Pain Q&As

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=200 BGCOLOR="#003333" TEXT="#F7F7FF" background="067d8c00dduajq.jpg"> <div> <A HREF="id200.htm" TARGET="_top" TITLE="Fatigue QAs"><U>Fatigue Q&As</U></A></div> <div> <A HREF="id203.htm" TARGET="_top" TITLE="Lymphoedema QAs"><U>Lymphoedema Q&As</U></A></div> <div> <B>Pain Q&As</B></div> <div> <A HREF="id201.htm" TARGET="_top" TITLE="Nausea QAs"><U>Nausea Q&As</U></A></div> <div> <A HREF="id204.htm" TARGET="_top" TITLE="Other QAs"><U>Other Q&As</U></A></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> Click on the question to go to the answer</div> <div> Click on Top to return to questions</div> </td> <td valign="top" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#0066FF" FACE="Arial" ><B>Don't Say That Word</B></FONT><FONT SIZE="1" COLOR="#333399" FACE="Arial" >   </FONT>  |     <A HREF="index.htm" TARGET="_top" TITLE="Dont Say That Word"><U>home</U></A></div> <div> back to  <A HREF="id166.htm" TARGET="_top" TITLE="Living With Cancer QA"><U><B>Living With Cancer Q&A</B></U></A></div> <div> Pain Q&As</div> <div> <B> <A NAME="top"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Questions:</B></div> <bR> <div> <A HREF="#1__morphine_is_invaluable_in_the" TITLE="Pain QAs"><U><U>1. What is the highest dose of morphine you can have?</U></U></A></div> <bR> <div> <A HREF="#2___the_tens_machine_is_a_device_for" TITLE="Pain QAs"><U><U>2. What is a TENS machine? Can it help with cancer pain? </U></U></A></div> <bR> <div> <A HREF="#3____the_leaves_and_buds_of_the" TITLE="Pain QAs"><U><U>3. I have pain as a result of cancer. My pain killing tablets control this quite well but a friend has said that cannabis could be used instead. Is this true? </U></U></A></div> <bR> <div> <A HREF="#4___it_may_seem_surprising_but_although" TITLE="Pain QAs"><U><U>4. How does radiotherapy to the bone reduce pain from secondary cancer? What actually happens to the bone? </U></U></A></div> <bR> <div> <A HREF="#5___unfortunately_people_with_cancer_do" TITLE="Pain QAs"><U><U>5. My son has been told he has an incurable cancer. He needs regular painkillers. Will he have to pay for his prescriptions?</U></U></A></div> <bR> <div> <A HREF="#6___brain_tumours_like_most_cancers" TITLE="Pain QAs"><U><U>6. My father has a brain tumour. He has had radiotherapy and chemotherapy but these are no longer helping. The doctors have suggested 'steroids'. How can these help?</U></U></A></div> <bR> <div> <B>Answers:</B></div> <bR> <div> <B> <A NAME="1__morphine_is_invaluable_in_the"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>1. </B>Morphine is invaluable in the management of severe pain for many people. Both patients and doctors are sometimes anxious about using morphine so it is important to be aware that, when used to treat severe pain, morphine is not addictive, it does not shorten life-expectancy and is safe if the dose is matched to the pain. This last point is really the answer to your question in that the correct dose of morphine is the dose that gets rid of the pain. The actual dose needed to do this varies tremendously from patient to patient. The dose should always therefore be matched against the needs of the individual. This means that there is no actual upper limit to the dose that can be given. </div> <bR> <div> Morphine does have side-effects. Two which are common are constipation and nausea and with higher doses of the morphine additional drugs to relieve or prevent these symptoms may be needed.</div> <div> Provided higher-doses of morphine produce better pain control, without undue side-effects, then the dose can be increased progressively. But it is essential that this increase should be carefully monitored by your medical team. </div> <bR> <div> <A HREF="#top" TITLE="Pain QAs"><U><B>[Top]</B></U></A></div> <bR> <div> <B> <A NAME="2___the_tens_machine_is_a_device_for"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>2.  </B>The TENS machine is a device for transmitting electrical energy through the skin to the nerves, to try and relieve pain. The initials TENS stand for transcutaneous electrical nerve stimulation. </div> <bR> <div> There are a number of different types of TENS machines, some are quite large whilst others are small and portable, but all work on the same principle. They all use electricity, from the mains or from batteries, to produce electrical impulses which pass through wires to two electrodes placed on the skin. The electrodes are silicone rubber pads containing fine particles of carbon which transmit the impulse to the skin.</div> <bR> <div> The treatment itself is painless and may last anywhere from a few minutes to hours and can be continued for as long as it is helpful (although there is tendency for the treatment to become less effective after several months).</div> <div> The benefit is often not immediate and it may take some days to find the most effective position for the electrodes. When the treatment does work people often say that it changes the pain to a much more comfortable sensation of buzzing or humming TENS machines are not suitable for some people with heart pacemakers. It has also been said that they are less effective for people taking morphine or other strong pain killers but this is not universally true. </div> <bR> <div> TENS machines tend to work best on parts of the body where there is a good cushion of tissue between the skin and any underlying bone.</div> <bR> <div> There are differing reports about the value of TENS machines in controlling cancer pain. Some doctors have said they don't think they help whilst others claim they are very useful. For people who do have pain from cancer that is not well controlled with other treatments it is always worthwhile discussing it with their doctors to see whether they think a TENS machine could help. </div> <bR> <div> <A HREF="#top" TITLE="Pain QAs"><U><B>[Top]</B></U></A></div> <bR> <div> <B> <A NAME="3____the_leaves_and_buds_of_the"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>3.   </B>The leaves and buds of the cannabis plant have been used in herbal remedies for over 3000 years for conditions as varied as malaria and constipation. In the Middle Ages cannabis was used as a pain killer, particularly for rheumatic pain. </div> <bR> <div> In recent years more some 66 different active chemicals have been identified in the cannabis, marijuana, plant and these are called cannabinoids. In the UK a synthetic, man made, version of one of these cannabinoids is available on prescription as a drug called Nabilone (although the use of cannabis, or marijuana, in its natural form remains illegal). </div> <bR> <div> Cannabis does have some analgesic (pain killing) effect and at least 5 clinical trials have been carried out comparing cannabis or cannabinoid drugs with more conventional pain killers for people who have pain due to a cancer. These have shown that the pain killing benefit of cannabis or cannabinoids is no better than ordinary codeine (a widely used analgesic, available on prescription or as an ingredient in many over the counter pain killers). </div> <bR> <div> Whilst this means that cannabis, or cannabinoids, might help ease mild or moderate (but not severe) pain their side effects make them undesirable. These include sedation, confusion, altered perception of time and space, low blood pressure and palpitations. Marijuana also contains chemicals which can cause cancer (carcinogens) and smoking the drug can cause respiratory problems. The cannabinoid drugs also share a number of these side effects. </div> <bR> <div> So because there are many other pain killers which are just as, if not more, effective and because of the side effects they cause, neither cannabis nor cannabis extracts are recommended as a treatment for pain control. </div> <bR> <div> The leaves and buds of the cannabis plant have been used in herbal remedies for over 3000 years for conditions as varied as malaria and constipation. In the Middle Ages cannabis was used as a pain killer, particularly for rheumatic pain. </div> <bR> <div> In recent years more some 66 different active chemicals have been identified in the cannabis, marijuana, plant and these are called cannabinoids. In the UK a synthetic, man made, version of one of these cannabinoids is available on prescription as a drug called Nabilone (although the use of cannabis, or marijuana, in its natural form remains illegal). </div> <bR> <div> Cannabis does have some analgesic (pain killing) effect and at least 5 clinical trials have been carried out comparing cannabis or cannabinoid drugs with more conventional pain killers for people who have pain due to a cancer. These have shown that the pain killing benefit of cannabis or cannabinoids is no better than ordinary codeine (a widely used analgesic, available on prescription or as an ingredient in many over the counter pain killers). </div> <bR> <div> Whilst this means that cannabis, or cannabinoids, might help ease mild or moderate (but not severe) pain their side effects make them undesirable. These include sedation, confusion, altered perception of time and space, low blood pressure and palpitations. Marijuana also contains chemicals which can cause cancer (carcinogens) and smoking the drug can cause respiratory problems. The cannabinoid drugs also share a number of these side effects.</div> <div>  </div> <div> So because there are many other pain killers which are just as, if not more, effective and because of the side effects they cause, neither cannabis nor cannabis extracts are recommended as a treatment for pain control. </div> <bR> <div> <A HREF="#top" TITLE="Pain QAs"><U><B>[Top]</B></U></A></div> <bR> <div> <B> <A NAME="4___it_may_seem_surprising_but_although"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>4.  </B>It may seem surprising but although doctors have known for more than fifty years that radiotherapy can often relieve the pain caused by secondary bone cancer, the way in which the treatment actually works is still not understood. </div> <bR> <div> Often x-rays and scan tests will show some reduction in tumour seedlings, and healing of the damaged bone, in the months after radiotherapy. But equally often those same tests will show no change at all, even when there has been excellent pain relief.</div> <bR> <div> Despite the uncertainty about how it works the evidence for the value of radiotherapy in this situation is overwhelming. Overall about seven out of ten people get good pain relief, and of those about three out ten get complete freedom from pain. The improvement is not immediate, taking 7 to 10 days after treatment to become apparent and then sometimes as long as 4 to 6 weeks to get the full benefit. Some people find the treatment gives permanent pain relief but on average the improvement lasts about 3 to 4 months, but the treatment can often be repeated if the pain does come back. </div> <bR> <div> <A HREF="#top" TITLE="Pain QAs"><U><B>[Top]</B></U></A></div> <bR> <div> <B> <A NAME="5___unfortunately_people_with_cancer_do"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>5.  </B>Unfortunately people with cancer do have to pay a prescription charge for their prescriptions unless they fall into one of the groups of people that the government has decided are exempt from charges and who do not have to pay. These groups are: </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">people over the age of 60</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">people getting Income Suppport or a Jobseeker's Allowance</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">you have one of a small number of 'permanent' medical conditions, these include some types of diabetes and an under-active thyroid gland (hypothyroidism or myxoedema)</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">you have a continuing physical disability which means that you cannot go out without the help of another person </div> <bR> <div> If your son does not qualify for free prescriptions then there are two ways in which he might be able to