Question 1

How risky is cat ownership during pregnancy due to increased risk of disease in mothers and their offspring from parasites in cat feces?

Accepted Answer

How risky is cat ownership during pregnancy due to increased risk of disease in mothers and their offspring from parasites in cat feces?Do you wash your hands after cleaning your cat’s litter box? Do you use disposable/latex gloves? Do you inhale the litter box dust—snort it?If you are taking usual, normal precautions of taking care of your cat and litter, you won’t get toxoplasmosis. As noted by another writer, toxo comes from outdoor cats hunting mice. If your cats are indoor, then you won’t have issues.If you really are worried, have someone else clean the litter box through your pregnancy; or buy latex/disposable gloves and wear a surgical mask.Of all the years and cats I have had, I’ve never had an issue; nor has anyone I know—ever. I’m not saying it doesn’t happen, I’m just saying it is a very, very rare disease.BTW, cats don’t suck baby’s breath, either. That’s an old wive’s tale that needs to go away, too.

Question 2

One of my friends lives far away from my school but he still wants to go to this school. He is using our address. How do we fill out the school form? We don't know what to exactly put on the form, we need massive help. We need to finish this today.

Accepted Answer

My district has a window of time that allows students to transfer to chosen schools. Almost all transfers are accepted.There is a specific procedure to do this correctly.If the student lives in a different district, they have to officially notify that district that they are planning on going to a neighboring district. Paperwork must be signed by both districts.Please contact all the districts involved. They can help you with the steps.Each year the student must reapply for the transfer. My district only denies transfers when attendance or behavior has been an issue.

Question 3

How do SENSEX or NIFTY 50 index always increase in value over the long term while the companies forming part of the index move in and out? Is it possible that after 20 years from now, the SENSEX or NIFTY 50 value may fall to levels of today?

Accepted Answer

The answer lies in your question itself. It happens because poor performing companies are removed and strong performing companies are added thereby ensuring that the index continues to perform well. Also weightage of the companies changes as well

Question 4

What do you think will be (or currently is) the next major event historians will credit as a crippling blow to human progress?

