Cancer and Pain Management

What is pain?

Pain is an unpleasant sensory or emotional experience. It may be sudden (acute) or long-term (chronic).

• Acute pain. This can be mild to severe pain, that starts quickly, and lasts a fairly short time, often less than 3 months. It's often a signal that body tissue is being injured in some way. It generally goes away when the injury heals.

• Chronic pain. This may range from mild to severe and is present to some degree for longer periods of time. It generally lasts longer than 3 months.

With cancer, will I have pain?

Many people believe people with cancer must be in pain. This is not always the case. Also, even if pain can't be prevented, it can often be reduced or controlled. Pain management is an important topic to discuss with your healthcare provider.

Pain may happen as a result of cancer, cancer treatment, or both. Pain may also happen for other reasons. It's normal to sometimes have general discomfort, headaches, pains, and muscle strains in daily life, even without cancer. And, even after a cancer diagnosis, not every pain is linked to or caused by cancer. Cancer pain may depend on the type of cancer, the type of treatment, the stage (extent) of the disease, and how well a person can handle pain.

What should I do if I am in pain?

A test can't be used to measure different levels of pain. To reduce or get rid of any pain you have, you'll need to talk with your healthcare provider. Tell them about the pain and give details about your level of discomfort.

The answers to these questions can help your provider find the cause of the pain. Then they can create a plan to help you get as much relief as possible.

You may be asked these questions to more accurately assess your condition:

• Can you describe the pain and what it feels like?

• What do you think could be the cause?

• How strong is the pain? To answer this, your healthcare provider may ask you to rate your pain using a scale from 0 to 10; 0 is no pain and 10 is extreme pain.

• When did the pain start and how long does it last?

• Is the pain worse during certain times of the day or night?

• Can you show where on your body you have pain?

• Does the pain move or travel? If yes, can you show how and where?

• Have you taken any medicines to ease the pain, or tried any other things to reduce the pain? Have you had any relief?

• Have you noticed some activities or positions that make the pain better or worse?

You may want to make some notes. This way, when your healthcare provider asks specific questions about your pain, you can give accurate answers. Write down the details of any mild pain you might have been having. This way you won't forget to report them. Think about keeping a diary of your pain. Or ask a friend or family member to help track your symptoms. The types of information that you may want to note in your diary include:

• Date

• Time

• Pain scale rating

• Type and dose of medicine

• Time pain medicine was taken

• How well pain responded to medicine

• Any other pain relief methods used

Your healthcare provider may need to look at your diary when making a plan to ease your pain and make you more comfortable. Bring it with you to your provider visits.

How can I describe my pain?

When your healthcare provider asks about your pain, you will need to explain how your pain feels as clearly as possible. When you are asked how it feels, using these terms may be helpful:

• Dull pain. A slow or weak pain, not very sudden or strong.

• Throbbing pain. A pain that surges, beats, or pounds.

• Steady pain. A pain that doesn't change in its intensity.

• Sharp pain. Pain that causes intense mental or physical distress, that may feel "knife-like."

• Acute pain. Severe pain that lasts for a fairly short time.

• Chronic or persistent pain. Mild to severe pain that is present to some degree for long periods of time.

• Breakthrough pain. This is moderate to severe pain that happens when you are taking medicine for chronic pain. It happens even though you're taking your medicines on time (pain that "breaks through" the medicine).

• Radiating pain. Pain that starts in one place and travels to another.

What causes pain with cancer?

Cancer pain that lasts a few days or longer should be checked right away. It may be due to one or more of these:

• Pain from a tumor that is pressing on body organs, nerves, or bones

• Increased pressure in a confined space, like the head

• Poor blood circulation

• Blockage of an organ or canal in the body

• Cancer cells that have spread to other sites in the body (metastasis)

• Infection or inflammation

• Side effects from chemotherapy, radiation therapy, or surgery

• Stiffness from inactivity

• Psychological responses to tension, depression, or anxiety

Treatment for pain

Your healthcare provider will figure out specific pain treatment for you based on:

• Your age, overall health, and medical history

• Type of cancer

• Extent of disease

• How well you can handle certain medicines, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Cancer pain may be treated directly with chemo or radiation therapy to help shrink a tumor that's causing the pain. Sometimes surgery may even be advised specifically to reduce pain. Many approaches may be used to treat pain. These include both methods that use medicine (pharmacological) and methods that don't use medicine (nonpharmacological).

What is pharmacological pain management?

This type of pain management for cancer uses medicines.

Oncology clinics often offer several pain management choices for any procedure that may be painful, such as a bone marrow aspiration or lumbar puncture. There are many types of medicines and several ways they might be used during medical procedures. They vary from very temporary (10 minute) mild sedation to full general anesthesia (where you are in a deep sleep) in the operating room.

