American Cancer Society's Guide to Pain Control: Understanding and Managing Cancer Pain
5/5
()
About this ebook
Read more from American Cancer Society
Quick & Healthy: 50 Simple Delicious Recipes for Every Day Rating: 0 out of 5 stars0 ratingsWhat to Eat During Cancer Treatment Rating: 0 out of 5 stars0 ratings
Related to American Cancer Society's Guide to Pain Control
Related ebooks
The Chronic Pain Management Sourcebook Rating: 5 out of 5 stars5/5A Day without Pain Rating: 0 out of 5 stars0 ratingsBecoming an Empowered Patient Rating: 0 out of 5 stars0 ratingsThe Opioid-Free Pain Relief Kit: 10 Simple Steps to Ease Your Pain Rating: 0 out of 5 stars0 ratingsMe and My Pain: The challenges of living with chronic pain Rating: 0 out of 5 stars0 ratingsChronic Fatigue Syndrome, Fibromyalgia, and Other Invisible Illnesses: The Comprehensive Guide Rating: 4 out of 5 stars4/5What Your Doctor Didn't Tell You: How Complementary and Alternative Medicine Can Help Your Pain Rating: 0 out of 5 stars0 ratingsMayo Clinic Guide to Pain Relief: How to Manage, Reduce and Control Chronic Pain Rating: 5 out of 5 stars5/5Everyday Strength: A Cancer Patient's Guide to Spiritual Survival Rating: 0 out of 5 stars0 ratingsPaindemic: A Practical and Holistic Look at Chronic Pain, the Medical System, and the antiPAIN Lifestyle Rating: 0 out of 5 stars0 ratingsNatural Painkillers How to Relieve Pain Without Drug Dependence or Side Effects Rating: 0 out of 5 stars0 ratingsHow Can I Help?: Everyday Ways to Help Your Loved Ones Live with Cancer Rating: 0 out of 5 stars0 ratingsLiving Well With Chronic Illness Rating: 0 out of 5 stars0 ratingsImproving Outcomes in Chronic Obstructive Pulmonary Disease: Optimizing Maintenance Therapy Across Health Care Settings Rating: 0 out of 5 stars0 ratingsTerminal Hope: What Cancer Taught Me About Living and Dying Rating: 0 out of 5 stars0 ratingsAs my body attacks itself: My journey with autoimmune disease, chronic pain & fatigue Rating: 0 out of 5 stars0 ratingsLiving With Thyroid Cancer: Living With Thyroid Cancer, #2 Rating: 0 out of 5 stars0 ratingsKicking Sick: Your Go-To Guide for Thriving with Chronic Health Conditions Rating: 0 out of 5 stars0 ratingsSurvival Symphony: My Lung Cancer Journey Rating: 0 out of 5 stars0 ratingsHealing at the Borderland of Medicine and Religion Rating: 0 out of 5 stars0 ratingsPsychology, Psychiatry and Chronic Pain Rating: 0 out of 5 stars0 ratingsDoctor Brooklyn: Love & Life at the End of a Knife Rating: 0 out of 5 stars0 ratingsReal Fibromyalgia Rx Rating: 5 out of 5 stars5/5The Human Side of Cancer: Living with Hope, Coping with Uncertainty Rating: 0 out of 5 stars0 ratingsThe Mayo Clinic Breast Cancer Book: Prevention, Treatment, Care, Coping, Living with Hope Rating: 0 out of 5 stars0 ratingsHuman Tumours Secreting Catecholamines: Clinical and Physiopathological Study of the Pheochromocytomas Rating: 5 out of 5 stars5/5The Way Through Chronic Pain: Tools to Reclaim Your Healing Power Rating: 0 out of 5 stars0 ratings
Medical For You
Peptide Protocols: Volume One Rating: 4 out of 5 stars4/5The Hormone Reset Diet: Heal Your Metabolism to Lose Up to 15 Pounds in 21 Days Rating: 4 out of 5 stars4/5Mediterranean Diet Meal Prep Cookbook: Easy And Healthy Recipes You Can Meal Prep For The Week Rating: 5 out of 5 stars5/5The Obesity Code: the bestselling guide to unlocking the secrets of weight loss Rating: 4 out of 5 stars4/5Tight Hip Twisted Core: The Key To Unresolved Pain Rating: 4 out of 5 stars4/5What Happened to You?: Conversations on Trauma, Resilience, and Healing Rating: 4 out of 5 stars4/5The 40 Day Dopamine Fast Rating: 4 out of 5 stars4/5Holistic Herbal: A Safe and Practical Guide to Making and Using Herbal Remedies Rating: 4 out of 5 stars4/5Mating in Captivity: Unlocking Erotic