Accepted Answer

I’m always careful with such hypotheticals because as we all know; the fundamentally chaotic nature of the universe is of such ass-bending complexity that makesing accurate predictions is basically impossible. Will we die in a nuclear inferno? Will swarms of monstrous Kaiju erupt from deep within the earth’s crust and make potty across all five continents? Will a virulent form of space herpes get carried across the interstellar void and scab up our plumbing to the point where reproduction requires a full set of kebab skewers?I don’t know and neither do you.So, let’s start with what we do know.We’re all fucked.It’s not just that the sun is going to explode in around 4 or five billion years’ time. I mean it is definitely going to do that and you really don’t want to be in the vicinity when that happens. But if you read enough Larry Niven then you’ll come to appreciate that the technology we currently possess is rubbish. We might be able to take some comfort in that. One only has to look back a few decades to realize how crap technology from the past looks today.And I’m not just talking about Tamagotchi.As I write this, the only man-made object to have left our own solar system – Voyager I -- is clipping along at a cool 38,000 mph (61,000 km/h) some 11.7 billion miles (18.8 billion kilometers) above our heads. At that speed, in around 40,000 years’ time it will have a close encounter of the blurred kind with a star called AC +79 3888, which lies around 17.6 light-years from where you are sitting right now.Whilst it seems doubtful that there will be any aliens there to throw the poor old thing the kind of welcoming committee it truly deserves, voyager will continue to orbit the Milky Way for such a long time that we might as well call it forever. And if it ever is picked up by alien intelligences and examined, they will no doubt come to a singular damning conclusion.Its creators were rubbish.OK, maybe that’s not fair. The whole thing is mightily impressed by the standards of the 1970’s, but the fact remains that Voyager has less computing power than you would find in a typical key fob. Yes, that thing that unlocks your car is smarter than our first interstellar spacecraft. Which means that even if you could hack into its systems and reprogram it so that it knew how to unlock your car, it probably wouldn’t be able to do it. And even if it could, even travelling at the speed of light, it would take the signal 17 hours to signNow Voyager and another 17 hours for it to transmit back to you. So, if you wanted to use your car at 11am on Tuesday morning you’d have to wake up at 1am on Monday morning in order to unlock it.Using Voyager to unlock your car would be a stupid thing to do.Indeed, as Wire reported back in 2013:The computers aboard the Voyager probes each have 69.63 kilobytes of memory, total. That’s about enough to store one average internet JPEG file. The probes’ scientific data is encoded on old-fashioned digital 8-track tape machines rather than whatever solid state drive your high-end laptop is currently using. Once it's been transmitted to Earth, the spacecraft has to write over old data in order to have enough room for new observations.So whilst sitting here in 2017 I can think of few ways that humanity might escape the death of our sun, I do have to acknowledge that the computer I’m typing on is rubbish, the super-fast broadband I’m using to communicate with you is shit and despite being a bastion of modern progressive values by the standards of my time I – or rather my contemporary culture – might one day be the stuff of museum trips where goggle eyes children marvel at the fact that 21st century man watched television instead of having information beamed directly into their cerebral cortex.So maybe we'll have the means to dodge that sun sized bullet when it's lobbed our way.But like I said, it’s not just that.It’s the fact that the universe is going to die of heat death.For those of you who don’t know, heat death will occur because the second law of thermodynamics – which stipulates that the amount of entropy in a system must always increase – demands that it occurs.At least we think it does.The amount of entropy in a system is a measure of how disordered the system is - the higher the entropy, the more disordered it is. Heat-death occurs when the universe has signNowed a state of maximum entropy, when all of the energy has migrated to places of less energy. At this point nothing is happening anymore and you have less chance of extracting a bit of work out of the universe than the White House Chief of Staff has of convincing the President to switch of the news and get something done.Because at that point, the universe is no longer alive.It’s an ex universe, if you will, and no amount of fancy technology or elaborate wearing of cravats is going to change that.And I know what you’re thinking. Considering the year, we just had, heat death sounds like some kind of blessed release but I’m afraid that I’m going to have to put one or two flies in the ointment. Because firstly, it might not even happen if the Universe turns out to be so massive that it falls back in on itself.Talk about fat shaming.And secondly because even if it does happen it’s going to take quite some time. In fact, it’s not going to happen for about 10 to the power of 103 years. And that’s a long time. Long enough that even the Simpsons will have been cancled.So, we’re definitely screwed, but not just yet.So, what is the more immediate danger?It depends on who you ask really.I mean, I know you asked me, but I’m going to spend some time looking at some other opinions.The common thought is that we will blow ourselves up, descend into savagery and become vassals to a race of bipedal primates who have developed a hyoid bone for some reason or another. This, ‘planet of the ape’s theorem,’ is all well and good, but the reality of a nuclear exchange is somewhat less dramatic. Yes, we have the power to render the earth uninhabitable and yes, a nuke is going to go off at some point – it’s pretty much inevitable—but no, not all nuclear conflicts will result in our annihilation and very few of them will produce a race of horse riding apes with bolt action rifles. Donald Trump’s frightening obsession with nuclear weapons is liable to get a lot of people killed it’s true. We might lose Seoul, we might lose Tokyo or even New York.But we’ve lost cities before.Which is not to minimize the risk or the horror of such events. It’s just that they are not likely to result in ‘end of time,’ scenarios.There have been seven world wars that I can think of — each one more devastating than the one that went before it — but the fact remains that the last time great powers fired at one another in anger was in 1945. The systems we put in place to prevent war between such mighty nations were well thought out and robust.The proof of that is in the total lack of nuclear exchange.I know that some madman might get hold of the launch codes and I know that some of you just spat out your tea out in wonder that I’m unaware that Donald Trump and Putin are madmen and they already have hold of the launch codes and yes, you’re right that’s bothersome. But mass-murdering prick though Putin might be, he is nevertheless a pretty shrewd guy. He’s not likely to blow up the world for one simple reason. It’s where he keeps all his stuff.And he likes his stuff.Meanwhile, Trump is no Nihilist either. He probably doesn’t know what the word means and in the unlikely event that he decided to launch an illegal attack, his order would probably be refused or else someone would have the foresight to put a little nutmeg in his hot milk so that he drifted off into a pleasant dream about sharing a hot tub with his eldest daughter.So not war then.At least, not in any way we can predict without succumbing to what is fondly known as ‘Philip K Dick,’ syndrome.What about the end times then? What if the four horsemen of the apocalypse are checking bridles and bits as we speak? What if Trump is the antichrist and hordes of undead are going to be let loose upon this earth to wreak havoc and ruin holidays?Well, since I don’t believe in any of the Sky gods that were invented b Bronze Age man, I’m going to have to nix that one too. If you do ever meet me in hell, feel free to throw another log on the pire to remind me of my hubris.So if not fire and brimstone, then what about some sort of societal malaise? The deprivations of modernity, the depravity and hedonism that will lead us to a latter-day Sodom and Gomora without any need for Angels of death or back door shenanigans?It’s true, that there has been a lot of talk of the post-truth reality we live in and the danger it poses to democracy and whilst I share the concerns of many, I don’t see it as the onset of any fundamental doom. Whilst it is true that the populists are in ascension, the sad reality of their position is that their ideas are shit. And shit is pernicious by evolutionary ‘design.’ A turd that has been sprayed with febreeze still smells like a turd up close .Trust me, I know.One year in, only 32 percent of Americans now support Donald Trump and whilst that number is depressingly high it’s not unusual for roughly one third of any social group – even one writ large across a nation the size of the U.S. – to be composed of abject morons.