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Cancer Patients and Pain
The National Cancer Institute (NCI) estimates that nearly 40 percent of American adults will be diagnosed with cancer at some point in their lives. Symptoms vary widely depending on the type, location, and progress of the cancer.
Pain is one of the most prevalent symptoms, as well as a common side effect of many cancer treatments. In addition, up to 60 percent of cancer survivors experience post-cancer pain that negatively affects their quality of life, work prospects, and mental health.
One study shows that on a scale of 1 to 10, about 88 percent of cancer patients reported pain that was 5 or greater. More than 81 percent also said that pain interfered with their function.1 Cancer pain was usually felt in different parts in the body and tended to be chronic (lasting for more than six months) and gradually increasing in intensity (breakthrough pain).2
Cancer Pain Management
Cancer pain relief is possible with opioid pain medications. Doctors often prescribe them to help patients manage the pain associated with their cancer diagnoses and treatments. Opioids effectively reduce:
- Moderate to severe pain caused by chronic disease
- Acute pain from surgery (e.g., pain that lasts for less than six months)
Opioids for Cancer Pain
Opioids refer to a class of drugs that are derived naturally from opium poppy plants (opiates) or produced synthetically in laboratories (opioids). Regardless of how they're made, all opioids are chemically alike. They work by attaching themselves to opioid receptors throughout the body, preventing them from transmitting pain signals to the brain.
The most common opioids prescribed to cancer patients include:
- Hydrocodone (Vicodin)
- Oxycodone (OxyContin)
- Hydromorphone (Dilaudid)
- Levorphanol (Levo-Dromoran)
- Methadone (Dolophine, Methadose)
- Morphine (Avinza, MS-Contin)
- Oxymorphone (Opana)
- Fentanyl (Actiq, Duragesic, Subsys)
Besides helping with pain, opioids produce feelings of mental relaxation and euphoria. Unfortunately, these side effects make them prone to abuse.
Cancer and Opioid Addiction
Cancer patients may take more opioids than prescribed or take them longer than recommended. Whether it is done to relieve pain or to get the relaxing and euphoric effects, it is considered opioid abuse.
What makes opioids dangerous is that if you use them long enough, you can still become dependent even if you follow your doctor's prescription.
Opioid dependence results in tolerance and causes a person to increase their dose gradually. This puts them at risk of developing addiction and overdose. Cancer patients with a dependence on opioids may also experience withdrawal symptoms whenever they try to stop using.
Symptoms of opioid withdrawal include:
- Muscle pain
- Runny nose
- Teary eyes
- Difficulty sleeping
- Frequent yawning
- Nausea and vomiting
- Dilated pupils
- Abdominal cramps
Accidental addiction to opioids is also possible. This tends to happen with long-term opioid use or when taking opioids with alcohol.
Dangers of Mixing Alcohol and Opiates
Alcohol, opioids, and opiates are central nervous system depressants. Meaning, they slow down brain activity and some of its functions. Taking them alone can be somewhat relaxing. Combined, they produce dangerous mental and physical effects.
For people who are not yet addicted to opioids, alcohol increases their risk for drug addiction. That's because alcoholic drinks amplify the effects of opioids. Mixing alcohol with opioids may cause opioid overdose and other severe side effects, including:
- Loss of coordination
- Extreme sleepiness
- Slurred speech or inability to talk
- Decreased blood pressure
- Irregular heart rate
- Slow and shallow breathing
- Respiratory arrest
- Snoring or gurgling sounds
- Loss of consciousness
- Bluish skin color
- Dark lips
- Possible death
Maintaining an open, honest relationship between the patient and doctor is the best way to prevent drug addiction in cancer patients. You should never take more than the prescribed dose without consulting your doctor first.
Alcohol Abuse in Cancer Patients
Alcohol is a known risk factor for certain types of cancer. Some of these include cancers of the head and neck, esophageal cancer, breast cancer, colorectal cancer, and liver cancer.3
Research also shows that while chronic heavy drinking increases the risk for cancer, moderate alcohol consumption of up to two drinks per day is also associated with the development of certain cancers.3,4
Why Does Alcohol Use Raise Cancer Risk?
Most alcoholic drinks contain ethanol, which the body breaks down into acetaldehyde. According to cancer research, ethanol and acetaldehyde are potentially carcinogenic or cancer-causing for humans.5 Studies also show that alcohol consumption raises estrogen levels in women. When a person has too much estrogen in their body, it increases their breast cancer risk along with ovarian and uterine cancer.6
Does Cessation of Alcohol Consumption Lead to Lower Cancer Risk?