Intelligence Rating: 4 out of 5 stars4/5The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally Rating: 4 out of 5 stars4/5WomanCode: Perfect Your Cycle, Amplify Your Fertility, Supercharge Your Sex Drive, and Become a Power Source Rating: 4 out of 5 stars4/5ATOMIC HABITS:: How to Disagree With Your Brain so You Can Break Bad Habits and End Negative Thinking Rating: 5 out of 5 stars5/5The Vagina Bible: The Vulva and the Vagina: Separating the Myth from the Medicine Rating: 5 out of 5 stars5/5The Amazing Liver and Gallbladder Flush Rating: 5 out of 5 stars5/5Adult ADHD: How to Succeed as a Hunter in a Farmer's World Rating: 4 out of 5 stars4/5Lies My Gov't Told Me: And the Better Future Coming Rating: 4 out of 5 stars4/5Gut: The Inside Story of Our Body's Most Underrated Organ (Revised Edition) Rating: 4 out of 5 stars4/5"Cause Unknown": The Epidemic of Sudden Deaths in 2021 & 2022 Rating: 5 out of 5 stars5/5Summary of Dr. Gundry's Diet Evolution: Turn off the Genes That Are Killing You and Your Waistline Rating: 3 out of 5 stars3/5Living Daily With Adult ADD or ADHD: 365 Tips o the Day Rating: 5 out of 5 stars5/5Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner Rating: 4 out of 5 stars4/5Herbal Healing for Women Rating: 4 out of 5 stars4/5Women With Attention Deficit Disorder: Embrace Your Differences and Transform Your Life Rating: 5 out of 5 stars5/5
Reviews for American Cancer Society's Guide to Pain Control
1 rating0 reviews
Book preview
American Cancer Society's Guide to Pain Control - American Cancer Society
Books published by the American Cancer Society
A Breast Cancer Journey: Your Personal Guidebook, Second Edition
American Cancer Society Consumers Guide to Cancer Drugs, Second Edition, Wilkes, Ades, and Krakoff
American Cancer Society’s Complementary and Alternative Cancer Methods Handbook
American Cancer Society’s Guide to Complementary and Alternative Cancer Methods
Angels & Monsters: A child’s eye view of cancer, Murray and Howard
Because Someone I Love Has Cancer: Kids’ Activity Book
Cancer in the Family: Helping Children Cope with a Parent’s Illness, Heiney et al.
Cancer: What Causes It, What Doesn’t
Caregiving: A Step-By-Step Resource for Caring for the Person with Cancer at Home, Revised Edition, Houts and Bucher
Coming to Terms with Cancer: A Glossary of Cancer-Related Terms, Laughlin
Couples Confronting Cancer: Keeping Your Relationship Strong, Fincannon and Bruss
Crossing Divides: A Couple’s Story of Cancer, Hope, and Hiking Montana’s Continental Divide, Bischke
Eating Well, Staying Well During and After Cancer, Bloch et al.
Good for You! Reducing Your Risk of Developing Cancer
Healthy Me: A Read-along Coloring & Activity Book, Hawthorne (illustrated by Blyth)
Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery, Second Edition, Eyre, Lange, and Morris
Kicking Butts: Your Path to Quitting Smoking
Our Mom Has Cancer, Ackermann and Ackermann
Also by the American Cancer Society
American Cancer Society’s Healthy Eating Cookbook: A celebration of food, friends, and healthy living, Second Edition
Celebrate! Healthy Entertaining for Any Occasion
Kids’ First Cookbook: Delicious-Nutritious Treats to Make Yourself!
Published by
American Cancer Society
Health Promotions
1599 Clifton Road NE
Atlanta, Georgia 30329, USA
© 2004 American Cancer Society
All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the prior written permission of the publisher.
Printed in the United States of America
Cover designed by Jill Dible
5 4 3 2 1 04 05 06 07 08
Library of Congress Cataloging-in-Publication Data
American Cancer Society’s guide to pain control : understanding and managing cancer pain.— Rev. ed.
p. cm.
Previous ed. has subtitle: Powerful methods to overcome cancer pain.
Includes bibliographical references and index.