(I don’t really think they are all morons, calm down.)Nor am I surprised that democracy has gotten into such a sorry state. We invent things, it’s what we do. There are very few people who don’t know who the Wright brothers are (or were I guess,) because they invented the airplane and airplanes transformed the world in wondrous and terrible ways. But they also invented the plane crash. Orville Wright was piloting his flyer in 1908 -- just five years after his first successful flight—when he crashed and produced the world’s first plane crash fatality. His passenger Lieutenant Thomas Selfridge, died in the crash you see. And I know what you are thinking. How ironic it is that the person who invented flying machines just happened to be piloting the first one to go into the ground with enough force to kill somebody. But it’s not ironic at all. It was 1908. There weren’t that many pilots about.Keep up.The concept of the unforeseen down side to otherwise quite lovely things is known as an integral accident and it applies to the invention of pretty much everything humans have ever made; buttons, candy floss, Wankel rotary engines. You name it, if human beings invented it, it comes with some kind of downside.We invented social media. We got Trump and Brexit.Which sucks, but it’s important to note that integral accidents can be mitigated to a certain extent often, after it becomes apparent that the thing we invented is dangerous. Those people that craved a non-politician in the White house are liable to rue the day they voted for Trump and sure a lot of them think that a rue is a precursor to a béchamel sauce and it is, but that's not what I'm getting at here --I don't have time to explain what a homophone is, and even if I did, many would object to it on the grounds that they prefer to eat food that is ‘straight.’Whilst many people still firmly believe that their opinion is as valid as anyone else’s, many more are wakening up to the idea that expertise in any given field warrants some kind of collateral. The fight back might take some time, but sooner or later people will look to experts to fix the mess we’re in. Scoff if you like but before too long, people will want to see the grown-ups in charge again. Brexit might be watered down into a thin soup and Trump’s presidency will one day be a painful memory of instead of the constant kick in the dick it is today.So, I hardly think the collapse of democracy is imminent and nor do I buy the idea that violent revolution is just around the corner. Neoliberalism will either opt to balance the scales to sufficient extent that wealth becomes more evenly distributed or they will go the way of the French Aristocrats circa 1789. That’s a given.But I think that they are liable to see such things coming this time around. Many of the super wealthy are becoming increasingly paranoid about just how monstrously conspicuous their comparative wealth is becoming. Their greed isn’t the issue. It’s the insatiability of their greed that is unacceptable and they going to have to start giving some of it back. People voted for Trump and Brexit as a way of addressing the retrograde slide form prosperity into something that looked like prosperity but smelled a bit like a Taco Bell supper. Right diagnosis, wrong cure. Next time around it might be a Jeremy Corbyn or a Bernie Sanders grabbing the protest vote and at that point, we’re liable to see some Lockean repositioning take place.So, what does that leave us with?I hate to bring this up really because it’s one of those answers that I could have just led with. I chose not to because – well – because it’s snowing outside; the fire is burning and I live in a plush loft apartment in a building inhabited primarily by hipster doofuses and aging lothario foreign language lecturers.So, it’s quiet and warm, somewhere in the building a man is wearing a beret, smoking a cigarillo and listening to experimental jazz.And I like to write.But you know what I’m going to say anyway.The next event that historians are likely to see as a crippling blow to humanity is climate change.I told you that you weren’t going to like it.Geoffrey Parker’s War, Climate Change and Catastrophe in the Seventeenth Century is one of the most important history books ever written. It’s also very long book which is why it’s rather fortunate that I agreed to write the Cliff notes for it that you can find here. I usually only do political philosophy.So, here I am then, plagiarizing myself.Parker, takes things further than most in his quest to understand the meaning of a century’s-worth of turbulence spread across the whole globe. Beginning by breaking down the evidence for signNow climatic cooling in the 17th-century (due to decreased solar activity), he moves on to detailed study of the effects the cooling had on societies and regimes across the world. From this detailed spadework, he constructs a persuasive argument that accounts for the different ways in which the effects of climate change played out across the century – an argument with profound implications for a future likely to see serious climate change of its own.The important take home from all of this is that Parker was not suggesting that the climate changes of the past had anything whatsoever to do with humans. The climatic cooling of the 17th century was entirely non- anthropogenic in nature. Humans had begun to globalize its true, and we’d certainly started polluting the atmosphere what with the burning of peat and the shallow mining of coal. But such efforts were -- to use the words of Professor Parker -- ‘small and twatty,’ compared to the kind of polluting we do today.Ok, those are my words not his.However, regardless of whether or not the sudden drop in temperature had anything to do with humans or not is entirely beside the point. The general crisis of the 17th century has long been known as one of the shittiest periods in human history and in Global crisis, Parker makes a convincing case that the general crisis not only had an awful lot to do with the weather but that the impact of climate change was felt across the entire surface of the planet. Indeed, as Trevor Roper once noted, the crisis left the seventeenth century broken in the middle, irreparably broken.The freak weather conditions and abnormally cold summers around the world damaged crops and helped cause widespread famine and disease. These had a devastating effect around the world, wiping out millions of people. Coupled with this, rampant political mismanagement made things worse. Much worse. Parker argued that a fatal synergy between the two phenomena – climate change and political incompetence – which came together to cause recession and revolution around the world, lasting for two generations and convincing those who lived through it that they faced unprecedented hardships.And what hardships they were.The seventeenth century saw more wars and political turmoil than ever before in human history. Between 1636 and 1666, 49 major revolts and revolutions took place across the world. There were 27 in Europe (including Russia and Turkey), 7 in the Americas, and 15 in Asia and Africa.In several cases local conflicts triggered much longer, more widespread, more destructive wars. The Bohemian revolt of 1618 helped start The Thirty Years War, a prolonged conflict that lasted three decades and eventually involved all the major states of Europe. A Manchurian war against the Chinese emperor the same year led to 70 years of fighting in the region.And it all took place against a background of extreme weather events related to global climate change.Sub-Saharan Africa endured a drought from 1614 to 1619. In Europe, 1616 was known as the year without a summer and was the wettest in 500 years.Droughts affected whole swathes of North and South America, while both Europe and the Middle East suffered intense cold during 1620. Such conditions laid waste to crops and livestock, leading to widespread food shortages and famine.A fatal synergy indeed.Such observations don’t reveal anything particularly novel of course. Politics is all about property or—in the modern age – money. Money is an expression of resources – crops, human labor, cravats, mogwai, bottles of imported water, jams and custards. Anything that can be traded – including abstract concepts such as debt and risk – can be boiled down to some kind of resource. Which is interesting because humanity at heart relies only on one commodity.The sun.Oh, I know that I said it was going to blow up – and it will – and I also know that ‘man cannot live on sunbeam alone,’ but we live in a solar economy nonetheless. Our local star grows the crops, warms the oceans, created conditions ripe for the laying down of fossil fuels, allows oxygen to exist in gaseous form and has an indirect influence on the sale of millinery to bald men.Oh, and it drives the weather.The link between weather and property should be obvious to anyone who has tried to button their coat up as a hurricane approaches a coastal town. I have, and as one button came free of its bearings it flew from my coat and literally exploded upon contact with a nearby wall.There are few things that can so emphatically convince a person to go indoors than a ‘button bullet.’And it’s not just that strong winds tend to blow things down. Slight variation in temperature averages can have an egregious effect on the human ecosystem. The apathetic Sun Spot activity that coincided with the 17th century’s Little Ice Age froze the Thames solid enough that in both 1683 and 1684, fairs were held on it. The first of these fairs occurred in 1607, the last in 1814.But there were also famines, storms, logistical nightmares and monetary crisis. And since politics is all about property, the political classes were met with challenges that they were woefully ill equipped to deal with and no number of ice skating elephants on major European rivers were going to change that. Farms were destroyed by encroaching glaciers. The golden Horn – In Turkey – froze in 1622. In 1658 a Swedish army marched across the sea and invaded nearby Denmark. Norse colonies in Greenland starved to death. Iceland was surrounded by permanent sheet ice; the population halved. The button, stoves, and ceramic tiles were all invented. Viticulture disappeared from northern climates, famines killed off around 10 percent of the human population which – of course – led to an explosion of Witch Hunts as the authorities decided to blame crop failure on single women.