Running head: NURSING INTERVENTIONS FOR CANCER PAIN 1

Nursing Interventions for Pain in Cancer Patients

Courtney Eades

Brigham Young University-Idaho School of Nursing

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Collaborative Pain Management in Cancer Patients

The Problem of Pain in Cancer Patients

Pain continues to be a problem for many cancer patients. Cancer pain is a type of pain

that requires a great deal of management to control and maintain the patient’s quality of life. As

cancer survival rates increase due to advancing medical treatments, there is increasing need to

control pain in patients compared to before (Dickenson and Falk, 2014, p. 1647). The number of

cancer patients in the world is increasing, and the majority of these patients experience moderate

to severe pain. Boveldt et al. (2014) claims that “pain is one of the most prevalent symptoms of

patients with cancer,” and that more than half of cancer patients experience pain (p. 1204). With

more than half of cancer patients complaining of significant pain, collaborative care measures

need to be employed.

Without pain control, patients’ quality of life decreases. They are potentially unable to

perform activities of daily living such as getting dressed and getting around the house or even the

activities that they enjoy like spending time with family or hobbies that they participated in

before being diagnosed with cancer. Boveldt et al. (2014) said that in addition to causing

difficulty with activities of daily living cancer pain often causes anxiety, depression, and sleep

disturbances (p. 1203). As a result, pain management is an important part of a cancer patients’

health care.

Pathophysiology of Cancer Pain

The mechanisms of cancer pain are more complex and involve more stimulating factors

than other common types of pain. Patel, Hacker, Murks, and Ryan (2016) affirm that because of

the complex nature of cancer pain, the different members of the healthcare team need to more

fully understand the underlying pathophysiology to be capable of assisting the cancer patient
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with maximizing life. The more the interdisciplinary healthcare team knows about the underlying

cause of discomfort in cancer patients, the more successful they will be in to improving their

patients’ quality of life. Nurses especially need to be able to comprehend the process of pain in

cancer patients to be able to develop the most beneficial interventions. As patient advocates,

nurses can make a greater impact as they learn more to understand what their patient is going

through.

Cancer pain has many different elements involved. Patel et al. (2016) describes cancer

pain as a combination of continuous, progressive pain with periods of breakthrough pain (p.

1648). Breakthrough pain is defined as pain that develops even when the patient’s baseline pain

is under control with treatment. Patel et al. (2016) finds that it is this breakthrough pain that is

the most difficult to treat. Both continuous and breakthrough pain have different physiologic

mechanisms. Patel et al. (2016) explains that the reason cancer pain is so complicated is that it

includes both inflammatory and neuropathic pain stimulations (p. 1648). Inflammatory pain

occurs as the inflammatory response is triggered by the tumor or as the tumor releases pain

mediators on its own. Neuropathic pain occurs as the tumor damages the nerves themselves

either by cancer cells invading the nerves or by the tumor compressing the nerve. Because the

pain is being caused from different sources, different types of treatments will be required to

control the types of pain. This requires specific communication between the different members

of the healthcare team.

Pain Assessment

Another important element of care for a patient with cancer pain is the pain assessment. It

is important that members of the healthcare team can efficiently assess pain in order to be able to

assist in the management of pain. Lim et al. (2015) claims that “reliable and comprehensive pain
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assessment is an essential first step for ideal cancer pain management” (p. 226). According to

Lim et al. (2015), there are many obstacles to an accurate pain assessment of cancer patients such

as a patient’s unwillingness to express the severity of the pain, the healthcare provider’s

interpretation of the patient’s pain symptoms, and the patient’s skepticism of opioid analgesics

because of fear of addiction (p. 226, 228). Patients can sometimes try to be tough and might

report their pain as lower than it really is which prevents the healthcare team from providing

adequate pain treatment, allows the pain to escalate out of control, and decreases a patient’s

quality of life. In addition, a physician could put their own interpretation of how patients are

expressing their pain which can sometimes be biased and an inaccurate assessment of pain.

Considering these as well as other assessment difficulties, the healthcare team should be careful

to perform an adequate pain assessment.

In order to combat these barriers to accurate pain assessment, different pain assessment

tools have been developed. Lim et al. (2015) found that the self-reporting bedside pain

assessment tool provided for 79.5% pain control satisfaction for cancer patients (p. 227). They

claim that this pain assessment tool “reduced the gap between pain intensity reported by

patients” and the pain that the healthcare team reported when using other assessment tools (Lim

et al., 2015, p. 228). The self-reporting pain assessment will not work when in some situations

such as when patients are unconscious or with infants and young children. However, in most

situations, it will allow for the healthcare team to better understand the discomfort being felt by

the patient and be able to treat more effectively.

Patient Education

Patient education is one of the most critical duties of the healthcare team, and nurses have

the most vital role in patient education. Lim et al. (2015) explains that one of the main problems
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with effective pain management for cancer patients is the patient’s understanding of the process

of pain management, and that “only 60% of patients had adequate knowledge of cancer pain

management” (p. 226). When patients misunderstand the principles and importance of pain

management for maintaining quality of life and ability to complete activities of daily living, the

patient will be less likely to seek pain management. Educating a patient about the assessment

tool being used can improve the accuracy of the assessment which will, in turn, allow for better

care of patient’s discomfort. Lim et al. (2015) also found that patients are typically uneducated

on the effects of opioid analgesics, and consequently, may be unwilling to use them even when

the best choice for their pain management (p. 226). Education about the medications and

interventions used in pain management is an important part of allowing a patient to be included

in their own care.