ISBN 0-944235-52-2 (pbk. : alk. paper)
1. Cancer pain. 2. cancer pain—Treatment. I. Title: Guide to pain control. II. American Cancer Society.
RC262.A645 2004
616’.0472—dc22
2003025526
Brief Contents
CHAPTER 1
Understanding Cancer Pain
CHAPTER 2
Coping with the Emotional and Social Impact of Cancer Pain
CHAPTER 3
Achieving Effective Pain Control
CHAPTER 4
Describing and Measuring Your Pain
CHAPTER 5
Pain Relief through Medication
CHAPTER 6
Other Medical Approaches to Pain Management
CHAPTER 7
Complementary Nondrug Treatments
CHAPTER 8
Managing Side Effects of Opioids
CHAPTER 9
Cancer Pain in Specific Groups
EDITOR
Amy Brittain
MANAGING EDITOR
Gianna Marsella, MA
BOOK PUBLISHING MANAGER
Candace Magee
DIRECTOR,PUBLISHING
Diane Scott-Lichter,MA
DIRECT CHANNELS
ANAGING DIRECTOR
Chuck Westbrook
EDITORIAL REVIEW
Terri Ades, MS, APRN-BC, AOCN
Director of Cancer Information
American Cancer Society
Atlanta, Georgia
Betty R. Ferrell, PhD, FAAN
Research Scientist
City of Hope National Medical Center
Duarte, California
A Note to the Reader
The information contained in this book is not intended as medical advice and should not be relied upon as a substitute for talking with your doctor. This information may not address all possible actions, precautions, side effects, or interactions. All matters regarding your health require the supervision of a medical doctor who is familiar with your medical needs. For more information, contact your American Cancer Society at 800-ACS-2345 or http://www.cancer.org.
Contents
Foreword by Betty R. Ferrell, PhD, FAAN
Advances in Understanding Pain
Partnering to Manage Paini
The Role of this Book in Pain Control
Everyone Has a Right to Pain Relief
Introduction
The Impact of Cancer Pain
Cancer Pain Is Undertreated
Methods of Pain Control
What You Can Do
How to Use This Book
About the American Cancer Society
Acknowledgments
CHAPTER 1
Understanding Cancer Pain
What Is Cancer?
What Is Pain?
Types of Pain
Acute Pain
Chronic Pain
Breakthrough Pain
Nociceptive Pain
Neuropathic Pain
Factors that Influence Pain
Causes of Pain
Diagnostic Procedures
Cancer Treatment
Tumor-Related Pain
Pain Due to Other Causes
Help is on the Way
CHAPTER 2
Coping with the Emotional and Social Impact of Cancer Pain
Pain’s Impact on Quality of Life
Measuring Quality of Life
Common Feelings about Cancer and Cancer Pain
Factors that Affect Feelings about Pain
Individual Reactions to Pain
Pain and Depression
Pain and Anxiety
The Impact of Pain on Relationships
Support from Friends and Family
Asking for Help
When to Seek Counseling
Finding Support
Support Groups
Individual Therapy
Family Therapy
Choosing a Counselor
Why Do Some People Need Help and Others Don’t?
Will Insurance Pay for Counseling and Therapy Services?