(There have pretty much always been Republicans.)In other words, climate change – despite not having been caused by human action -- nevertheless had a dramatic effect on the human population. Climate change, property, political crisis. The three go hand in hand.In the wake of such evidence, it is hard to imagine how the Earth’s next phase of anthropogenic climate change is set to challenge humanity. It might seem fairly benign right now. A few hot summers, some particularly virulent hurricane seasons, footage of starving polar bears, sheets of ice the size of Belgium sheering away from the Antarctic ice shelf… Coral bleaching, sea levels that rose 8 inches during the 20th century and may rise 16 inches during this one. Ocean acidification, extreme weather events, potato farming in Greenland, early snow melts, glacial retreats and a big question mark surrounding what the hell we’re going to do with all the dead Penguins once shit gets too warm for them.Actually, none of it is benign at all. It’s already scary as all hell.But it’s all merely a series of monstrously unpleasant hor d'oeuvre. Like vol-au-vents filled with bits of bee sick. Wait, no, that’s honey.People like honey.It’s more like a plate of sliders made of pig snouts and trifle… or … something like that.Let’s be clear.We’re not ‘doing nothing.’Any predictions as to what the planet is going to look like in 2100 is dependent on the actions that we take today. A favorite refrain of climate change skeptics is to point to the fact that so few of us are currently underwater whilst ignoring the fact that we have acted to mitigate the damage that has already been done. Fears of an ever-expanding hole in the ozone layer – something that if left unchecked would have led to skyrocketing cancers – cannot now be dismissed as environmental hysteria. The hole closed because the international community got together and restricted the use of CFC’s. You can’t put out a fire and then run through the burned brush telling everyone that it’s not hot at all, and that CNN’s reporting of California wild fires was fake news.That’s not a QED moment.So, what are we doing?The Paris Agreement hammered out by delegates from 196 countries in December 2015, calls for holding the ongoing rise in global average temperature to well below 2 °C above pre-industrial levels, while pursuing efforts to limit the temperature increase to 1.5 °C.What? That’s it? I just put my heating up by that much and I’m still a bit cold.Well, it does sound that way yes, but those who read the mashed potato analogy from an answer I gave here will understand that a two degree change in temperature can bring with it cataclysmic changes.According to NASA:The European Geosciences Union published a study in April 2016 that examined the impact of a 1.5 degree Celsius vs. a 2.0 C temperature increase by the end of the century, given what we know so far about how climate works. It found that the jump from 1.5 to 2 degrees—a third more of an increase—raises the impact by about that same fraction, very roughly, on most of the phenomena the study covered. Heat waves would last around a third longer, rain storms would be about a third more intense, the increase in sea level would be approximately that much higher and the percentage of tropical coral reefs at risk of severe degradation would be roughly that much greater.But in some cases, that extra increase in temperature makes things much direr. At 1.5 C, the study found that tropical coral reefs stand a chance of adapting and reversing a portion of their die-off in the last half of the century. But at 2 C, the chance of recovery vanishes. Tropical corals are virtually wiped out by the year 2100.With a 1.5 C rise in temperature, the Mediterranean area is forecast to have about 9 percent less fresh water available. At 2 C, that water deficit nearly doubles. So, does the decrease in wheat and maize harvest in the tropics.On a global scale, production of wheat and soy is forecast to increase with a 1.5 C temperature rise, partly because warming is favorable for farming in higher latitudes and partly because the added carbon dioxide in the atmosphere, which is largely responsible for the temperature increase, is thought to have a fertilization effect. But at 2 C, that advantage plummets by 700 percent for soy and disappears entirely for wheat.Shit!Much of the food we eat is already close to a thermal limit anyway and that does not take into account the fact that pests and pathogens may spread more rapidly at higher temperatures. At certain temperature thresholds, crops don’t die but nor do they produce seeds and if you’re thinking ‘Fuck it, I’ll just eat burgers without the bun well, what the fuck are you going to feed the cows on Einstein?Huh? Didn’t think of that did you huh?Actually, you probably did, I’m making unnecessarily harsh judgments about your intelligence.Soz.Growing corn that does not produce a corncob might be fun for a while but it will get old super-fast especially for vegetarians like me. It’s literally the only thing on the menu at KFC that I can eat.Not that I’ve ever been to KFC but you know, never say never.Now, you might be thinking that all of this has a lot more to do with climatology and horticulture than it does with politics but that’s simply not the case. Going back to the notion that politics is property and property is money we come back full circle to the notion that if climate change is not kept in check then things are liable to get a bit ‘wiggy.’But, I hear you say. Can’t we just science the hell out of the problem?The temptation to assume that new technologies might swoop in and save us is ever present in discussions about such matters. After all, during the Little Ice Age, people invented stoves and buttons. And I applaud their innovations but I’m sorry, I don’t share the optimism of some of the more exuberant climate change enablers. To begin with there is no guarantee that we will indeed come up with a series of technical innovations robust enough to save the day. Sure, give it up for buttons but most technology we make today revolves around the size of -- or indeed absence of -- bezels around increasingly foolish looking mobile phones. Such technology is far from being ‘green’ in any way shape or form. Apple refuses to tell us how much pollution went into producing its batteries, screens, chipboards and earphones and all the coal and gas burned to manufacture, ship and assemble iPhone parts doesn’t get included in a corporation’s environmental rating. But the very fact that they won’t tell us, tells us that their phones are grubby little pieces of shiny consumerism so desirable, so sensual that we just ‘gots to have them.’Let’s face it, our technology, however much we love it and wish it was not so, is really, really dirty.So, there’s that.Of more concern is the fact that such technology might be reactionary. Houses mounted with retractable pontoons aren’t a thing and they won’t be a thing until people start realizing that retractable pontoons become an absolute must item – a flotation, flotation, flotation mantra if you will.That’s a good joke if you’re British. You’ll just have to trust me.What all this boils down to is at the very least some kind of severe economic stress and at the worst the end of all civilization. The latter is no good. We know this for two reasons.1. Thomas Hobbes warned us that in a world without the state there would be:No place for industry, because the fruit thereof is uncertain, and consequently, no culture of the earth; no navigation, nor use of commodities that may be imported by sea; no commodious building; no instruments of moving and removing things as require much force; no knowledge of the face of the earth; no account of time; no arts; no letters; no society. And what is worst of all, continual fear and danger of violent death; and the life of man, solitary, poor, nasty, brutish and short.2. We’ve all seen the walking dead and know that the zombies are the least of people’s problems.Which is not to say that the severe economic stress brought on by climate change will be a walk in the park. As if we hadn’t seen enough evidence of the dangers of economic stress form Geoffrey Parker’s analysis of the global crisis, we have plenty of examples of things going tits up without any egging on whatsoever from a slew of crappy weather events. The collapse of Weimar Germany, the Russian revolution, revolutionary France, the fall of Rome, Trump and Brexit! All these events were brought on via economic stresses. The Ming empire collapsed – in 1644 -- in the middle of a famine. The Russian Rurik dynasty came to its end during the ‘time of troubles’ a period that began in 1598 and ended in 1613. That the great Russian famine of 1601 -1603 – an event that killed 2 million Russians one third of the entire population – took place slap bang in the middle of the interregnum is no coincidence.Bad economy, bad politics. Hungry people are easily radicalized. Aggrieved people are unpredictable creatures.Trump decided that Americans didn’t want anything to do with the Paris agreements and that’s fine. It remains one of the most shortsighted and petulant acts of recent political memory but oh well, what do we really expect from a man who is to a basket of dildos what a carrot is to another near-identical carrot. His sulking is unlikely to derail the process not least of all because by the time the U.S. officially withdraws, there is a strong chance that he will no longer be president.Even so, there remains a chance that the accords will fail, that other nations will jump ship or that our calculations are off. I If we hit a 2 or 3 degree increase in global temperatures then we will be hard pressed to deal with the consequences. Extreme weather events will multiply, sixty-foot high Kaiju will destroy city after city, the pomegranate will become extinct, cheese will lose its flavor and all around the world those hit hardest by economic downturns – the poor and ill-educated – will suffer.And in their suffering, they might decide to vote in a lunatic.And that scares me.Or it would do but for two things.I’ll probably allready be dead.Even if not, I built a bunker in the basement that the sales people assure me Godzilla himself could not break into.Sleep tight.For general musings or indeed if you want to contact me / yell at me or ask for my phone number, you can contact me via Twitter.

