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Effective Pain Management For
Cancer Patients
Wen-Hsing, Yang
Long Island University

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Abstract
Ineffective cancer pain management makes patients suffer and severely impacts their daily
living. Western medication (morphine, narcotic drugs, analgesia) and combination with
complementary alternative medicine (CAT) (acupuncture, massage, herbals) are used to decrease
the level of pain. Health professionals evaluate patients’ pain, offering them the treatment or
combination of treatments that would be best for them. Professionals must use pain assessment
tools and carefully evaluate the patient. Pain medications can be helpful but can produce adverse
side effects. Combining treatments can be helpful to manage the pain. The researchers used
Prequest, American Cancer Society as databases to understand effective pain management
methods and the key words include cancer pain, oxycodone, and CAT. While studies in these
two articles lack sufficient methodology, contain shades of bias and contain relatively small
sample populations the outcome for the use of combination therapy and oxycodone is promising
and recommended but clinically unclear. Do cancer patients obtain more relief from a
combination of oxycodone plus CAT compared to the use of oxycodone alone to decrease cancer
pain?

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Effective Pain Management for Cancer Patients
Clinical Case Study
Pain is a common experience for people with cancer, especially if they cannot be cured.
Two of my cancer patients do not receive adequate pain reliefs, due to language barriers and
cultural beliefs. One of them, Mrs. Chen who has stomach cancer, uses CAT and oxycodone, Mr.
Wang who has liver cancer, takes oxycodone instead of morphine to reduce pain. Mrs. Chen uses
a CAT to decrease the pain and the medication’s adverse side effects. This helps her to reduce
nausea and vomiting caused by the side effects of the oxycodone. Mr. Wang who takes
oxycodone was afraid of addiction and refused to take other combination medication which may
alleviate more of his pain. Also, the pain assessment by the healthcare professional was not
effective due to language barriers and cultural perspective. These tools (the Visual Analogue
Scale, the McGill Pain questionnaire, the Numerical Rating Scale and the Face Pain Rating
Scale) are used to identify intensity of pain, the location of the pain, the quality of the pain and
the duration of the pain. However, the healthcare professional misunderstood these Chinese
patients’ cultural values and misinterpreted the pain assessment scales, leading to a poor
outcome. Mrs. Chen and Mr. Wang did not know how to use the tools (language barriers). That
is the main reason my clients do not receive adequate pain relief.
PICO Question:
Do cancer patients obtain more relief from a combination of oxycodone plus CAT
compared to the use of oxycodone alone to decrease cancer pain? P=Population. Why do cancer
patients not receive adequate pain relief? Approximately 50 to 70 percent of cancer clients
suffer un-relief cancer pain, due to their stage of illness and at certain point (American Cancer
Society, 2013). More than 40 percent of cancer clients receive inadequate pain reliefs from their

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pain medication (American Cancer Society, 2013). This leads to a decrease in the physical and
psychological activity of daily living.
I=Intervention. What kind of treatment is used in the clinical setting, combination with
CAT and medication or simple pharmacology therapy? To treat pain effectively, the caregiver
must evaluate a combination of several factors: the clients’ unique symptoms and physical
attributes, the stage of his/her particular cancer, the current medical prescriptions and the
alternative options such as acupuncture, massage and music, solely or in combination.
C=Compare. How does combination CAT and single pharmacology therapy help cancer
clients? Pharmacology therapy, CAT or a combination of the two are common intervention to
manage cancer pain. Comparing these therapies and finding the best treatment for the cancer
client is necessary for optimal pain relief. The acupuncture study explored treating varieties of
cancer (liver, stomach, lung) with different combinations of acupuncture and drugs to find the
best combination for pain relief.
O=Outcome: which one is more successful in treating cancer pain? In the acupuncture
article, there was support for addition of acupuncture in therapy but the studies which were done
in China, and are predisposed toward the use of acupuncture because of the cultural background
of the population. In the oxycodone article, there was no significant clinical difference between
the use of oxycodone over morphine and hydromorphone but the researchers recommended the
use of oxycodone.
Acupuncture Efficacy:
Acupuncture is a traditional Chinese medicine which can be used to reduce pain. The
question posed by the current survey: "Is acupuncture effective with or without additional

