Your doctor may respond by saying that what has been prescribed ’should’ be enough. Such a reply implies that the poor pain relief is somehow your fault. Don’t let your doctor make you feel guilty because you are still in pain. If you are still in pain, it is because you are not getting enough of a strong enough painkiller often enough—simple as that. It is your doctor’s responsibility and duty to correct that situation and if he or she does not do so you have every right to complain and ask for immediate referral to another doctor. The fault does not lie with you.

Some doctors will refuse to increase, or will even reduce your dose of painkiller if they decide it is making you too drowsy. They may do this even though your pain is not controlled. I believe that you have the right to have enough painkiller to control your pain, especially if your cancer cannot be cured and the cause of your pain cannot be corrected. You should decide whether you would prefer to be more alert and in more pain or drowsier and in less pain, even though the decision to be drowsier could mean that you don’t live quite as long as you would have otherwise. Your wishes in this regard are more likely to be respected if you talk to trusted family members or friends and your doctors about them before the situation ever arises. You could even put them in writing if you want to be as sure as possible that your last days will be as you want.

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The word remission means that the cancer growths have got smaller. If your doctor tells you that you are in a complete remission, this is certainly extremely good news. It means that no traces of cancer can be found in your body at that particular time. It does not guarantee that there are no cancer cells still in your body. As you already know, there are no tests that can detect very tiny cancer seedlings. Fair enough, you may say, but surely a complete remission means at least a definite possibility of permanent cure. I’m afraid that even this is not always true. Complete remissions can be produced by palliative cancer treatments. These remissions are never permanent. On the other hand, a complete remission with potentially curative treatment certainly does mean possible permanent cure. You can’t say it is a definite cure until later—after enough years have gone by for any dormant seedlings to activate and make their presence obvious.

The expression partial remission means the cancer deposits have got smaller, but are still detectable. They can still be felt, or seen on X-rays, scans, biopsies etc, or detected through blood tests. A treatment that quickly produces a partial remission may eventually produce a complete remission if continued. People with partial remissions tend to live longer than people whose cancers don’t respond to treatment. However, of course, no one who has only a partial remission is ever cured.

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