Question 5

What is the reason for pain in a cancer patient and how can you reduce it?

Accepted Answer

Causes of cancer painMost cancer pain is caused by the tumour pressing on bones, nerves or other organs in the body.Sometimes pain is due to your cancer treatment. For example, some chemotherapy drugs can cause numbness and tingling in your hands and feet. Or they might cause a burning sensation at the spot where you have the injection.Radiotherapy can cause skin redness and irritation.Remember that some pain might have nothing to do with your cancer. You could have the general aches and pains that everyone gets from time to time.Acute and chronic painCancer pain can be acute or chronic.Acute pain is due to damage caused by an injury and tends to only last a short time. For example, having an operation can cause acute pain. The pain goes when the wound heals. In the meantime, painkillers will usually keep it under control.Chronic pain is due to changes to the nerves. Nerve changes may be due to cancer pressing on nerves or due to chemicals produced by a tumour. It can also be caused by nerve changes due to cancer treatment.Chronic pain continues long after the injury or treatment is over and can range from mild to severe. It can be there all the time. Sometimes pain can come on quickly – for example, when you have a dressing changed or move around. This type of pain is called incident pain.Chronic pain is also called persistent pain.Types of cancer painIt is extremely important for your doctor to find out the type and cause of your pain. Then they can treat it in the right way. Different types of pain need different treatment.Nerve painBone painSoft tissue painPhantom painReferred painHow much pain you might haveThe amount of pain you have with cancer depends on:the type of cancer you havewhere it isthe stage of your cancerwhether the cancer or treatment has damaged any nervesOther factors can also affect how you feel pain - such as fear, anxiety, depression and a lack of sleep .It’s very important to let your medical team know straight away if you have pain. Don’t try to put up with it – this can cause nerve changes that could make the pain harder to control in the future.Controlling chronic painChronic pain is also called persistent pain. It can be difficult to treat, but often painkillers or other pain control methods can successfully control it.Pain that is not well controlled can develop into chronic pain. So it is important to take the painkillers that the doctor prescribes for you. Trying to put up with the pain can make it harder to control in the future.People with chronic cancer pain might have times when their medicines do not control the pain. This is called breakthrough pain.Tell your doctor or nurse if you’re taking regular painkillers but still get pain at times. They can prescribe extra doses of painkillers for you to take when you need them.Cancer patients often experience signNow pain. Sometimes this is a side effect of the treatment, and sometimes because of the cancer itself. Cancer pain is often chronic, meaning that it is persistent and prolonged and doesn't improve with time like the acute short-term pain one feels after a minor injury. Cancer pain may also involve breakthrough pain, which is a sudden increase in intensity despite ongoing control of the chronic pain. Getting relief from cancer pain often requires careful management.This article discusses how to describe pain, causes of cancer pain, current cancer pain management guidelines, other methods of cancer pain control, problems with cancer pain management, pain after the end of treatment, and other cancer pain management tips. It also lists several key references and web sites.Basic Cancer Pain Management TipsIf you are experiencing pain, tell your doctor. Don't try to tough it out. This can make the pain harder to control later. Pain can be a sign of other problems, and can interfere with the healing process.It is important to speak up if you are in pain and to describe the pain to your doctor and nurses. Studies have shown that of cancer patients with severe pain, about a third were receiving inadequate pain medication. Likewise of patients with neuropathic pain, more than 90% were not receiving appropriate co-analgesics.If you have severe pain with a sudden onset, immediately call your oncologist, and if you cannot signNow him, go to the nearest emergency room.There is no need to save the pain medications for when your pain is most severe. Despite what you see on television, in most cases involving cancer pain management, pain medication does not become less effective after extended use. Increases in analgesic dosing usually occur as a result of disease progression and not because of any increased tolerance or loss of efficacy.Fear of addiction is also not a good reason to avoid pain medication. The dose is titrated carefully to control the cancer pain. If the pain medication is taken strictly according to the doctor's instructions, addiction is unlikely.Although most cancer patients do experience some pain, about a third of cancer patients do not experience severe pain. Of those cancer patients who experience severe pain, 8 out of 9 can have their pain adequately controlled through modern pain management techniques. (See Zech 1995, Ventafridda 1987, and Mercadante 1999.)Complete freedom from pain is unrealistic, but it is possible to control pain signNowly in most cancer patients.Cancer patients hospitalized in oncology wards are more likely to receive appropriate pain management than cancer patients hospitalized in other wards.Most cancer patients take their pain medications orally in pill or liquid form, not through injections. Intravenous infusion occurs mainly when the patient is already hooked up to an IV. Use of suppositories and skin patches is rather uncommon.Describing PainAccurately describing the pain can help your doctor pinpoint the cause. Try to provide as much information as possible. The following are a few good places to start:Location. Is the pain in one particular location or a set of locations? If so, where? Does it change location? Is it spreading or just moving? Is it near the surface or deep inside? Sometimes pain is felt in a location that is different than the source of the pain. Sometimes pain is not focal but rather more generalized.Severity. Rate the pain on a scale from 0 to 10, where 0 means no pain, 1 is very mild pain, 5 is moderate pain, and 10 is the worst pain you have ever had. (For young children there is the Wong-Baker Faces Pain Rating Scale that runs from 0 to 5 and couples the pain ratings with smiley/sad faces. A similar visual pain rating tool is the Oucher Scale. These tools help patients with limited verbal abilities to describe the intensity of their pain.) Compare it to other types of pain you have had previously (e.g., toothaches, headaches, cramps, back pain, stubbed toe, childbirth, menstrual period, appendicitis).Quality. Is the pain sharp or dull? Hot (burning/searing) or cold? Constant or throbbing or shooting?Onset. Does the pain come on suddenly or gradually?Duration. Does the pain come and go, or is it there all the time?Course. Is the pain stable, improving, fluctuating or getting worse?Time of Day. Does the pain change according to time of day? Do you feel the pain immediately after waking up in the morning? Is the pain sometimes so severe that it wakes you up from a deep sleep? Does the pain interfere with your ability to fall asleep? Does the pain get better after you sleep?Interactions. Is there anything that makes the pain better and anything that makes it worse? Does it hurt only if you touch it? Does rubbing it make it feel better or worse? (Is it sore to the touch?) Does ice or a heat-pack make it better or