1. The Prostate Net Pain Management for Patients and Caregivers Biren Saraiya MD The Cancer Institute of New Jersey

2. Question for audience What concerns do you have about pain control? 1. My doctor does not think pain is important 2. My doctor is too busy to talk about symptoms including pain 3. If I talk about my pain, my doctors will not treat my cancer 4. Doctors will not be able to control pain 5. Pain medications will make me an addict 6. Pain medications will make me “loopy” 7. Pain is inevitable

3. Key Points Pain control is desirable and achievable There are many choices for pain therapy – Oral medications – Intravenous medications – Patches – Radiation/surgery Pain control requires frequent reassessment, adapting to needs and management of side effects

4. Goals of Care In Cancer treatment, there are two goals: – Cure the cancer – Palliative the symptoms (prolong quality of life) In either setting, optimal pain control is desired

5. Pain Therapeutics Pharmacological – NSAIDS (ibuprofen) – Acetaminophen (tylenol) – Antidepressants – Anti-seizure medications – Opioids Short acting (Oxycodone, hydromorphone) Long acting (oxycontin, MS Contin, Methadone)

6. Pain Therapeutics Pharmacological (different delivery systems) – Pain pumps – Patches (lidocaine, fentanyl) Non pharmacological – Radiation, Surgery – Exercise, Heat/Cold – Quadramet

7. Understanding Opioids Works well for different types of pain Not concerned about addiction Most side effects (nausea, vomiting, drowsiness etc.) last only few hours to days Exception is constipation When need to increase medication dose, increase in PERCENTAGES, not absolute numbers dosing should be based on desired and achieved pain control (mild, moderate, severe) Changes should be in percentages, not absolute numbers

8. Professional Help Pain Management Specialists – Anesthesiologists – Medical Doctors Palliative Care Specialists – Medical Doctors who also specialize in symptom management