Cancer and Pain Management

What is pain?

Pain is an unpleasant sensory or emotional experience. It may be acute or chronic.

• Acute pain can be mild to severe and last a relatively short time, usually 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 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 necessarily 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 is 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 related to or caused by cancer. Cancer pain may depend on the type of cancer, the stage (extent) of the disease, and an person's tolerance for pain.

What should I do if I am in pain?

A test can't be used to measure different levels of pain. So that any pain you may have can be reduced or eliminated, you will need to talk to your healthcare provider about the pain and give specific details about your level of discomfort.

The answers to these questions can help your healthcare provider locate the cause of the pain and develop a plan to help you get as much relief as possible.

The following questions may be asked of you to more accurately evaluate 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 exactly 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 relieve the pain, or tried any other things to reduce the pain? Have you had any relief?

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

You may want to make some notes so that when your healthcare provider asks specific questions about your pain, you will be able to give accurate answers. Write down the details of any discomfort you might have been having so you will not forget to report them. Consider 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 taken

• Any other pain relief methods used

Your healthcare provider may need to refer to your diary when making a plan to relieve your pain and make you more comfortable. Be sure to bring it with you to your healthcare provider visits.

How can I describe my pain?

When your healthcare provider asks about your pain, you will need to communicate how your pain feels in as specific terms as possible. When you are asked how it feels, using the following 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 does not 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 a relatively short period of time.

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

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

What causes pain with cancer?

Cancer pain that lasts several days or longer may result from one or more of the following and should be evaluated right away:

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

• Poor blood circulation

• Blockage of an organ or canal in the body

• Metastasis (cancer cells that have spread to other sites in the body)

• Infection or inflammation

• Side effects from chemotherapy, radiation therapy, or surgery

• Stiffness from inactivity

• Psychological responses to tension, depression, or anxiety

Treatment for pain

Specific treatment for pain will be determined by your healthcare provider based on the following:

• Your age, overall health, and medical history

• Type of cancer

• Extent of disease

• Your tolerance for specific medicines, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Cancer pain may be treated directly with chemotherapy or radiation therapy to help shrink a tumor that's causing the pain. Sometimes a surgical procedure may even be recommended specifically to reduce pain. Multiple approaches may be used to treat pain including both pharmacological and nonpharmacological.

What is pharmacological pain management?

Pharmacological pain management for cancer refers to the use of medicines.

Oncology clinics usually 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 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 an injection under the skin (subcutaneous injection)

• Through a needle in a vein (IV)

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

• By blocking a specific 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 is important to understand that the ultimate goal is comfort. This means taking appropriate measures to control or relieve pain. 

Questions to ask about your pain medicine

Each time a pain medicine is prescribed by your healthcare provider, consider seeking answers to the following 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 relieved with the recommended dose?

• What would warrant 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 particular 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 doctor might also change the way you are taking the medicine.

Be sure to 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 does not start working within the time frame specified by your healthcare provider.

• Your pain medicine does not work for the length of time specified by your healthcare provider.

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

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

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

• You experience serious side effects such as difficulty breathing, dizziness, and rashes.

If serious side effects happen, call your healthcare provider immediately. Side effects such as sleepiness, nausea, and itching usually resolve after your body adjusts to the medicine. However, call your healthcare provider if you have any side effects from your pain medicine.

What is nonpharmacological pain management?

Nonpharmacological pain management is the management of pain without medicines. This method utilizes ways to alter thoughts and focus concentration to better manage and reduce pain. Methods of nonpharmacological pain include:

Education and psychological conditioning

Not knowing what to expect with cancer treatment is very stressful. However, if you are prepared and can anticipate what will happen, your stress level will be much lower. To decrease your anxiety about cancer treatment, consider the following:

• Ask for an explanation of each step of a procedure.

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

• 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 discomfort.

Imagery

Using mental images of sights, sounds, tastes, smells, and feelings can help shift attention away from the pain.

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 watching TV or listening to music helpful. Use distraction appropriately, and not in place of an explanation of what to expect.

Relaxation

Relaxation exercises include deep breathing and stretching and can often reduce discomfort.

Other nonpharmacological pain management may use alternative therapies. These include comfort therapy, physical and occupational therapy, psychosocial therapy/counseling, and neurostimulation to better manage and reduce pain. Examples of these nonpharmacological pain management techniques include the following:

Comfort therapy

Comfort therapy may involve the following:

• 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 involve the following:

• Water therapy

• Tone and strengthening

• Desensitization

Psychosocial therapy or counseling

Psychosocial therapy or counseling may involve the following:

• Individual counseling

• Family counseling

• Group counseling

• Cognitive behavior therapy

Neurostimulation

Neurostimulation may involve the following:

• Transcutaneous electrical nerve stimulation (TENS)

• Acupuncture

• Acupressure