worse? Are you able to distract yourself from the pain, and if so, how?Movement and Position. Do you experience pain when you move? When you don't move? Does it get better or worse if you change to a different position (stand, sit, lie on side/back)?Daily Functioning. Are there any regular activities that you've stopped doing because of the pain? This is an indication that the pain is moderate to severe in intensity.Triggers. Does the pain cause other complications, such as nausea? Is the pain preceded by warning signs of impending pain (e.g., nausea, irritability, visual auras)? Are there any triggers that cause the pain (e.g., exposure to tobacco smoke, feathers or other allergens)?Medications. Have you taken any medication for the pain? Did it help? Did it eliminate the pain, or just dull it? How many pills did you take and when? (Bring the pill bottles with you to your doctor appointment.)Causes of Cancer PainPain can be caused by many different aspects of having cancer:The tumor may be pressing on a nerve or the spinal cord, causing neuropathic pain. Approximately 40% of cancer pain is neuropathic. If the cancer has spread, you may be feeling pain in a different location than the original tumor.Tissue inflammation and damage can cause nociceptive pain.The tumor may block blood vessels, lymph vessels or parts of the digestive system, causing pain.Surgery, radiation therapy and chemotherapy can damage tissues, causing pain.Surgery can damage nerves, causing pain. It is not uncommon for women undergoing a total mastectomy or axillary node dissection to develop a burning pain sensation in the chest, armpit and arm 1-2 months after surgery. This Post Breast Therapy Pain Syndrome is due to damage to the intercostobrachial nerve.Chemotherapy can damage nerves, causing pain. This is often called neuropathy.Drugs given to counter some of the side effects of treatment can often cause pain. For example, the drugs given to increase white blood cell counts can cause bone pain. In adults bone pain occurs primarily in the lower back, hips and sternum.Pain does not necessarily mean that the cancer has spread or returned. Some people like to think that the pain means the treatment is working, fighting the cancer, but this isn't necessarily the case either. Likewise, the severity of pain does not correlate with the degree of metastasis or the seriousness of the cancer.Cancer Pain Control: The WHO Analgesic LadderThe World Health Organization (WHO) has published a three-step analgesic ladder for the management of cancer pain. This matches the type of pain medication to the severity of the pain.Analgesics are drugs that control pain without causing unconsciousness. They do not entirely eliminate pain, but mask or mute it. These drugs often lower raise body temperature (e.g., good for fever) and reduce inflammation.Mild Pain. Mild painkillers include non-opioids like acetaminophen and non-steroidal anti-inflammatory drugs. These drugs are often available over-the-counter without a prescription. Nefopam should not be used in treating cancer pain.Acetaminophen (paracetamol, Tylenol). It is gentle on the stomach and kidneys and doesn't affect platelets. However, acetaminophen doesn't relieve inflammation and swelling, and there is a risk of liver damage if taken in high doses (12 or more regular strength Tylenol or 4,000 mg a day) or when consumed with alcohol.Non-steroidal anti-inflammatory drugs (NSAIDs). Examples of non-steroidal anti-inflammatory drugs include sodium salicylate (aspirin, Anacin, Bayer, Bufferin, Ecotrin), ibuprofen (Advil, Motrin), naproxen (Aleve, ), calcium (), nonacetylated salicylates (choline magnesium trisalicylate (Trilisate) and (Disalicid)), as well as the COX-2 inhibitors (, , ). (Excedrin is a combination of aspirin with acetaminophen.) NSAIDs reduce swelling and inflammation and associated pain. They are also antipyretic, in that they reduce or prevent fever. They are particularly helpful in treating cancer pain affecting skin, muscle and bone, as well as liver pain and pain from soft tissue infiltration.NSAIDs can be harsh on the stomach and can cause indigestion, heartburn, stomach irritation, abdominal pain, and nausea. There is a risk of gastrointestinal bleeding if taken in high doses. Do not take them on an empty stomach. Instead, take them after a meal or a snack or with a glass of milk. NSAIDs should not be taken with alcohol. NSAIDs can also cause fluid retention and an increase in blood pressure. There is a risk of heart attack or stroke when taken at high doses long-term. There is also a risk of kidney and liver damage, although this is less common. Patients who are on a low-dose aspirin regimen should avoid taking ibuprofen for pain, and instead use Tylenol or Aleve. NSAIDs may trigger an asthma attack in some asthmatics.The side effects of NSAIDs may limit long-term use. NSAIDs are typically used for 1-2 months.Moderate Pain. Weak opioids, often used in conjunction with non-opioids. Weak opioids include codeine phosphate (codeine), , dihydrocodeine (DHC), and dextropropoxyphene. Combinations of weak opioids with non-opioids include as Tylenol with Codeine, Tylex, Remedeine, Solpadol, Co-Proxamol and Distalgesic. These drugs require a prescription. should not be used in treating cancer pain. Co-Proxamol (a combination of acetominophen with dextropropoxyphene) is no longer used in the UK because of high complication rates. Note that drugs containing subtherapeutic doses of opioids have not been found to be effective in managing cancer pain.Severe Pain. Strong opioids, such as , diamorphine hydrochloride (heroin), meperidine hydrochloride (, Dolantin), , (, , , ), (), and . These drugs require a prescription. Strong opioids that may not be suitable for cancer pain include: (, , Temgesic), Dextromoramide, Dipipanone, Meptazinol, , , Papaveratum, and Pethidine.The doctor will start you off at a low dose, and gradually increase the dose (up to certain limits) until the pain is controlled. If the pain persists, the doctor will step the patient up the analgesic ladder until the pain is adequately controlled.The guidelines also recommend giving pain medication according to a strict schedule (e.g., every 3-6 hours), instead of on demand, as this has been found to be signNowly more effective in controlling pain in cancer patients. Do not skip any doses of your pain medication. It is important to take the pain medication by the clock before you start feeling pain, as waiting until you feel some pain can make the pain more difficult to control.If the pain returns before your next scheduled dose, tell your doctor. You doctor can either increase your dose or put you on a different pain medication.With regard to moderate cancer pain, most of the opioids are interchangeable in effect. If one is found to be ineffective, the others will be unlikely to control the pain, and the doctor should step the patient up the analgesic ladder. Only when one opioid has unacceptable side effects (e.g., renal failure) should attempts be made to substitute another opioid at the same step.With regard to severe cancer pain, if one strong opioid is found to be ineffective, switching to another strong opioid may be an effective way of controlling the pain. In one study three-quarters of cancer patients who did not respond to had a successful outcome when switched to . has higher oral bioavailability than and is twice as potent. Other drugs often used in opioid rotation for include and . During opioid rotation, the new pain medication is often prescribed at a lower initial dose than the equivalent of the prior medication, as this often yields a good response.In the presence of acute or breakthrough pain, the slow release opioid preparations for chronic pain should be replaced