Pain Management

Hi Filly5903add7,

Welcome to our Online Community here at Macmillan. I’m Kirstine, one of the information nurses. I’m sorry to read that you partner’s condition seems to be changing, and he doesn’t feel quite so well anymore. I can understand why you seek to understand better what is happening.

It’s difficult for us to offer any definitive insight into what this may be as we can’t see him to assess and have no access to NHS records. It’s important to be keeping regular communication up with health professionals who are directly involved in supporting you both right now, as they can advise more accurately on what they are observing. Weakness and fatigue can be signs of later stages of cancer, but doctors will also be able to offer some simple checks to rule out anything that might be treatable, such as a chest infection, anaemia or fluid build-up, for example. If there is less contact with the hospital team now, then this might be the GP, district nurses and possibly the community palliative care team who can be contacted to assess.

Coping with pain in advanced cancer can be challenging, but there are many options there to help. We can’t offer direct advice on what medicines to take as we are not the prescribing health professional, but I can offer some general guidance on what to expect when chatting with the GP, district nurses or palliative care team about his pain. You are right, that you need to clarify with the GP about the codeine and the oral morphine if you are not sure on how to use these right now. Very often the oral morphine will replace codeine, but it can be taken alongside plain paracetamol if this has been advised.

Oral morphine can be prescribed in low doses to begin to see how the person tolerates it and to see if it helps with pain. I would encourage you to keep a pain diary of what he takes and what time, and it can also help to note down if it’s helping or not. Some people will do this by scoring the pain out of 10 (0 = no pain, 10 is the worst pain) just before taking a dose of painkiller, then re-scoring around 45 minutes later to see if it has reduced any. This type of information can be useful when talking to the GP as they can see what is helping and make adjustments where needed. Some people may have their doses carefully increased under medical supervision, and sometimes this may lead to the GP switching to longer acting painkillers when it is established that he manages without too many unpleasant side effects.

I can appreciate why you might be worried by taking temazepam alongside morphine, as both can cause drowsiness or unsteadiness on the feet. It’s not unusual however for both of these to be prescribed together, especially if the doctor has assessed this could be helpful for symptoms. If you notice any worrying side effects like unsteadiness or being too sleepy, please do speak with the doctor again who can review. Sometimes they may suggest stopping, or reducing doses, or sometimes they may plan with you and your partner about what matters most in their symptom management. Some people may choose to have less pain but know this may mean they will be sleepier than they were before. This might mean less time walking, and more time spent at rest, either sitting, or spending more time in bed. This can be a normal progression in advanced disease and can help the person to be as comfortable as possible, and also to conserve their energy for spells of precious interaction with loved ones from a restful and comfortable spot.

This is a difficult time for you both. It can sometimes be easier to talk through how you are feeling on the phone. Please know you are welcome to ring us if it might help to have space to talk this over. We’re here to listen and offer advice where we can.

Kindest regards,

Kirstine – Macmillan

Cancer Information Nurse Specialist

You can also speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or send us an email. Ref KDf/ AP