Essay Sample: Pain Management among African American Adults with Prostate Cancer

One of the serious issues that cancer patients face is handling the pain that results from the fast growth of the affected cells or chemotherapy (Pujol and Monti, 2007; Jan, 2015; Lin, Chen, and Chiu, 2011). The cause of pain among cancer patients can also be attributed to the psychological, biological and social consequences. About 50% to 70% of patients suffering from this illness complain of pain during treatment methods such as surgical operations, radiotherapy, and chemotherapy (Pujol & Monti, 2007). In other instances, inactivity of muscles may result in musculoskeletal or neuropathic pain. In most cases, patients have complained of recurring pain before the appropriate time for another dose. Such pain leads to trouble in sleeping and affects their normal lives. One of the main problems of pharmacological pain-relieving strategies is the tendency to develop drug resistance and dependence. The use of opioid among African-Americans may also increase the chances of developing an addiction. This paper will use the above-mentioned PICOT question to compare the clinical outcomes of the two methods used to relieve pain among cancer patients.

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Patient population

According to McGinley, Tay, and Moul (2015), prostate cancer us the commonest noncutaneous malignancy that affects men around the world. The research further reveals that many cases are reported among men of African origin. However, the high mortality rates due to prostate cancer are reported among the Afro-Caribbean men. Studies have revealed that about 50.6% of African-Americans have a dominant nodule on the anterior of the prostate as compared to 28% of women. According to the American Cancer Society (2016), about 1 out of 6 blacks were diagnosed with cancer between 2010 and 2012 while the ratio of the whites was 1 to 8. Among the advanced cases, the ratio of prostate cancer cases among African Americans is 1 in 23 while that of the whites is 1 in 42. Therefore, some of the established risk factors for this disease include age, race, as well as the history of the family due to genetic susceptibility.

Intervention

As mentioned before, most cancer patients experience pain as a result of cell overgrowth, surgery, radiotherapy or chemotherapy. Various reactions from a patient can be used to establish whether he feels pain or discomfort as a result of the disease or treatment options. According to Campbell, et al. (2004), the Caregiver Strain Index (CSI) can be applied in the establishment of strain levels as exhibited by the patient. In addition, the Profile of Mood States-Short Form (POMS-SF) can also be used to evaluate the mood where higher scores show that a sick person is distressed. Advanced cases of prostate cancer are often characterized by malignant bone pain (Eman, Beyaz, Saglam, & Gurcu, 2012). Some prostate cancer patients also experience pelvic and perineal pain. However, it is essential to differentiate between prostate cancer-related pain and that from other complications.

Compare control

It is revealed that most African-Americans prefer radiation treatment as compared to surgery (McGinley, Tay, & Moul, 2015). About 70% of this population choose radical prostatectomy as compared to whites. The pharmacological alternative is subdivided into three categories of analgesics that include opioid, non-opioid and adjuvant (Bader, et al., 2012). Whenever a patient experiences mild to moderate pain, he can be given a non-opioid analgesic with close monitoring of the adverse effects of every drug. Opioids can be prescribed in situations where a patient experiences moderate to severe pain. A lot of care should be taken to avoid unwanted effects such as dependence on opioids as well as addiction. The vital factors to consider while using this drug are age, the nature or magnitude of pain, and the presence of other diseases or medication. In cases that present complication in an attempt to establish an equilibrium between side effects and relief, adjuvant analgesics can be considered. However, this medication must be combined with primary analgesics to improve patient outcome.

The non-pharmacological and complementary alternatives for pain management in prostate cancer cases can be categorized under the biopsychosocial model, physical modalities, psychological, behavioral and psychosocial intervention (Pujol & Monti, 2007). All these non-pharmacological options target to improve the mental, physical and social strength of the patient which is believed to have an impact on the management of pain. However, the effective application of these pain management tool still requires research to enhance precision and applicability. Some pain management techniques such as traditional Chinese medicine have proven to be effective in curing pain for many years. Some excellent examples of the Chinese alternatives are acupuncture, electro acupuncture, and acupressure. Many physicians have used acupuncture to manage pain related to prostate cancer (Jan 2015; Lin, Chen, and Chiu, 2011). Acupuncture provides a better alternative for patients who experience adverse side effects of analgesics such as vomiting and nausea. However, uncertainty exists in the ability of acupuncture to eliminate hot flashes and lethargy among prostate cancer patients. The absence of this clarity does not prevent the use of this alternative pain relieving strategy.

Outcome

The use of pharmacological alternatives is expected to reduce pain but at the same time present side effects on some patients (Eman, Beyaz, Saglam, & Gurcu, 2012). Some patients may develop drug resistance or dependence in cases where the only option is pharmacological. However, the main goal is to relieve pain among African American male adults with prostate cancer pain. The use of pharmacological options should be compared to the alternatives such as acupuncture to determine the most effective intervention for pain.

Time

It has been established that most conditions may only demand 3-6 acupuncture sessions to complete the course while cancer patients may require up to twelve visits (Lin, Chen, & Chiu, 2011). Therefore, the number of visits can be spread over a three-week period after which the effectiveness of the approach can be assessed and compared to the response of patients using analgesics. Advanced cancer stages or intense pain may require more sessions in the same way the pharmacological option may require additional doses before comparison of effectiveness is made.

In conclusion, prostate cancer patients are likely to experience pain as a result of the treatment options that include chemotherapy and radiotherapy. Alternatively, pain may result from the stage of the disease or growth of the cancerous cells. This pain can be relieved by pharmacological products in the form of drugs, analgesics, and non-analgesics. One of the main problem presented by such drugs is the development of resistance, dependence, addiction or adverse effects. The presence of alternative means that include acupuncture can be applied and evaluated to determine their efficacy in managing pain among African Americans suffering from prostate cancer-related pain.

References

BIBLIOGRAPHY American Cancer Society. (2016). Cancer facts & figures for African Americans 2016-2018. Atlanta: American Cancer Society, 2016.

Bader, P., Echtle, D., Fonteyne, V., Livadas, K., Meerleer, G. D., Borda, A. P., . . . Vranken, J. (2012). Prostate cancer pain management: EAU guidelines on pain management. World Journal of Urology, , DOI 10.1007/s00345-012-0825-1.

Campbell, L. C., Keefe, F. J., McKee, D. C., Edwards, C. L., Herman, S. H., Johnson, L. E., . . . Donattuci, C. F. (2004). Prostate cancer in African Americans: relationship of patient and partner self-efficacy to quality of life. Journal of Pain and Symptom Management, 28(5), 433-444.

Eman, A., Beyaz, S. G., Saglam, H., & Gurcu, M. E. (2012). Pain management in prostate cancer. Open Journal of Urology, 2, 164-172.

Jan, A. (2015). The role of acupuncture in the management of prostate cancer. Medical Acupuncture, 27(3), https://doi.org/10.1089/acu.2015.1095.

Lin, Y., Chen, K., & Chiu, J. (2011). Use of acupuncture among patients with prostate cancer covered by National Health Insurance in Taiwan: A retrospective population-based study. Medical Acupuncture, 23(2), 101-106.

McGinley, K. F., Tay, K. J., & Moul, J. W. (2015). Prostate cancer in men of African origin. Nature Reviews Urology, 13(2), DOI: 10.1038/nrurol.2015.298.

Pujol, L. A., & Monti, D. A. (2007). Managing cancer pain With nonpharmacologic and complementary therapies. The Journal of the American Osteopathic Association, 107(7), ES15-ES21.