One of the most frightening and stressful aspects of caregiving is not knowing what to do when your loved one is experiencing pain. It’s important to remember that there is actually no reason for this pain to go untreated or be ignored. It is usually more effective to treat pain earlier rather than later, when it might become more severe and be even more unbearable. Pain that goes untreated can lead to a major disruption in a person's ability to work, to deal with relationships, and with their view of the world in general. By recognizing the fact that under- and untreated cancer pain can lead to needless suffering, despair, and deeper depression, a caregiver has the ability to inform members of their loved one’s medical team and alert them to the severity of the pain. When you’re caring for someone who has this type of pain, you may be asked to: administer medication, including having to make decisions about what to give and when to give it; keep records of all medications given, including doses, quantities, and how often; encourage or remind the person about taking their medications; provide a number of non-drug interventions, such as massage, applying ointments and lotions, cold and heat, positioning and helping them with their mobility; help provide distractions, as well as emotional support.
 
Questions that you should ask the doctor regarding a loved one’s pain control plan include: How do I administer the medication? Can pain medicines in pill form be crushed or broken into halves or quarters? What do I do if the medicine wears off and the pain returns, but it’s too early for another pill? What do I do if the pain doesn’t go away, even though the pills are being taken as prescribed and as early as allowed? Can more medicine be taken, or should the doctor be called first? What happens if pain wakes them up in the middle of the night? What do I do if a dose is skipped by accident? What can I do for breakthrough pain? What side effects should I watch for and when should I call for professional help? What can be done for side effects? Who can help me in getting answers to any or all of these questions? Sometimes, you may be able to have a nurse come to your home and assist with some of these tasks, and teach you how to manage the pain control plan. Some insurance companies will pay for an RN to come to your home and help monitor the situation. You can check to see if you are able to receive this kind of help by checking with the doctor, social worker or with the insurance company itself. Also, one of the most important things to know is whom to call when you have a problem or concern, during and after office hours. Knowing this may help to alleviate some of your own stress, especially if you don’t feel as though you have to make all of the decisions.
 
If it makes you nervous trying to figure out when to give a loved one medication, or deciding upon how much to give them, some of  the following ideas may help you feel less overwhelmed and helpless: Educate yourself as to what pain management and/or palliative care is. Know the specific pain control plan for your loved one, and don't be afraid to ask the doctor or nurse for detailed information (remember to write everything down). Know which medicines are given around the clock, and which are given as needed (written on the prescription as "prn"). Give medication at regular times to keep enough medicine in the blood stream to keep the pain away. Give medication before pain has a chance to build up, keeping in mind that pain is harder to control if it’s allowed to build to a severe level. Give pills during the night, or get on a pain control plan that does not require nighttime doses. Too much time between pills means that the amount of medicine keeps dropping and the level of pain increases. Do not stop pain medicine suddenly, since this will be a shock to the body and withdrawal symptoms may occur. Discontinuing any pain medication should be discussed with a doctor first; and when it’s to be done, it must be done in a gradual, step-down method.
 
Some other things you can do to make it easier for you when administering medication is to: Set an alarm to remind you when medications are due. Use plastic medicine boxes with squares for each day of the week and slots for medicine times, allowing you to fill the box for an entire week at a time. Always call ahead to the pharmacy before trying to fill a prescription because some drug stores don’t carry all pain medicines. Remember to always use the same pharmacy because the pharmacists will become familiar with and understand what the medication plan is and how it works; they may even have helpful suggestions for you on how to handle side effects. Remember to call the doctor for new prescriptions and refills before the last pain medicine is given, making sure that you have at least a three-day supply of pain medication at all times. If it’s the end of a week, be sure that you have at least a 5-day supply before needing to refill. If you’re planning to be out of town, be certain to have a sufficient supply until you have returned home.
 
Some of the non-drug pain interventions, known as complementary and alternative therapies, include the use of massage therapy, meditation, acupuncture, and herbal treatments. Something as simple as the use of heat and cold, which can be administered by a caregiver at home, can help to relieve pain. You can get this information from a medical professional, and they can provide you with a skin care plan, information on positioning, and the proper use of heat and cold. Heat generally relaxes the muscles and gives a sense of comfort; however, do not set heating pads on high because they may burn the skin quite easily. Remember not to place heating pads over or near areas where radiation marks are on the skin, even when the treatments are over. Warm showers, baths, hot water bottles and warm washcloths can be soothing as well. Cold is best used to alleviate pain that comes from inflammation or swelling, soothing the muscles and skin. Physical therapists can provide you with information on appropriate exercises, massages or equipment that can help patients move with less pain. For example, massage sore spots like the back, neck and shoulders using smooth, long strokes for about three minutes. It’s best to use a lubricant that has been warmed, and this can be done by placing a bottle of lotion into a sink of hot water for 10 minutes.
 
Here are a few more suggestions on how a caregiver can be a productive member of the pain management/palliative care team:

• educate yourself on pain management
• take part in the pain management program by learning what is needed, providing encouragement and reminders
• help keep daily information about the kind of pain a loved one is experiencing   
• check on the level of pain being experienced by using a 10-point rating scale (one being the least amount of pain, and 10 being the worst level of pain)
•  ask questions of the doctor; seek consultation with a pain specialist if you are not satisfied with the doctor's recommendations
•  provide your loved one with distractions that will help get their mind off the pain   
•  maintain open communication about any pain-related concerns

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