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medication in the treatment of cancer pain?" This survey of Random Clinical Trials (RCT)
searched 14 databases to accept 15 trials within its selection criteria. The total number of
participants was 1,157 (extremely small), the acupuncture style varied among the studies, but the
practitioners’ (those administering the acupuncture) backgrounds were not reported in any of the
studies. The survey date was from the inception of the databsaes until April 2011; the paper was
published online on March 25, 2012. Ultimately, the review found the individual studies
inconclusive due to the limited number of studies and the inadequate methodological quality of
the studies themselves. All of the trials were deemed to have a high risk of bias due to the
randomization process, insufficient information on dropouts and withdrawals, and the lack of
allocation concealment in all but one study. While the reviewers recommended further rigorous
exploration of this topic, there were conclusions of individual studies that recommended the use
of acupuncture.
Several problems exist with this inquiry. The range of cancer types and the differing
pains associated with them is too simply broad for this purpose. If there was a focus on a specific
type of cancer and its associated pain, there might have been more coherence to the findings, that
is, if those more focused studies existed, which they do not in these particular databases. Also,
the methods used in the application of the acupuncture were not uniform. There were several
variations of the kind of acupuncture practiced so this also must be addressed when trying to
reach a consensus on the subject. There must be a focus on one kind of acupuncture.
Oxycodone, the Great Reliever:
In A Systematic Review of Oxycodone in the management of cancer pain, the authors
(King, Reid, Forbes .,& Hanks, 2011) scanned databases (including Medline, EMBASE and

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CINAHL) and current medical literature for studies exploring the efficacy, tolerability and
possible adverse effects of replacing morphine and hydromorphone with oxycodone in adult
cancer clients who experience moderate to severe pain. The resultant 29 studies included 14
RCTs and were filtered either electronically from the databases up to the date July 31, 2009 or
hand searched from recent articles and international conference proceedings. After careful meta-
analysis of the material, there were no significant differences, no adverse side effects nor
toleration problems reported with the use of oxycodone, and there were some improvements for
patients who experience stomach problems with the use of morphine alone.
The topic was clearly defined and carefully searched. Included were studies written in
English, concerning adults in severe to moderate pain. Excluded were studies in which patients
switched from one opioid to another. The conclusion of recommending oxycodone is well
supported by the studies used but there were a few problems or omissions of material that must
be noted. Some of the studies did not have adequate allocation concealment, but the authors did
not find this significant to the conclusions. Concerns over bias were noted several times but also
not deemed significant to the conclusions. Side effects of nausea and hallucinations from
morphine use were similar, but factors in one study using morphine and sustained release
oxycodone and amytriptyline (for sleeping) were too confusing for clear analysis. A total of 3000
patients were included in these studies and the authors have no problem recommending
oxycodone as a replacement for morphine and hydromorphone. But the question is why would
they? Oxycodone is a blend of acetomenophen and morphine, two proven pain relievers in the
medical establishment. Barring possible unforeseen side effects from this unusual combination,
logically they should do wonderful things to relieve the pain ridden individual when combined.

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Is it really necessary to check that these two different drugs are still behaving responsively to the
individual who needs pain relief? The answer is absolutely for the safety of the patients.
My patient Mrs. Chen is taking oxycodone for her cancer and she fits within the age,
cancer and pain range the criteria noted above. She also uses acupuncture for pain relief so it is
considered combination therapy for pain. It is not necessary for me to devise a protocol or
address additional barriers in implementation since my patient is already using oxycodone. Mr.
Wang is also clearly fits within the criteria above. But for him, we could easily recommend using
combination therapy to ease his pain. If we suggested acupuncture, the recommendations
supported extending the numbers of the acupuncture treatments and lengthening the time of the
acupuncture sessions (even though the timing of the original sessions was reported as short).
This additional expenditure on acupuncture would be well worth it if Mr. Wang’s pain was
severe that particular day and the additional relief would be necessary to such a fragile
constitution.
Summary:
To summarize, the purpose of this research is to understand what kind of pain
management is better for the cancer clients: using CAT and pain medications or simply using
pain medications alone. Cancer patients and my Chinese cancer patients are included. These two
articles are systematic reviews which include cancer patients and treatment but do not show
significant differences between medication therapy and combination treatment. There are no
simple ways to compare the results of the two articles which are both flawed. You cannot
recommend one over the other as a clinical finding and therefore, it is not necessary to make any
changes in the clinical setting. However CAT is becoming a popular option for pain relief.

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Patients are welcome to open their minds and try something new even if it is not clinically
proven and especially if it is not harmful to their bodies. A patient feeling pain-free on
oxycodone may find additional relief through CAT. There are many kind of acupuncture with
different stages of cancer making research difficult and the results unreliable and unproven. But
this does not mean that acupuncture is neither helpful nor effective. If a single treatment is not
effective, you can try additional therapy or both of them together until the combination is
appropriate for the pain.

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Reference:
American Cancer Society.(2013). Pain information for professionals. Retrieved from
http://www.cancer.org/myacs/newengland/programsandservices/pain-information-for-
professionals.
Choi, T.Y., Lee, M. S., Kim, T.H., Zaslawski, C., & Ernst, E. (2012). Acupuncture for the
treatment of cancer pain: a systematic review of randomized clinical trials.
supportive care in cancer, 21(6),1147-1158. Doi: 10.1007/s00520-012-14329
King, S.J., Reid, C., Forbes, K., & Hanks, G. (2011). A systematic review of oxycodone in the
management of cancer pain. Palliative Medicine, 25(5), 454-470. Doi: 10.1177/02692163
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