Some people need medicine they can take to control cancer pain. Pain medicine may be given in one or more of the following methods:

• By mouth (orally in pill form, liquid, or as a lozenge placed inside the cheek or under the tongue)

• With a shot under the skin (subcutaneous injection)

• Through a needle in a vein (by IV or intravenously)

• With a special tube (catheter) in a space around the spinal column (epidural)

• By blocking a certain nerve that is causing pain 

• Through a patch that sticks on the skin

• Through implanted methods (such as a pump that is implanted in the body)

• By inserting rectal suppositories

Some people can build up a tolerance to pain relievers. Over time, doses or types of medicine used for pain relief may need to be increased or changed. Fear of addiction to opioids is common. But it's rarely a problem when the medicines are used correctly. It's important to understand that the ultimate goal is comfort. This means taking appropriate measures to control or ease pain. 

Questions to ask about your pain medicine

Each time your healthcare provider prescribes a pain medicine, ask these questions:

• What dose of pain medicine is being prescribed and how many times a day will I be taking medicine?

• What should I do if my pain is not eased with the advised dose?

• Why might I need a dosage increase?

• Should I call you before increasing the dose?

• What if a dose is missed or not taken on time?

• Should this medicine be taken with food or on an empty stomach?

• Should I be taking this medicine (if tablet or capsule) with a certain type of liquid?

• How long does it take the medicine to start working? How long should each dose work?

• Is it safe to drink alcohol, drive, or operate machinery while taking this pain medicine? Are there any activity restrictions?

• Are there prescription or over-the-counter medicines that are dangerous to take with this medicine?

• Are there any side effects with this medicine? If yes, is there any way to prevent or reduce them?

What if I need to change my pain medicine?

If you are dissatisfied with the medicine you have been prescribed, talk with your healthcare provider or cancer treatment team. There may be other ways to ease the pain, including switching to a different pain medicine. Your provider might also change the way you are taking the medicine.

Talk with your healthcare provider if the medicine isn't working. A different pain medicine, different dose, or different combination of pain medicines may be needed if:

• Your pain continues or gets worse.

• Your pain medicine doesn't start working within the time frame specified by your healthcare provider.

• Your pain medicine doesn't work for the length of time specified by your provider.

• You are having breakthrough pain (moderate to severe pain that "breaks through" between doses).

• The dosage schedule or method is inconvenient and you're having trouble adapting your schedule.

• Pain becomes disruptive to your daily activities, such as eating, sleeping, working, and sexual activity.

• You have serious side effects, such as trouble breathing, dizziness, and rashes.

If serious side effects happen, get medical care right away. Side effects, such as sleepiness, nausea, and itching, often go away after your body adjusts to the medicine. But call your healthcare provider if you have any side effects from your pain medicine.

What is nonpharmacological pain management?

This type of pain management doesn't use medicines. This method uses ways to change thoughts and focus concentration to better manage and reduce pain. Methods can include:

Education and psychological conditioning

Not knowing what to expect with cancer treatment is very stressful. But knowing what to expect can help reduce your stress level. Here are some ways to help prepare yourself and decrease your anxiety about your treatment:

• Ask to have each step of a procedure explained.

• Meet with the person who will be doing the procedure. Ask questions and write down their answers.

• Tour the room where the procedure will take place.

• Ask what you can expect as an outcome of the treatment.

Hypnosis

With hypnosis, a psychologist or trained clinician guides you into an altered state of consciousness. This helps you to focus or narrow your attention to reduce mild pain.

Imagery

Using mental images of sights, sounds, tastes, smells, and feelings can help shift attention away from the pain. You might think of a pleasant, relaxing place or a happy memory.

Distraction

Distraction is often used to help children, especially babies. Using colorful, moving objects, or singing songs, telling stories, or looking at books or videos can distract preschoolers. Older children and adults may find it helpful to watch TV or listen to music. Use distraction appropriately, and not in place of an explanation of what to expect.

Relaxation

Relaxation exercises include deep breathing and stretching. They can often reduce mild pain.

Other nonmedicine pain management may use alternative therapies. These include comfort therapy, physical and occupational therapy, talk therapy (counseling), and neurostimulation to better manage and reduce pain. Examples of these nonmedicine pain management methods include the following:

Comfort therapy

Comfort therapy may include any of these:

• Companionship

• Exercise

• Heat or cold application

• Lotions or massage therapy

• Meditation

• Music, art, or drama therapy

• Pastoral counseling

• Positioning

Physical and occupational therapy

Physical and occupational therapy may include:

• Water therapy

• Tone and strengthening

• Desensitization

Talk therapy (counseling)

Talk therapy may include:

• Individual counseling

• Family counseling

• Group counseling

• Cognitive behavior therapy

Neurostimulation

This may include:

• Transcutaneous electrical nerve stimulation (TENS)

• Acupuncture

• Acupressure