By Darci Picoult
It began with a bump. The size of a pinhead. Innocuous. An innocuous little pinhead of a bump on my vulva. Given that my gynecologist said the bump was probably nothing, I laughed it off. Which, in turn, made my bump mad. Very mad. It wanted my attention. And so it grew. I smeared it in medicine. It grew more. More medicine. More growth. Hanukkah came. Then Christmas. A war raged between us. I went to battle in the middle of the night with salt baths and creams. Prayed for its departure...
For mild to moderate pain, the doctor may prescribe a Step 1 pain medication such as aspirin, acetaminophen, or a nonsteroidal anti-inflammatory drug (NSAID). Patients should be monitored for side effects, especially those caused by NSAIDs, such as kidney, heart and blood vessel, or stomach and intestinal problems.
When pain lasts or increases, the doctor may change the prescription to a Step 2 or Step 3 pain medication. Most patients with cancer -related pain will need a Step 2 or Step 3 medication. The doctor may skip Step 1 medications if the patient initially has moderate to severe pain.
At each step, the doctor may prescribe additional drugs or treatments (for example, radiation therapy).
The patient should take doses regularly, "by mouth, by the clock" (at scheduled times), to maintain a constant level of the drug in the body; this will help prevent recurrence of pain. If the patient is unable to swallow, the drugs are given by other routes (for example, by infusion or injection).
The doctor may prescribe additional doses of drug that can be taken as needed for pain that occurs between scheduled doses of drug.
The doctor will adjust the pain medication regimen for each patient's individual circumstances and physical condition.
Acetaminophen and NSAIDs
NSAIDs are effective for relief of mild pain. They may be given with opioids for the relief of moderate to severe pain. Acetaminophen also relieves pain, although it does not have the anti-inflammatory effect that aspirin and NSAIDs do. Patients, especially older patients, who are taking acetaminophen or NSAIDs should be closely monitored for side effects. Aspirin should not be given to children to treat pain.
Opioids are very effective for the relief of moderate to severe pain. Many patients with cancer pain, however, become tolerant to opioids during long-term therapy. Therefore, increasing doses may be needed to continue to relieve pain. A patient's tolerance of an opioid or physical dependence on it is not the same as addiction (psychological dependence). Mistaken concerns about addiction can result in undertreating pain.