Symptom control
This section
describes some of the symptoms which may occur during the final
stages of cancer. Some are caused by the cancer itself while
others are the result of treatment. You may experience one or
more of these symptoms, or none at all. However, any that do
occur may be controlled with help from the nursing and medical
team caring for you.
PainMany people are frightened of pain. However we now have a better understanding of the causes of pain, with new and more effective ways of treating it, so there is rarely any need to suffer uncontrolled pain at any time. Everyone feels pain differently and even people with the same disease have very different experiences. You therefore need to help your doctors and nurses to understand your pain so that they can treat it effectively. Many people believe that they should put off using painkillers for as long as possible, only seeking help when their pain becomes unbearable. This is simply not true. There is a whole range of effective painkillers for different types and severities of pain so there is no need to save them until your pain is severe. Some types of pain are more difficult to treat and therefore do not be surprised if your doctor gives you other types of drugs to take as well as your painkillers. Anti-inflammatory drugs, antidepressants, anticonvulsants (usually used to treat epilepsy) and muscle relaxants all help with different types of pain. OTHER DRUGS USED
TO HELP RELIEVE PAIN
If you have frequent or constant pain it is important to take painkillers regularly. Each dose of the painkiller should be enough to control your pain right through to the next dose. If your pain returns before your next dose is due, be sure to tell your doctor so that a more effective dose or drug can be used. It may take a few days to get the drugs and doses right, so be willing to persevere and don't suffer in silence! Strong painkillers have three common side effects - drowsiness, sickness and constipation. The drowsiness will usually wear off after a few days, so that it should be possible for you to be pain-free and yet still alert enough to do all that you want to do. If you feel nauseated, anti-sickness pills can help in the short term, and you will usually find that the nausea settles gradually over a few days. Constipation is so common that everyone taking strong painkillers should take a laxative regularly; many people need one which softens the stools and stimulates the bowel, moving the stools along more quickly. Ask your doctor or pharmacist for advice. Don't be afraid to vary the dose to keep your bowels moving easily. Most painkillers are available in liquid form if swallowing is difficult or one type of painkiller can be delivered through a patch stuck on the skin. If swallowing is not possible, or if you are drowsy or confused and not keen to take anything by mouth, giving the painkiller continuously through a tiny needle inserted under the skin is often very effective. Enough painkiller for 24 hours is made up and a syringe driver or small portable pump is used to inject the drug under the skin. A syringe driver is very easy to set up and there is no need to insert it into a vein or worry about it becoming dislodged. If you are up and about, the syringe driver can be carried in a special pocket, or if you are in bed then it can sit on the bedside table. Other medicines, for example to treat sickness, can also be delivered with the painkiller. 'Getting addicted' is a common worry. However, there is no danger of becoming hooked on drugs such as morphine when you need them to help control your symptoms. Strong feelings such as fear, anxiety, depression and tiredness can make your pain worse. Therefore it is important to try to treat the emotional as well as the physical causes of your pain. Learning to relax and get rid of some of your fears and anxieties, if only for short periods of time each day, can play a very useful part in controlling your pain. You can relax by becoming aware of different groups of muscles around your body and learning to relax them so that you can do this consciously when you are under stress or in pain. Visualisation helps you to bring happy relaxed pictures into your mind and use them to help you distract yourself and overcome some of your pain. Massage with soothing aromatherapy oils can help you relax. Feeling sickIf you feel sick or have trouble keeping food down, your doctor can prescribe an anti-sickness drug to help. These may be tablets, or suppositories which are inserted in your back passage (these are useful if you cannot manage to swallow tablets because of your nausea). Like pain tablets, anti-sickness drugs should be taken regularly to prevent the nausea returning. Eating problemsMany people lose their appetite and perhaps feel sick much of the time as well. These may be the symptoms of the illness itself or the result of treatment, such as radiotherapy and chemotherapy. You may be put off even by the sight and smell of food and your worries about this final stage of your illness may make things worse. Small frequent simple meals, concentrating on your favourite foods, are likely to be most tempting. Our section on diet provides hints and advice on coping with eating problems. Your metabolism has slowed down so don't force yourself to eat. Simple fluids may be all that you need to keep you comfortable. You may notice that your mouth feels very dry. This is not a sign that you are dehydrated or necessarily need more fluid, and usually it is not helped at all by pushing yourself to drink more. You may want to try sucking pieces of fruit such as pineapple, or your carers can make fruit juices into ice lollies or ice cubes which you can suck to moisten your mouth. If the dry mouth is interfering with your ability to eat or talk, artificial saliva spray or lozenges may help. FatigueFatigue (feeling exhausted all or most of the time) is a common and difficult problem. It can be caused either by the progress of your disease or as a result of coping with your other symptoms, such as pain. If you do feel tired, it is important to pace yourself and to save your energy for the things which matter to you and which you enjoy. Don't waste your energy on duty things like doing the vacuuming or cutting the grass - be willing to let other people tackle these if they offer. Just work within your limitations. But remember you will not do yourself any harm by doing too much - you can simply rest and relax a bit more tomorrow. Fatigue and weakness can make it harder for you to concentrate and engage fully in what is going on around you. Therefore if you have important things to do to put your affairs in order, it is best to do them as soon as possible. This will have the added advantage that once they are done, you can relax. Treatable complicationsThere are certain complications of your cancer which your doctors may want to treat even at a late stage, as treating them can dramatically improve the quality of your life. These include:
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