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)

7. Other treatments for pain

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

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

18. Thank you
Questions?