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Effective Symptom Management:
working with your team
Suzana Makowski, MD
Goals

• What are your goals for today's talk?

• Pain and other physical symptoms

• Psychological, spiritual, and social concerns

• Where to turn?
Managing Pain

• It is common

• Barriers to treatment are many

• What can you do?

    • Keep track of your pain and use of medicines

    • Work with your doctor, nurse, and pharmacist - team approach

    • Address your worries
What doctors need to
know about your Pain

• Location

• Intensity: how bad is it?

• 'Quality': what does it feel like?

• Timeline

• What makes it better/worse

    • What have you tried, were there side effects...
Understanding Pain
Management

                     Definitions:

                     • Adjuvant

                     • Non-opioid:
                       acetaminophen (Tylenol)
                       ibuprofen or naprosen

                     • Opioid: morphine,
                       oxycodone, fentanyl,
                       hydromorphone
                       (Dilaudid)
Opioids

• Addiction versus dependence versus tolerance


• Long-acting and short-acting (immediate release)

• Pill/liquid versus IV

• Side effects:

    • constipation - doesn't go away

    • Sleepiness, nausea

    • Less common: confusion, twitching (myoclonus)
Other treatments for pain
Pain - other treatments

• Radiation therapy

• Interventional pain (anesthesia)

   • Nerve blocks

   • Intraspinal medicine/pumps

• Non-pharmacologic

   • Physical therapy, including TENS, compresses

   • Psychological/behavioral therapy

   • Complementary or alternative therapy
Things to look out for

• Sudden changes in pain intensity or location

• New weakness

• New incontinence of urine or stool

                Call your doctor right away
Gastrointestinal symptoms
• Nausea

• Vomiting

• Anorexia (loss of appetite)

    • Megace

    • Dexamethasone

    • Small, frequent meals, plastic/wooden utensils

• Constipation

    • Senna & colace

    • Yakima paste
Weakness and fatigue

• Let your doctor know

• How are you sleeping?

• There are many causes and treatment is targeted when
  possible

   • Anemia

   • Insomnia

   • Anxiety, depression, stress

   • Other...
Psychological symptoms

• Anxiety, fear, uncertainty

• Depression, sadness, grief

• Concern for family and future

• Dignity

• Resilience and hope
Your team

• Doctors

• Nurses

• Social worker

• Psychologist

• Family, friends, chaplains

• When you need more help: palliative care
What is palliative care?

• Treatment that focuses on alleviating suffering, improving
  sense of well-being

• It is available at all stages of illness

• It can be offered alone or during other therapies/treatment
  in the hospital, and sometimes at home or in a clinic

• It is a team approach - lending support to patients and
  their family
Other resources


• The Center for Mindfulness

• www.cancer-pain.org

• www.getpalliativecare.org
Summary

• Work with your team... We're here to help

• Treat and identify symptoms early:

   • pain, fatigue, GI symptoms, psychological concerns

                     You're not alone
                     We want to help
                      We can help
Thank you
Questions?

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Prostate cancer

  • 1. Effective Symptom Management: working with your team Suzana Makowski, MD
  • 2. Goals • What are your goals for today's talk? • Pain and other physical symptoms • Psychological, spiritual, and social concerns • Where to turn?
  • 3. Managing Pain • It is common • Barriers to treatment are many • What can you do? • Keep track of your pain and use of medicines • Work with your doctor, nurse, and pharmacist - team approach • Address your worries
  • 4. What doctors need to know about your Pain • Location • Intensity: how bad is it? • 'Quality': what does it feel like? • Timeline • What makes it better/worse • What have you tried, were there side effects...
  • 5. Understanding Pain Management Definitions: • Adjuvant • Non-opioid: acetaminophen (Tylenol) ibuprofen or naprosen • Opioid: morphine, oxycodone, fentanyl, hydromorphone (Dilaudid)
  • 6. Opioids • Addiction versus dependence versus tolerance • Long-acting and short-acting (immediate release) • Pill/liquid versus IV • Side effects: • constipation - doesn't go away • Sleepiness, nausea • Less common: confusion, twitching (myoclonus)
  • 8. Pain - other treatments • Radiation therapy • Interventional pain (anesthesia) • Nerve blocks • Intraspinal medicine/pumps • Non-pharmacologic • Physical therapy, including TENS, compresses • Psychological/behavioral therapy • Complementary or alternative therapy
  • 9. Things to look out for • Sudden changes in pain intensity or location • New weakness • New incontinence of urine or stool Call your doctor right away
  • 10.
  • 11. Gastrointestinal symptoms • Nausea • Vomiting • Anorexia (loss of appetite) • Megace • Dexamethasone • Small, frequent meals, plastic/wooden utensils • Constipation • Senna & colace • Yakima paste
  • 12. Weakness and fatigue • Let your doctor know • How are you sleeping? • There are many causes and treatment is targeted when possible • Anemia • Insomnia • Anxiety, depression, stress • Other...
  • 13. Psychological symptoms • Anxiety, fear, uncertainty • Depression, sadness, grief • Concern for family and future • Dignity • Resilience and hope
  • 14. Your team • Doctors • Nurses • Social worker • Psychologist • Family, friends, chaplains • When you need more help: palliative care
  • 15. What is palliative care? • Treatment that focuses on alleviating suffering, improving sense of well-being • It is available at all stages of illness • It can be offered alone or during other therapies/treatment in the hospital, and sometimes at home or in a clinic • It is a team approach - lending support to patients and their family
  • 16. Other resources • The Center for Mindfulness • www.cancer-pain.org • www.getpalliativecare.org
  • 17. Summary • Work with your team... We're here to help • Treat and identify symptoms early: • pain, fatigue, GI symptoms, psychological concerns You're not alone We want to help We can help