with a normal release versions, such as short-acting . Slow release preparations take longer to take effect (e.g., 1-2 hours compared with 15-20 minutes) and also take longer to signNow peak effectiveness (e.g., 4 hours compared with 1 hour) as compared with normal release versions. Breakthrough pain is more likely to occur as the time approaches for the next dose of pain medication. It often occurs in response to an action taken by the patient (e.g., movement) and typically lasts about 30 minutes.For more information on the WHO analgesic ladder, see WHO Guidelines: Cancer Pain Relief, 2nd Edition, World Health Organization, Geneva, 1996.Other Pain MedicationsOther drugs are often prescribed to help control pain. These include other anti-inflammatory drugs (NSAIDs), bisphosphonates, steroids, anticonvulsants, antidepressants, and muscle relaxants.Bisphosphonates reduce high levels of calcium in the blood. This can help with bone pain, especially when cancer has spread to the bone (breast cancer, prostate cancer) or in patients with myeloma. Bisphosphonates also help rebuild bone strength. Examples of bisphosphonates used in cancer treatment include disodium , ibandronic acid, sodium , and acid.Steroids can help with pain from nerve compression (e.g., when a tumor is pressing on or damaging a nerve), spinal cord compression, liver pain, and bone pain. Steroids are particularly effective at reducing pain caused by swelling and inflammation. Examples of steroids used in cancer treatment include (), hydrocortisone, , and .Low doses of tricyclic antidepressants (e.g., (), (), (), (), (), (), () and ()) and anticonvulsants (e.g., (), (), (), (), () and ()) can help reduce neuropathic pain caused when a nerve is damaged, such as when a tumor is pressing on a nerve. This includes pain with a sensation of tingling or burning. It may take 1-2 weeks for the drug to have an effect. Some anticonvulsants may reduce red and white blood cell counts, and so may be contraindicated in cancer patients receiving chemotherapy.Muscle relaxants are sometimes given when the pain is being caused by a muscle spasm. This Examples of muscle relaxants include (), (), () and (). acts as an analgesic when given in low doses. It can help with neuropathic pain and ischaemic pain (from low blood supply). It can, however, contribute to opioid toxicity and can cause transient hypertension. administration should be supervised by a pain specialist.If pain is being caused by an underlying infection, your doctor may prescribe antibiotics to fight the infection.Do not take herbal pain medications without discussing it with your doctor. The herbal remedies may interact with, interfere with or duplicate your treatment regimen, causing serious complications and even death. Herbal supplements are drugs and should be treated with the same caution as any other medication. Since herbal supplements are unregulated, safety may be more of an issue than with other medications.Homeopathy has not be found to help control cancer pain.Other Methods of Cancer Pain ControlThere are a variety of other methods of controlling cancer pain besides drugs. Ask your doctor before using any of these methods. Start using any of these methods gradually, as what helps alleviate pain in one individual might actually stimulate pain in another. If it hurts, stop doing it.Massage Therapy. Massage can help provide temporary relief from certain types of cancer pain, such as bone pain. It also helps relax muscles. This may be enough to enable the cancer patient to fall asleep. Massage therapists may require written approval from your oncologist, as massage can stimulate blood flow. Percussion and vibration massagers may also help. Do not rub areas where you recently received radiation therapy, as this may irritate the skin.Ice Packs. Cold temperature can help dull pain and reduce inflammation. This is particularly helpful with surgical pain, such as pain at the incision site. Wrap the ice pack in a towel. Some patients use a bag of frozen corn or peas, as this can be molded to the shape of the body more easily than a bag of ice.Hot bath or soak. The heat can help with some types of pain by relaxing muscles and stimulating circulation. For example, soaking ones hands and feet can sometimes provide temporary relief from Raynaud's Phenomenon and Peripheral Neuropathy. Moist air may also help with chest pain.Moist Heat Wraps. Laying a moist hot towel on the source of the pain can also help. Several manufacturers make heat packs containing hydroscopic beads that are heated to the correct temperature in a microwave oven. These beads absorb moisture from the air, and release it when heated. This yields moist heat that can be therapeutic in nature. They are particularly helpful with back pain. Common brand names include Therabeads and MediBeads.Transcutaneous Electrical Nerve Stimulation (TENS). TENS involves placing electrodes near the location of the pain and delivering mild electric shocks of varying duration, intensity and frequency. This stimulates the nerves and may help temporarily block certain forms of localized pain. It is often used by physical therapists along with a moist hot towel wrap. It should be avoided by anyone with a heart condition or who suffers from seizures.Acupuncture and Acupressure. Like TENS, acupuncture works by stimulating nerves to cause the body to release endorphins, a form of natural painkiller. As with TENS, the relief is usually temporary in duration.Movement and Position. Mild exercise can help with some forms of pain. Lying or sitting for extended periods can cause pain and bed sores, so it is a good idea to change position from time to time. Special shaped pillows may be helpful, as well as pressure-relieving mattresses. Bead-filled nylon hugging pillows available from many department stores may also help.If you are suffering from back pain, try using a wedge pillow to change the angle of the head relative to the body. Also put a pillow under your knees. Try also putting a rolled up towel at the lumbar position of your back (near the waist).A physical therapist can teach you exercises to help alleviate certain types of mild pain.Distraction. Directing your attention away from the pain can help provide temporary relief. If you have nothing to do but focus on the pain, the pain will feel worse. If you can read a book, watch television, listen to music or talk with friends, it may distract you from the pain for a while. Humor can also help. Boredom and depression can lower pain tolerance.Most of these methods are effective only for short periods of time, and may need to be alternated.Hypnosis, meditation, visualization (guided imagery or thinking about a pleasant experience), aromatherapy, breathing techniques and relaxation techniques are rarely sufficient on their own for controlling cancer pain. But they can help reduce stress and emotional anxiety and improve the effectiveness of other cancer pain control methods. Talking with a counselor may also help. Some religious individuals have found that prayer and talking with a religious chaplain (priest, rabbi, minister) helps reduce anxiety.Getting enough sleep may help you manage your pain. Cancer patients who don't get enough sleep often have a harder time dealing with pain. Pain can also make it harder to fall asleep and increase your fatigue. (Pain interferes with sleep in about a quarter of cancer patients.) If you are having trouble falling asleep, talk to your doctor. Some of your medications, such as steroids, may be causing insomnia. Your doctor may change your medication schedule to have you take the steroids in the morning instead of the evening. He may also prescribe a mild sedative or sleeping pills to help you fall asleep in the evening. You can