pain management for cancer

I was originally diagnosed with adenocarcinoma of the right lung nearly two years ago. After the dissection of a lymph node in early December I started to feel pain in my shoulders. After a month I could not take it any longer and I started to take tylenol, which helped, switched to Advil after 4 month , have been on Advil 400mg/6hours around the clock since.
Lately I find that it is no longer enough. The pharmacist tells me I can take up to 600mg/6 hours.

My oncologist  on my last visit gave me a prescription for Dilaudid (0.5mg , 1 or 2 tablets po q 4H pen)  I am not sure of the meaning of po 4H... just in case Advil would no longer work.

I have been reading a little about dilaudid and I am concerned about taking it. What kind of quality of life would I have ? I understand there will be side effects but what concerns me most is : will I be able to  continue living alone , drive  a car. I already have difficulty breathing and dilaudid seems to cause shortness of breath

I was thinking of getting a small oxygen canister to carry around for my breathing when I go out. Would it help with dilaudid.

thank you in advance for your answer

Anailil

[HeinrikMD]

Hello again,

The directions for taking the medications could be read as follows:  1 to 2 tablets every 4 hours (q 4 H) , taken orally (PO “per orem”, though a friend who claims the real Latin should be “per os”) , when the pain arises (it is not likely “pen” but “prn” which is short for pro re nata, “when the occasion arises”). There is a bit of a contradiction here as the order of every 4 hours means round the clock, but the prn designation would mean “as needed” not continuous. For severe pain, there may really be a need to have the medications in your system round the clock, and a lot of patients are indeed advised to take their medications thus.
Controlling cancer pain can indeed be a challenge and some patients may need to take a lot of medications. Some medications like what was advised for you have a short active time, so you need to take them every 4 hours. You could discuss the possibility of taking fewer tablets by asking for medications that have a longer active time. There is indeed a side effect which is respiratory depression, and this is what you are worried about. For patients with pain, the dose to achieve pain control is usual much lower than the dose that would produce the respiratory problems, so this shouldn’t unduly worry you.
Stay positive.