CHAPTER 3
Achieving Effective Pain Control
Myths and Misconceptions about Cancer Pain
Myth 1: People Become Addicted to Pain Medications
Myth 2: Taking Too Much Pain Medication Will over Time Decrease Its Effectiveness
Myth 3: Pain Is a Normal Part of Having Cancer
Myth 4: Pain Means that the Cancer Is Growing
Myth 5: Pain Can’t Be Treated
Myth 6: Doctors Don’t Understand Pain
Myth 7: Good Patients Don’t Complain
Myth 8: Focusing on the Pain May Be a Distraction from Treating the Cance
Myth 9: People Should Be Able to Tough it Out
Myth 10: Pain Medications Cause Unpleasant Side Effects
The Importance of Communication
Communicating with Your Health Care Team
Communicating with Caregivers
Barriers to Communication
Language Barriers
Cultural Background
Pain Is Subjective
Limited Knowledge and Time
When to Seek Additional Help
CHAPTER 4
Describing and Measuring Your Pain
The Language
of Pain
Talking about Your Pain
Talking with Family Members and Caregivers about Pain
Talking with Your Health Care Team about Pain
How Pain Is Measured
The Initial Pain Assessment
Preparing for a Pain Assessment
When the Person with Cancer Is Unable to Discuss Pain
Tools for Rating Your Pain
Numeric Scales
Word Scales
The Faces Scale
Color Scales
The Brief Pain Inventory
What to Do after the Initial Pain Assessment
Your Pain Treatment Plan
Communicating about Pain and Pain Relief
The Pain Log
Assessment for Recurrence of Pain
CHAPTER 5
Pain Relief through Medication
Determining Pain Medication(s) Appropriate for You
Types of Medications Used to Control Cancer Pain
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Acetaminophen
Opioids
Other Types of Pain Medications
Adjuvant Medicines
Methods Used for Drug Delivery
Oral
Transmucosal
Sublingual
Transdermal (Skin Patch)
Rectal Suppositories
Injections
Patient-Controlled Analgesia (PCA)
Managing Your Drug Therapy Program
Controlling Breakthrough Pain
Tolerance, Dependence, and Addiction
Drug Tolerance
Drug Dependence
Psychological Dependence and Addiction
Changing Your Pain Medicine or Drug Therapy Plan
Pain Records, Charts, and Logs
What to Include in a Pain Record
CHAPTER 6
Other Medical Approaches to Pain Management
Palliative Therapy for Pain Control
Palliative Radiation Therapy
Palliative Chemotherapy
Hormonal Therapy
Bisphosphonate Therapy
Palliative Surgery
Nerve Blocks
Temporary Nerve Blocks
Permanent Nerve Blocks
Side Effects of Nerve Blocks
Location of Nerve Blocks
Spinal Opioid Infusion
Neurosurgery
CHAPTER 7
Complementary Nondrug Treatments
What Are Complementary Nondrug Treatments?
How Complementary Nondrug Treatments Can Help Control Pain
Access to Complementary Nondrug Treatments
Complementary Nondrug Methods
Acupuncture
Biofeedback
Distraction
Exercise
Humor Therapy
Hypnosis
Imagery and Visualization
Meditation
Music Therapy
Psychotherapy/Counseling
Relaxation
Skin Stimulation
Spirituality and Prayer
Transcutaneous Electrical Nerve Stimulation (TENS)
Yoga
CHAPTER 8
Managing Side Effects of Opioids
Opioid Analgesic Side Effects
Digestive Tract Side Effects
Central Nervous System Side Effects
CHAPTER 9
Cancer Pain in Specific Groups
Children and Cancer Pain
Sources of Cancer-Related Pain among Children
Pain Assessment in Children
Managing Cancer Pain in Children
Cancer Pain in the Elderly Person
Pain Assessment in Elderly Patients
Managing Cancer Pain in the Elderly Person
Emotional and Psychological Issues Related to Pain in the Elderly
Treatment Issues for People with a History of Substance Abuse
Culturally Diverse Groups
Impact on Care
Treating Pain in the Person with Advanced Disease
Pain Relief at the End of Life
Treating Severe Pain in Advanced Stages of Cancer
Hospice Care
Palliative Sedation
Conclusion
APPENDIX A
Cancer Pain Drug Information
Nonopioids
Opioids
Adjuvant Analgesics
APPENDIX B
Guidelines for Pain Management
Joint Commission on the Accreditation of Healthcare Organizations
American Pain Society
National Comprehensive Cancer Network
Cancer Pain Treatment Guidelines for Patients
Resources
Glossary
Index
Foreword
by Betty R. Ferrell, PhD, FAAN, Research Scientist City of Hope National Medical Center, Duarte, California
PAIN HAS THE POTENTIAL TO NEGATIVELY AFFECT physical, psychological, social, sexual, and spiritual well-being, as well as upset family members and caregivers. Providing all available pain-relief methods to people with cancer is not only essential for preserving quality of life, it is critical to successful cancer treatment. Patients are better able to tolerate cancer treatment when their pain is alleviated.
The American Cancer Society is dedicated to diminishing suffering from cancer and has focused major efforts—including the publication of the first and revised editions of this book—toward addressing the critical issue of pain management and enhancing quality of life for people facing cancer.
Advances in Understanding Pain
Major advances in cancer prevention, early detection, diagnosis, and treatment have been mirrored by major advances in the understanding and treatment of cancer pain. In 1994, the federal government issued guidelines for the treatment of cancer pain. These initial guidelines, published by the Agency for Health Care Policy and Research, have been reinforced and elaborated upon through major documents from the National Cancer Institute, professional organizations, and consumer groups. All of these groups have consistently agreed that pain negatively affects quality of life—and that, unfortunately, pain is often undertreated.