Cancer research is still limited on the subject. However, there is evidence that patients who quit alcohol have a lower risk of cancer than those who continue drinking alcohol.7
Alcohol and Cancer
The link between alcohol use and cancer goes beyond risks. Evidence suggests that over half of cancer survivors (56.5%) drink alcohol. More than 21 percent of these drinkers practiced binge drinking, which is a form of alcohol abuse.3
Drinking alcohol is associated with poor outcomes among people diagnosed with cancer.
Alcohol abuse complicates cancer treatments and may cause:
- Extended hospital stays
- Increased surgical procedures
- Longer recovery time
- More expensive healthcare
Excessive alcohol consumption is linked to higher mortality rates and morbidity rates after surgery. It means that patients who drink alcohol are more likely to die or experience health problems after cancer surgery. This may be caused by alcohol-related consequences such as nutritional deficiencies and poor immunity.7
Compared to non-drinkers, those who engage in heavy drinking and alcohol abuse are at an increased risk for cancer recurrence, secondary primary tumors (metastasis), and surgical complications. Alcohol abuse also contributed to a lower quality of life among patients with head and neck cancer.7
Cancer and Addiction Treatment
The chronic pain and struggles that accompany cancer increase a person's risk for opioid and alcohol addiction. Cancer patients and survivors must be monitored for signs of substance abuse.
Signs of an Opioid Addiction
In many cases of opioid addiction, the cancer patient may not realize they have developed a dependence on the drug. It requires self-awareness and an understanding of how opioids affect the body. Doctors, friends, and family members can also watch them closely for signs.
Signs of opioid addiction in cancer patients include:
- Taking the drug more frequently than prescribed
- Taking more than the prescribed dose
- Increased tolerance
- Running out of a prescription early
- Purchasing drugs from the street
- Using other drugs without their doctor’s approval
- Extreme drowsiness or sedation
- Isolating themselves
- Mood swings
- Relationship problems with friends and family
- Mental confusion
Signs of Alcohol Abuse
Although less common, cancer patients and survivors may also misuse alcohol alone or with opioids. Alcohol is an addictive substance that requires rehab once addiction develops.
Here are the signs of alcohol abuse in cancer patients:
- Drinking alcohol in large amounts or for longer periods
- Difficulty reducing the amount of alcohol consumption or struggling to quit drinking
- Spending a lot of time drinking or being sick from the effects of alcohol
- Having intense cravings for alcoholic drinks
- Experiencing problems at home, school, or work as a result of drinking alcohol
- Continuing to drink alcohol even though it causes problems with friends or family
- Giving up important activities or interests to drink alcohol
- Engaging in risky behavior after heavy drinking
- Drinking even though it causes feelings of depression, anxiety, and other health issues
- Consuming more alcohol to get the same effects previously experienced with less alcohol
- Experiencing withdrawal symptoms when the alcohol wears off
Tips to Prevent Drug Addiction in Cancer Patients
Doctors should regulate and monitor the use of prescription opioids in cancer patients. Opioids shouldn't be prescribed for more than two weeks as it increases the risk for opioid dependence and addiction.
Cancer patients must be educated with the risks associated with opioid use. They should be taught not to take opioids with alcohol and to only take them as prescribed. Moreover, they must learn to watch for signs of opioid dependence and addiction.
If you're a cancer patient or survivor, you can practice self-awareness to avoid dependence on opioids. Here are some tips to get you started:
- Keep a pain journal documenting the frequency and intensity of your pain
- Keep all your medical appointments and communicate openly with your doctors
- Let someone you love and trust oversee your intake of pain medications
- Build and maintain a reliable support system
- Enroll in peer support groups
- Enroll in therapy or counseling sessions
Treatment for Opioid and Alcohol Addiction in Cancer Patients
There are many challenges when it comes to managing pain in cancer patients and people recovering from cancer. Managing pain and addiction simultaneously is even more challenging. Fortunately, doctors have experience in this field and have found that a multidisciplinary rehabilitation program can often lead to a full recovery.
If you or someone you know is suffering from pain from cancer treatment and may be at risk of developing an addiction to opioids and alcohol, talk with your doctor to make sure you’re taking all the right precautions.