reduce the costs: </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">it is worth him having a word with his family doctor to ask if they can give him a fairly long supply of the drug each time (obviously if they only give him a week's supply of the drug on each prescription then this will be much more expensive for him than if they were to give him a month's supply)</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">if he needs lots of prescriptions he may be better off getting a 'prepayment certificate'. This is like a season ticket and gives you all your prescriptions 'free' for a period of either four months or twelve months. The cost of a 4 month certificate is currently £32.40 and that of a 12 month certificate is £89.00 </div> <bR> <div> You can find out all the details of the rules on treatment charges by contacting the Department of Health Publications, PO Box 777, London SE1 6XH (e-mail: doh@prolog.uk.com) and asking for leaflet HC11: help with health costs. This is also on the Department of Health website at www.doh.gov.uk/nhscharges/hc11.htm. Copies should also be available at major post offices, your local Social Security office or your family doctor's surgery.</div> <bR> <div> Many people, including some politicians and MPs do feel that it is unfair that cancer patients have to pay for their prescription drugs. There have been campaigns to try and change these rules but so far they have been unsuccessful. If you feel strongly about this then you could write to your local MP to let them know your views. (UK)</div> <bR> <div> Unfortunately people with cancer do have to pay a prescription charge for their prescriptions unless they fall into one of the groups of people that the government has decided are exempt from charges and who do not have to pay. These groups are: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">people over the age of 60</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">people getting Income Suppport or a Jobseeker's Allowance</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">you have one of a small number of 'permanent' medical conditions, these include some types of diabetes and an under-active thyroid gland (hypothyroidism or myxoedema)</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">you have a continuing physical disability which means that you cannot go out without the help of another person </div> <div> If your son does not qualify for free prescriptions then there are two ways in which he might be able to reduce the costs: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">it is worth him having a word with his family doctor to ask if they can give him a fairly long supply of the drug each time (obviously if they only give him a week's supply of the drug on each prescription then this will be much more expensive for him than if they were to give him a month's supply)</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">if he needs lots of prescriptions he may be better off getting a 'prepayment certificate'. This is like a season ticket and gives you all your prescriptions 'free' for a period of either four months or twelve months. The cost of a 4 month certificate is currently £32.40 and that of a 12 month certificate is £89.00 </div> <div> You can find out all the details of the rules on treatment charges by contacting the Department of Health Publications, PO Box 777, London SE1 6XH (e-mail: doh@prolog.uk.com) and asking for leaflet HC11: help with health costs. This is also on the Department of Health website at www.doh.gov.uk/nhscharges/hc11.htm. Copies should also be available at major post offices, your local Social Security office or your family doctor's surgery.</div> <bR> <div> Many people, including some politicians and MPs do feel that it is unfair that cancer patients have to pay for their prescription drugs. There have been campaigns to try and change these rules but so far they have been unsuccessful. If you feel strongly about this then you could write to your local MP to let them know your views.</div> <bR> <div> <A HREF="#top" TITLE="Pain QAs"><U><B>[Top]</B></U></A></div> <bR> <div> <B> <A NAME="6___brain_tumours_like_most_cancers"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>6.  </B>Brain tumours, like most cancers, are usually covered by a rim of inflammation, where the tumour meets the surrounding normal tissue. This area of inflammation is found with both primary brain tumours (those which start off in the brain) and secondary tumours which have spread to the brain from a cancer elsewhere in the body. </div> <div> The layer of inflammatory tissue makes the tumour seem larger than it actually is. It also causes pressure on the surrounding normal tissue. Because the brain fits quite tightly into the bony framework of the skull this means that the normal tissue is squeezed between the swelling caused by the tumour and inflammation and the rigid structure of the skull. The pressure this causes on the normal brain tissue leads to unpleasant symptoms like headache and sickness. </div> <bR> <div> Steroids are drugs which can reduce inflammation in the body. One steroid in particular, called dexamethasone, is very effective in easing the inflammation caused by brain tumours. </div> <bR> <div> Taking dexamethasone tablets can shrink the area of inflamed tissue surrounding tumours in the brain. This reduces the volume of abnormal tissue and so eases pressure and relieves symptoms. </div> <bR> <div> Unfortunately dexamethasone does not have any effect on the cancer itself and so the benefit that it gives is only temporary. But very often taking dexamethsaone can give a very valuable respite from problems like headache and sickness for some weeks or even months. In addition the steroid does have other benefits, like increasing appetite and energy levels, which can lead to an overall improvement in quality of life. </div> <bR> <div> <A HREF="#top" TITLE="Pain QAs"><U><B>[Top]</B></U></A></div> <bR> <bR> <bR> <bR> <bR> </td> </tr></table></body>