S4E26: Understanding How Breakthrough Cancer Pain is Managed

Why do I need two different medications for cancer pain? We explain their different roles and how using them as prescribed can improve your quality of life.

In this Episode:

• 01:18 – Pumpkin Spice Muffins
• 02:14 – Angel’s Share and Devil’s Cut
• 05:26 – A Swan Song – History of the Phrase
• 13:08 – Managing Breakthough Cancer Pain
• 24:24 – Ask the Ethicist: “I’m Dying of Cancer. Do I have to Tell Anyone?”

Will I Die in Pain?

In the not-so-distant past, healthcare practitioners have not managed pain very effectively, creating horror stories of family members dying in terrible pain. Today is much different, and pain can be very well managed by the care team. However, it’s important to use them as directed to get the maximum benefit.

What is Breakthrough Pain?

Cancer pain is not a stable type of pain. It will vary with things like how well you slept, how much activity you are doing, position, stress, etc. If it were stable, we could order one type of pain medication and be done. But since it is not, we need a second medication for what is called “breakthrough” pain, which is just as it sounds, pain that breaks through the regularly scheduled pain medication.

What is the Greatest Barrier to Cancer Pain Management?

Often, resistance by the patient to take medications as prescribed can be a big barrier to effective pain management. We talk about fears of addiction, and why this is not relevant at the end of life.

Some people are suspicious of the different medications prescribed, and think the doctor is just trying to “dope them up.” We go into detail about the roles of the different medications and why you need more than one.

Marianne talks about the teamwork of the different medications in managing pain:

“Think of the extended-release morphine as Diana ross and the short-acting as the Supremes. They each have their job and are just so much better together.“

Finally, some people just try to be stoic, and hold out for the pain meds “until I need it,” suffering needlessly through pain that affects their daily activities. With advanced cancer, it is all the more important to live each day as a gift; pain medications enable more good days to do the things you enjoy.

Help Alleviate the Fear

Have a friend or family member with advanced cancer? We hope that those of you who are listening will share this with others so that perhaps they can get ahead of the curve and alleviate some of the fear that they are going to die in pain.

A Swan Song

A swan song is a metaphor that refers to the final act, gesture, or performance given by a creative person such as a musician, actor, or artist just before they retire or die. Have you ever wondered about the phrase, and do swans really sing a song before they die? Charlie has an interesting history of the first known uses of the phrase and how it came to be in our vocabulary.

Ask the Ethicist: “I’m Dying of Cancer. Do I have to Tell Anyone?”

The Ethicist newsletter, in the NYTimes offers advice on life’s trickiest situations and moral dilemmas from the philosopher Kwame Anthony Appiah. We thought we would share one that was published earlier this month along with our own thoughts. How would you respond? Let us know in the comments below.

Recipe of the Week

If you’re one of those who can’t get enough pumpkin spice in the fall season, we’ve got the recipe for you! We think you can even say it’s healthy – loaded with fiber, wholesome pumpkin seeds, and the warmth of a fall treat. You can make loaves or muffins. Visit Serious Eats for the Pumpkin Spice Streusel recipe!

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From Everyone Dies:

Everyone Dies: and yes, it is normal!

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Mourning Jewelry

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