1. The Prostate Net Pain management for patients and caregivers Biren Saraiya MD The Cancer Institute of New Jersey

2. ARS ?

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 – Palliate the symptoms (prolong quality of life) In either setting, optimal pain control is desired

5. Pain S U C K S

6. Pain Subjective Underreported Compromises function Control requires Knowledgeable patient and clinician Side effects need to be addressed

7. Pain Therapeutics Non pharmacological – Heat/Cold – Exercise – Radiation, Surgery Pharmacological – Delivered differently Oral Intravenously Nerve block Patches (lidocaine, fentanyl)

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

9. Understanding Opioids Works well for different types of pain Concern for addiction low 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 Changes should be in percentages, not absolute numbers

10. Being advocate for yourself Establish a goal with your treatment team for pain control Ensure the treatment team meets the goal If goals not met, ask for help – Pain Management Specialists Anesthesiologists Medical Doctors – Palliative Care Specialists Medical Doctors who also specialize in symptom management