Partnering to Manage Pain
The successful management of pain requires a partnership between patients and health care professionals. People with cancer and caregivers who are informed about cancer pain will better understand the importance of expressing pain, overcoming fears of addiction and tolerance, exploring appropriate nondrug methods of pain relief, and expecting that all means available are used to provide optimal pain relief. Cancer care professionals can help improve quality of life for people in pain by understanding how to overcome social and cultural barriers, balance side effects of pain-control methods, and assess and treat pain.
The Role of this Book in Pain Control
The American Cancer Society’s Guide to Pain Control was first published in 2001 to inform patients and their families about cancer pain, how to manage it, and how to obtain the best pain-control care possible. The revised edition of this comprehensive resource for patients, families, and health care professionals reflects updated developments in pain control, with an increased focus on practical information for people with cancer. It is essential reading for people with cancer and their family members. This book explains how to take control of cancer pain and how to obtain emotional and social support, and emphasizes that pain can usually be alleviated.
Everyone Has a Right to Pain Relief
Research and advances in clinical practice in the last decade have provided strong evidence that cancer pain is not a necessary part of having cancer, and the majority of people with cancer should expect to experience relief from cancer pain. More and more people are living with cancer, and this population must be able to participate in work, family, and enjoyable activities without being hindered or debilitated by pain. Quality of life must also be preserved for special populations, such as infants and children, the elderly, patients with a history of substance abuse, patients from diverse cultures, and those who are critically ill.
Continuous efforts are being made in the oncology field to better inform health care professionals about the importance of preventing, assessing, and managing pain. Health care professionals should not only strive to prevent pain before it occurs, but continue to learn more about the origins of pain and shape state-of-the-art treatments to treat it. The cooperation between patients and medical professionals is as critical as ever; pain relief can only be achieved through the effective description and assessment of pain.
As our knowledge about cancer pain and how to manage it grow, so do the range of powerful pain-prevention and pain-relief resources at our disposal, including medications, nondrug methods, and complementary therapies. All people with cancer should expect high-quality treatment and care, including a personally tailored pain-relief plan. Pain relief is a basic right and is the foundation for coping with a diagnosis of cancer. Effective pain relief enables patients to focus their energies on fighting cancer and regaining control of their lives.
Introduction
ALTHOUGH PAIN IS ONE OF THE MOST FEARED complications of cancer, many people with cancer do not experience cancer-related pain. In most cases pain can be reduced so a person with cancer can continue most daily activities. Approximately nine out of ten people who have cancer-related pain can get effective pain relief.
Today, many different kinds of medicines and other methods can help relieve pain. With effective pain management, people with cancer pain are free to sleep and eat, enjoy the company of family and friends, and continue with work, hobbies, and other pleasurable activities.
The Impact of Cancer Pain
In general, about two out of every three people with cancer experience pain sometime during their cancer experience. Although cancer pain is often thought of as a crisis that emerges in advanced stages of disease, it may occur at any stage and may be caused by many factors—cancer itself, treatments, or factors unrelated to cancer.
Pain can have a significant impact on both physical and emotional aspects of life. It can cause suffering and reduce physical and social activity, appetite, and sleep. It can weaken the body and make it difficult to follow through with scheduled treatments. Uncontrolled pain negatively affects quality of life, preventing people from working productively, enjoying recreation, or taking pleasure in their usual roles in the family and society.
The psychological effects of cancer pain can also be devastating. An inability to meet financial, employment, and interpersonal demands can create a heavy burden. People with cancer may lose hope when pain occurs because they think pain signals the progression of disease. Chronic, severe, or unrelieved pain can lead to depression, and depression or anxiety can lower a person’s tolerance for pain and make the pain feel even worse.
Cancer Pain Is Undertreated
The inadequate treatment of cancer pain causes needless suffering. Although a variety of treatment methods exist to relieve cancer pain, research shows that it is still undertreated.
Even though treatments exist that can significantly reduce cancer pain and improve the quality of life of patients and their families, enormous barriers persist that can prevent these treatments from being adequately and appropriately applied. Patients’ and health professionals’ lack of knowledge about the appropriate use of treatments is a major barrier. Myths and misconceptions about pain, addiction, and tolerance may make patients reluctant to ask for or use pain medication and may make health professionals reluctant to prescribe pain medications. Health care professionals often lack knowledge about how to assess pain (that is, understand if the patient is having pain, and if so, how much pain, what type of pain, and its location or cause) and adequately treat pain. Fear of disciplinary action by licensing boards and criminal prosecution by drug enforcement agencies also hinders professionals from prescribing appropriate medicines and/or doses to relieve pain.
