People living with cancer may experience pain as a symptom of the cancer or as a side effect of cancer treatment. However, nearly all cancer-related pain can be successfully treated or managed with the help of your health care team. Addressing pain, fatigue, and other symptoms that affect your quality of life is known as palliative or supportive care and is an important part of your overall cancer treatment plan.
Your doctor or another member of your health care team will help you find the most effective pain-relief strategy. This article describes cancer pain and provides an overview of ways to manage and treat this pain with medication. Part II discusses additional pain management strategies.
The importance of pain relief
There are a number of different types of cancer pain. Cancer pain may be acute, lasting just a short time after a particular treatment or other event. It may be intermittent, meaning it only occurs from time to time, or it may be chronic, meaning it is not likely to go away within a short amount of time. Some patients may also have breakthrough pain, which is pain that increases suddenly even though it is being treated.
No matter what type of pain you experience, it is important to tell your doctor, nurse, or another member of your health care team. When cancer-related pain is not addressed, it can make other symptoms or side effects of cancer seem worse. A person may also experience unnecessary fatigue (a persistent sense of tiredness), depression, anger, worry, or stress. Finding a solution will help you remain active, sleep better, improve your appetite, and enjoy activities and time spent with your family and friends.
Communicating with your doctor
The type, intensity, and location of pain is different for everyone. Identifying the cause of the pain and finding an effective solution requires teamwork between you and your doctor. To make it easier to communicate with your doctor about how you are feeling, consider keeping a pain journal. Be sure to include information about pain caused by other health conditions you may have, including diabetes and arthritis.
To start keeping a pain journal:
- Write down the date and time you experienced pain and how long it lasted.
- Note what activities you were doing when the pain started.
- Describe where in your body the pain started and if it was specific to one area or spread to other parts of the body.
- Give your pain a number on a scale of zero to 10, with 10 being the highest level of pain.
- Use words that describe the type of pain, such as “burning,” “stabbing,” or “throbbing.”
- Track the type of pain control methods you have tried and how effectively they worked.
Along with the information you provide your doctor, he or she will also consider several other factors when deciding how to best treat or manage your pain, such as:
- The type of cancer
- Where the cancer is located
- The stage of your cancer
- Your pain threshold (your tolerance for pain)
- Your personal preferences for treatment
- Previous treatments for pain and how well they worked
Types of pain-relief strategies
After a thorough medical assessment of your pain, your doctor will work with you to develop a pain-relief plan. Some hospitals have pain specialists and palliative care specialists who focus on the physical and emotional side effects of cancer to help patients with pain that is hard to control.
There are different ways doctors can treat or manage cancer-related pain:
Treating the source of the pain. For example, pain is often caused by a tumor that is putting pressure on nerves. Removing the tumor with surgery or shrinking it with radiation therapy or chemotherapy could reduce or eliminate the pain.
Changing the perception of pain. Some medications change how your body feels pain, making it more tolerable.
Interfering with pain signals sent to the brain. If medication does not work, specialized medical procedures, such as spinal treatments or nerve blocks (pain medication is injected into a nerve or tissue surrounding a nerve to interfere with a pain signal), may be considered.
Medications for pain
Preventing pain from developing or getting worse is one of the most effective ways to treat cancer-related pain. When using medication to treat pain, patients usually receive it at regular, scheduled times. “Rescue” or extra doses are used to control breakthrough pain if it occurs.
There are many different pain-relief medications, called analgesics, available. Depending on the drug and the patient’s condition, they can be given in different ways, such as by mouth (as a pill or liquid), intravenously (injected into a vein), or absorbed through the skin (worn as a skin patch).
- Non-opioid medications, including acetaminophen (such as Tylenol) and ibuprofen (such as Advil and Motrin), are used to treat mild or moderate pain. They also are sometimes used along with other pain medicines to treat severe pain. These pain relievers can usually be bought without a prescription, but you should talk with your doctor about how often to use them, the appropriate dose, and how long to use these drugs. It is very important to tell your doctor if you are using any of these medications on a regular basis.
- Opioids, which are also called narcotics, are used for moderate to severe pain and are often taken along with non-opioid medications. A doctor must prescribe these drugs, which include hydrocodone, fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone (each of these has multiple brand names). Because they are such strong pain relievers, extra care and caution must be taken to ensure they are stored correctly.
- Other medications, such as antidepressants and anticonvulsants (anti-seizure medicines), may be recommended to help relieve some types of pain, including nerve pain.
It is important to know that medication is not the only option for controlling pain. Many other methods are available, some of which are referred to as complementary medicine (treatments used in addition to conventional medicine). Options you may consider include physical therapy, distraction techniques, acupuncture, and massage. The most complete and potentially successful approach to pain control often combines several methods. Additional methods for managing cancer pain are discussed in Part II of this series.
Common pain management concerns
Some patients do not want to tell their doctor they are experiencing pain because they are scared it means the cancer has worsened or spread. Others feel like pain is simply a part of living with cancer and that they should not complain. Although these thoughts are understandable, there are many reasons why pain occurs, and every patient has the right to live without pain.
Some patients worry about becoming addicted to pain medication, but this is uncommon if medication is used appropriately. Your health care team is trained to carefully monitor people taking pain medication and to help safely decrease your dose when you no longer need treatment. If you or family members have a history of alcohol or drug abuse, tell your doctor so he or she can do what is needed to help prevent a problem from developing.
It is also normal for patients with cancer to worry about the side effects of medications. Although some medications, particularly those for moderate or severe pain, cause side effects such as constipation, nausea, sleepiness, or confusion, not everyone experiences them. If you do, they often go away over time or are treatable. If a side effect does not go away, or if a medication you are taking is not effective, tell your doctor. Changing the timing, dose, or type of the medication may help.
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