Pain Management Barriers Nurses Can Help Cancer Survivors Navigate

“Identify your own bias,” Marshall urged. “Nurses should be aware of their own biases related to pain management and treatment, including disability, culture, societal norms, economic status, race/ethnicity, religion, and mental illness — including a history of substance abuse.”

Instruments such as the ONS Assessment Tools help nurses to assess patients’ pain, she noted.

The pilot study interviews suggested that restrictive prescribing policies have impacted patients’ access to opioid medications, Marshall reported. Patients reported that providers are hesitant to prescribe pain medication despite their cancer diagnoses and treatment, and new restrictions at pharmacies “made it challenging to pick up their medication,” she noted. For example, pharmacies require patients come pick up their medicines in person, rather than sending a family member. Nor can patients always call to make sure ahead of time that pharmacies have the prescribed drug, due to security concerns.

“Discussing these barriers can help reduce patient anxiety and prepare them,” Marshall said. “Understand your state’s opioid prescription regulations and be open with the patient upfront.… If your center has a pharmacy on-site, see if the patient can obtain refills there to save on multiple trips.”

Nurses should keep in mind that patients might not take pain medications as prescribed because of fear of becoming dependent on them and should be aware of and assess for adverse effects that can cause patients to stop using opioids, such as constipation.

“Nurses should encourage patients to use opioid medication as prescribed, not to reduce or increase their dose,” she concluded.

Marshall suggested sharing with patients online resources for safe handling, storage, and disposal of opioid medications, such as the Cancer Pain and Opioids for Cancer Pain sections on the American Cancer Society website.

Survivors also need to be educated about the risks of theft or diversion of their pain medications into the community. “Some patients safeguard opioid medication, but there is a lack of standardized education regarding safe disposal,” Marshall said.

Nurses should screen patients for potential opioid misuse and patient histories of opioid abuse (taking medication more frequently or at higher doses than prescribed, taking medication to achieve “highs,” or running out of medication early), Marshall said. But they should avoid using stigmatizing language when they address these issues.

Some patients voiced interest in alternatives to opioids for pain management. Numerous alternative techniques are available, from acupuncture and massage to meditation, yoga, music therapy, and art or pet therapy, Marshall noted. But they are poorly studied and, therefore, frequently not covered by insurers. Nurses should help patients seek out free acupuncture, massage, or art or pet therapy services offered by state agencies or cancer centers, she said.

Disclosures: This study was supported by the Geographical Management of Cancer Health Disparities Program (GMaP) from Moffitt Cancer Center with funding received from the National Cancer Institute Center to Reduce Cancer Health Disparities.

Reference

Marshall VK. Pain management, safe opioid use, and alternative pain management therapies. Presented at: ONS Bridge; September 12-14, 2023.