People with cancer may experience pain from the cancer itself or from side effects of a cancer treatment. However, nearly all cancer-related pain can be successfully treated or managed. Pain relief is an important part of the overall cancer treatment plan, and your doctor and other members of the health care team will help you find the solutions that are most effective for you. This article describes cancer pain and provides an overview of ways to manage and treat this pain. Part II discusses additional pain management strategies.

The importance of pain relief

Cancer pain may be chronic, meaning it is not likely to go away within a short time, or it may be intermittent, meaning it only occurs from time to time. It also may be acute, lasting just a short time after a particular treatment or other event. Some patients may have breakthrough pain, which is pain that increases suddenly even though it is being treated. No matter what kind of pain you experience, it is important that you tell your doctor.

When cancer-related pain is not addressed, a person may experience unnecessary fatigue (a persistent sense of tiredness), depression, anger, worry, or stress. Finding a solution helps you to remain active, sleep better, improve your appetite, and enjoy activities and time spent with family and friends.

Communicating with your doctor

The type, intensity, and location of pain differs from person to person. 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 diary. Be sure to include information on pain related to other health conditions you may have, such as diabetes or arthritis.

• 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.

• The type of cancer
  
  
• Where the cancer is located
  
  
• The stage of your cancer
  
  
• Your tolerance for pain (called your pain threshold)
  
  
• 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 or chemotherapy could reduce or eliminate the pain.
  
  
• Changing the perception of pain. Pain management tools, such as medication, can 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 occurring or worsening is one of the most effective ways to treat pain related to cancer. When using medication to treat pain, patients usually receive it at regular, scheduled times. “Rescue” or extra doses are used to bring breakthrough pain under control.

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 or intravenously (injected into a vein).

• Non-opioid medicines, 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, appropriate dose levels, 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-opiods. A doctor must prescribe these drugs, which include hydrocodone, fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone.
  
  
• 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 methods (treatments used in addition to conventional medicine). Methods 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 article.

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 cancer and that they should not complain. Although these thoughts are understandable, there are many reasons pain occurs and every patient has the right to live without pain.

Some patients worry about becoming addicted to pain medication, but this rarely occurs if medication is used appropriately. It is also normal for patients with cancer to worry about the side effects of medications. While 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.

More Information

ASCO Answers: Managing Pain

Managing Side Effects: Pain

Additional Resources

CancerCare: Controlling Cancer Pain — What You Need to Get Relief

National Cancer Institute: Pain Control — Support for People with Cancer

Last Updated: December 08, 2011