also try drinking a warm milky drink. Avoid exercising before bed, and activities that stimulate the mind.In terminal cancer patients, palliative chemotherapy, hormone therapy and radiation therapy has been used effectively to reduce cancer pain, especially for bone metastasis from breast and prostate cancer. Steroids and radiation therapy have been found to be helpful for headaches caused by brain metastasis.Problems with Pain MedicationsThe most common side effects of opioid pain medication are drowsiness, nausea/vomiting and constipation. Drowsiness and nausea typically go away after about 5 days.Many opioid pain medications can cause drowsiness and interfere with your ability to concentrate. You may be disoriented and confused, or your thinking and memory may be not as sharp as usual. Your reaction time will be reduced and you may be less alert. You should avoid driving or operating machinery while taking these pain medications.All opioid-based pain medications can cause constipation. Your doctor may prescribe a laxative to address this problem. Often two laxatives will be prescribed, one as a stool softener and one to stimulate the bowels. Consuming dietary fiber and drinking water may help.Another common problem with opioid pain medications is dry mouth. Drinking water can help resolve this problem.Opioid-based pain medication can also cause headaches.Allergic reactions to opioid-based pain medication are rare. If you experience an allergic reaction (swelling, itching, difficulty breathing, chest tightness, cough, change in skin color) after taking your pain medication, call 911 or go to the nearest emergency room.Steroids may increase your appetite, resulting in weight gain. They can also increase your blood sugar, leading to diabetes. Other common problems include indigestion and an increased risk of infection. If you become very thirsty or urinate frequently while taking steroids, let your doctor know. Steroids can also make you anxious and irritable, making it more difficult to sleep. Steroids are often given with a mild sedative, such as () or (), for this reason. These sedatives can also help alleviate muscle spasms. can cause short-term memory loss. Steroids can increase fluid retention, leading to swelling of ankles and fingers, an increase in blood pressure, and feeling bloated. Do not take antacids while on steroids without talking with your doctor, as some antacids can dissolve the coating on steroid pills.Do not take more than the indicated dose without talking with your doctor. Taking too high a dose can cause serious problems, such as liver or kidney failure and gastric bleeding.When an opioid-based drug is combined with a non-opioid drug, the presence of the non-opioid may limit the number of pills you can take a day.Do not take pain medications with alcohol.Too high a dose of pain medication can affect your breathing and reduce your blood pressure, resulting in dizziness or fainting. Let your doctor know immediately if you are experiencing any of these problems, as they can be very serious (potentially life-threatening).If you are receiving pain medication through a skin patch, let your doctor know if you have a high temperature. Increases in body temperature can increase the absorption rate, leading to too high a dosage.Do not take over-the-counter pain medication in addition to your prescription pain medication without consulting your doctor. Many prescription pain medications contain combinations of opioid pain medications with non-prescription pain medication. If you supplement your prescription with over-the-counter pain medication, you could end up with an overdose of the non-prescription pain medication. This can cause liver, kidney and stomach problems.AddictionAddiction is very unlikely to occur in cancer patients receiving pain medication under the supervision of a doctor. The dose is carefully adjusted to control the pain. Only when narcotics are taken when there is no pain or beyond the level required to control pain is addiction likely to occur.Do not chew the pain medication unless instructed to do so by your doctor. Most opiate-based pain medication is in slow release tablets that ensure a steady level of pain medication in your body until the next dose. If you chew the tablets it can interfere with the delivery of the pain medication, and can lead to addiction.If you forgot to take your pain medication as scheduled, do not double up your next dose. Taking more pain medication than is required to control the pain can lead to addiction.If the pain medication is not controlling your pain, do not increase your dosage without talking to your doctor. Your doctor may want to increase your dosage or switch you to a different pain medication, depending on your dosage. For example, if you are receiving pain medication through a patch, do not use extra patches simultaneously, as this won't control the pain any better and can be life-threatening.If you become depressed after stopping your pain medication, tell your doctor. Depression is a sign of withdrawal, and your doctor may want to take you off the pain medication more gradually or give you a small dose to combat the withdrawal. In most cases your doctor will not want you to stop taking the pain medications suddenly, but instead gradually step down the dosage.After you are done with pain medication, you can return it to your pharmacy for safe disposal. Do not flush it down the toilet or throw it out in the trash.Pain after the End of TreatmentIt is not unusual for cancer survivors to be more sensitive to every ache and pain or bump and bruise they experience for a year or more after the end of treatment. It is also not unusual to worry about the cancer returning or getting a different cancer. If you are worried about something, ask your oncologist or primary care physician. They can perform a physical exam and order appropriate tests to distinguish normal aches and pains from more serious conditions.There are also a variety of side effects of treatment that can have delayed onset. This includes peripheral neuropathy, where damage to the nerves in the hands and feet can cause sensations of heat, cold, pain, numbness and tingling. Raynaud's Phenomenon is a vascular condition in which the blood vessels and capillaries in the body's extrema contract inappropriately, causing a sensation similar to that which occurs when your feet fall asleep. The difference between Raynaud's Phenomenon and Peripheral Neuropathy is that with Raynaud's, the hands and feet can change color (red, white, blue) and get physically cold, as opposed to just having the sensation.Other Cancer Pain Management TipsBe careful how you store your pain medications. Keep them away from children. If you will be having a lot of visitors from people you don't know, do not store the pain medications (especially any narcotics) in an obvious location like the bathroom, as some people steal pain meds from cancer patients. You may want to lock them up. If you like having them in sight to remind yourself to take them, using a post-it note instead.Keep a pain journal in which you note the date and time you took any pain medications. Also note when you felt pain or the quality of pain changed. This can help your doctor. Since some pain medication can cause confusion or forgetfulness, it can also help you avoid taking an overdose.Keep the pain medication in the bottle. The bottle will have a label that reminds you how frequently to take the medication Always check the label before taking any pain medication, to make sure you are taking the proper dosage. If you missed a dose, do not double up the next dose, as this can cause addiction.Cancer pain: Relief is possible - Mayo Clinic

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