QUESTION: My husband has advanced cancer and is having a lot of pain. We have pain pills, which help some, but he is still too uncomfortable to move around. Is there anything that can be done or is cancer pain to be expected?

ANSWER: No one should have to live in severe pain. Although many advanced cancers do cause pain, most of the time it can be well controlled.

In a way, treating cancer pain is like having a car break down on the highway. Sometimes the cause is obvious and can be fixed easily (like running out of gas). Other times, the cause is less obvious and may involve a little trial and error before the problem is fixed. Of course, when this is the case, much time and money can be saved by hiring a good mechanic. There are hundreds of different cancers and many different types of pain. A medication that helps one problem may not be the answer for another. The most important key to good pain control is having a physician who is very knowledgeable about the causes and treatments of cancer pain.

A good cancer pain physician will review all the medical records, especially those pertaining to the cancer diagnosis. Any x-rays, CT scans, and MRI’s will also be reviewed. The physician will ask very specific questions about the pain such as its location, severity, whether it is constant or intermittent, how it actually feels (aching, stabbing, burning, etc.), and what medications have been taken and their effectiveness. A complete physical examination will also be performed. Recommendations for good pain control will usually follow. This may include radiation therapy, chemotherapy, surgery, and specialized techniques such as nerve blocks as well as different types of medications. Associated side effects can also be effectively treated.

QUESTION: My husband has cancer that has spread to his bones, causing a lot of pain. The morphine the doctor gave him works but we are afraid he will become a drug addict. Should he stop using the morphine?

ANSWER: Your husband should not stop taking the morphine. The key to effective pain management of chronic pain with a known cause is consistent dosing. The exact regimen should be worked out between you and your doctor but it usually will involve giving the pain medication at regular time intervals. As well, a supplemental dose also known as a breakthrough or rescue dose, should be available to treat flares of pain. Finding the best regimen may require several adjustments until the balance between pain relief and side effects is found. Most patients experience few or no side effects once this balance is achieved. Waiting until the pain is severe before taking the medication will make effective management more difficult.

Your husband is not in danger of becoming a drug addict. Drug addiction and physical dependence are two different things. Drug addiction is a type of psychological dependence. Drug addicts take narcotic pain medications to escape their everyday lives, despite the knowledge that this could be dangerous for them. They do not take pain medications under the supervision of a doctor and a nurse the way patients with cancer do. The drug addict needs more and more medication to get the "high" feeling he or she is seeking. This is because the body gets used to the medications the longer they are used due to the development of physical dependence.