Opioid Analgesics

Research and technology are developing more strategies for controlling pain in cancer

patients. However, opioid medications are still the most common medication and still viewed as

the best method of control for cancer pain available at this time (Portenoy, 2011, p. 2239).

Unfortunately, opioid medications come with many risks that cause patients to question their

desire to take them. One common problem is the risk of addiction. According to Portenoy

(2011), there are principles of opioid management that should be used to decrease this risk (p.

2240). Under the prescription and management of a physician, opioid analgesics can be safe for

cancer patients and improve their quality of life. Physicians can order long acting opioids that are

slower acting to reduce the euphoric effect and the likelihood of becoming addicted (Portenoy,

2011, p. 2241). However, there is still always the risk of developing an addiction to the opioids.

Because of this adequate education needs to be given to the patient about the risks, benefits, and
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the safety measures implemented to allow the patient to make the decision for themselves.

Included in this education should also be the other interventions available in addition to

medication to allow for a more holistic control of pain.

Nonpharmacological Nursing Interventions for Pain Control in Cancer Patients

In addition to pharmacological interventions for discomfort in cancer patients, there are

strategies a nurse could utilize not including medication that could potentially help a patient feel

relief. Portenoy (2011) described techniques such as guided imagery and relaxation training

which could “reduce pain and anxiety, improve coping, and increase self-efficacy” (p. 2245).

Guided imagery involves thinking of scenery, tastes, sounds, etc. that bring positive feelings to

the patient. Relaxation techniques involve focusing on a specific word repetitively. These

interventions allow patients to reduce their stress which will in turn reduce the inflammatory

response and possibly reduce pain. Guided imagery and relaxation training also increase quality

of life by reducing stress. These are interventions that can be taught by nurses so that patients can

try them on their own anytime.

Another example of a potential nonpharmacological nursing intervention is assisting a

patient to increase their self-efficacy and self-control in their health care. Boveldt et al. (2014)

proposed that empowered patients would have a better outcome in their pain management than

non-empowered patients. They found that patients have better outcomes when they not only have

care from a medical professional, but more importantly, are able to participate in their own care

(p. 1207). According to Boveldt et al. (2014), a patient’s empowerment includes their

“confidence in the ability to perform a task” as well as their knowledge of and availability of

necessary resources and support systems (p. 1207). A patient who feels active in their own care

is going to feel more in control of their situation and feel less stressed. The more that a nurse can
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help a patient be active in their own pain management, the more likely pain management will be

successful. Part of empowering a patient to be active in their care is educating the patient about

the disease process and the resources for pain management.

Another example of a nursing intervention that could benefit cancer patients is music

therapy. Li et al. (2011) found that music was able to reduce pain scores significantly in breast

cancer patients. Although there are several possible mechanisms for the benefit of music,

distraction of the brain from the painful stimuli is one likely factor (p. 416). The pain signals are

possibly interrupted by the stimuli from the music. Music therapy could also be reducing the

anxiety and stress in the patient and thus, treating the patient holistically. Above all, it is

important that the patient feels like their nurse cares. The patient should feel that their nurse is

taking the time to assess the pain fully and intervene in any way that could potentially improve

the patient’s quality of life. This can ultimately be done as nurses and rest of the healthcare team

learn more about cancer pain and try different interventions to supplement pharmacological

interventions.
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References

Boveldt, N. t., Vernooij-Dassen, M., Leppink, I., Samwel, H., Vissers, K., & Engels, Y. (2014).

Patient Empowerment in Cancer Pain Management: an Integrative Literature Review.

Psycho-Oncology, 23, 1203-1211.

Falk, S., & Dickenson, A. H. (2014). Pain and Nociception: Mechanisms of Cancer-Induced

Bone Pain. Journal of Clinical Oncology, 32, 1647-1654.

Li, X.-M., Yan, H., Zhou, K.-N., Dang, S.-N., Wang, D.-L., & Zhang, Y.-P. (2011). Effects of

Music Therapy on Pain Among Female Breast Cancer Patients After Radical

Mastectomy: Results from a Randomized Controlled Trial. Breast Cancer Res Treat, 128,

411-419.

Lim, S.-N., Han, H.-S., Lee, K.-H., Lee, S.-C., Kim, J., Yun, J., . . . Choi, J. (2015). A

Satisfaction Survey on Cancer Pain Management Using a Self-Reporting Pain

Assessment Tool. Journal of Palliative Medicine, 18, 225-231.

Patel, B., Hacker, E., Murks, C. M., & Ryan, C. J. (2016). Interdisciplinary Pain Education:

Moving From Discipline-Specific to Collaborative Practice. Clinical Journal of Oncology

Nursing, 20(6), 636-643.

Portenoy, R. K. (2011). Treatment of Cancer Pain. The Lancet, 377, 2236-2247.