Pain control is still considered a secondary issue rather than a central element of appropriate cancer care. Until recently, hospitals and health care systems did not have practice standards for pain control (see Appendix B on page 201 for more information about guidelines for pain management). Health insurance companies do not adequately reimburse for pain medications, and this restricts patients’ access to needed pain control. Further, because of societal and cultural barriers, patients often do not feel comfortable raising concerns about cancer pain. These barriers also inhibit doctors and nurses from appropriately and adequately prescribing pain medications and deter patients from using them.
Methods of Pain Control
Cancer pain can be treated in a variety of ways. One of the most effective methods of pain control is the use of medicines, or drug therapy. Nondrug therapies may also help manage pain, including applying heat or cold, massage, transcutaneous electrical nerve stimulation (TENS), exercise, immobilization (e.g., bracing a joint), nerve blocks and nervous system surgery, and acupuncture.
Pain relief can also be achieved by reducing a person’s reaction to pain. People can learn skills such as relaxation, imagery, meditation, distraction, biofeedback, hypnosis, and other techniques to increase their ability to cope with pain and remain as active as possible. These complementary nondrug methods can also help people cope with the emotional and psychological impact of pain on their quality of life and well-being, both of which can be significantly affected by pain.
What You Can Do
The first step in pain control is to identify and express the pain. If your doctor does not bring up the subject of pain, it is up to you to make your pain known. The cornerstone of effective pain management is a thorough pain assessment. What you tell your health care team about your pain and how you describe your pain help form the pain assessment. You can help by describing your experience of pain in as much detail as possible. Only you can describe the nature of your pain to your health care team, including:
the location
what it feels like
how long it lasts
when it started
the intensity or how severe it is
what makes it better and what makes it worse
Recording and reporting the effects of your pain and how it impacts your ability to function every day will also help with the evaluation. Your doctor will use your information along with a detailed history, physical examination, psychosocial assessment, and the results of any diagnostic studies to determine the treatment options that are best for you.
How to Use This Book
The American Cancer Society’s Guide to Pain Control is a comprehensive guide that will help you understand the complex issues involved in dealing with cancer pain. The goal of this book is to help people affected by cancer pain:
learn about pain
overcome the barriers to pain treatment
communicate with members of the health care team, including describing pain accurately
manage pain and related side effects
cope with the related emotional and social concerns
find helpful resources in the community and across the country
This book will walk you through the important issues and details related to pain control, from diagnosis throughout your cancer experience. You’ll discover how to achieve acceptable pain control and how to understand the optimal balance between pain relief and side effects of pain medication. As you read, you’ll learn about how cancer pain and its treatment affect your body, your emotions, your relationships with others, and your life in general. We encourage you to evaluate the information here and talk with your health care team to determine how best to treat your pain. Remember that you have a right to receive appropriate treatment for pain control.
About the American Cancer Society
Represented in more than 3,400 communities throughout the country and Puerto Rico, the American Cancer Society is a nonprofit health organization dedicated to eliminating cancer as a major health problem. This book is just one example of the many ways the American Cancer Society seeks to fulfill its mission: to save lives and diminish suffering from cancer through research, education, advocacy, and service.
The Society is the largest private source of cancer research dollars in the U.S. Approximately two million Americans volunteer their time to the Society to work to conquer cancer. To contact the American Cancer Society, call 800-ACS-2345 or visit our web site at http://www.cancer.org.
Acknowledgments
Many people helped shape this edition of the American Cancer Society’s Guide to Pain Control by providing us with valuable feedback on the first edition of this text:
Terri Ades, MS, APRN-BC, AOCN; Claudia Barnes, RN, BSN, CHPN; Debbie Bruins; Melinda Burns; Patrick J. Coyne, MSN, APRN, BC-PCM; Sherryll Crutcher; June Dahl, PhD; Doreen Donahue, OSW-C; Pat Dooley, RNC, BSN, MHSA; Wendy J. Evans, RN, MSN, AOCN; Betty R. Ferrell, PhD, FAAN; Walter B. Forman, MD, FACP, CMD; Michele E. Gaguski, MSN, RN, AOCN, APN-C; Lisa L. Hansen;