore. In fact, many patients would tell me that they are not afraid to die but are afraid of experiencing pain. The good news is they don’t need to experience the pain. There should be no reason for concern. Medicines that reduce pain are widely available, generally affordable and tolerable. Concerns about safety, especially in the light of celebrities dying from drug overdose, do not pertain to cancer patients.
Pain medicines are generally safe when used properly and under supervision. Our bodies will not easily go into overdose when there is and as long as there is pain to control. I have patients who take hundreds of milligrams of morphine but if you chance upon them in the mall, you wouldn’t suspect that they are taking that much morphine. Have no fear. The celebrities suffer their fate because of inappropriate use and combination of these drugs.