Cancer.Net: Doctor-Approved Patient Information from ASCO®

Managing Your Cancer-Related Pain

Voiceover: Pain is something that many people with cancer will experience at some point. However, most cancer-related pain can be successfully treated, with the help of your health care team. Pain can be caused by several different things, including the tumor or cancer itself, cancer surgery, radiation therapy, chemotherapy, or other systemic therapies.

Lidia Schapira, MD, FASCO; Medical Oncologist; Member, American Society of Clinical Oncology: A person with cancer may experience pain from many different sources. The pain could be a result of surgery, we call that post-operative pain. The pain could be a side effect, or toxicity, of one of the drugs or medications we use to treat or cure the cancer, and that may cause a pain, for instance, in the nerves. And we call that neuropathic pain. Or pain could come from actual cancer being inside an organ, such as bones or liver, and so that could really be what we call sometimes visceral pain, or skeletal pain.

Voiceover: It's very important that patients talk with their doctor about the pain they are experiencing, and describe their particular type of pain in as much detail as they can. This helps the doctor figure out why the pain is happening, and the best treatment options. Descriptions such as burning, stabbing, throbbing, or aching can help the doctor understand what you're feeling. Tracking the location, severity, and frequency of pain can also help provide important details when patients discuss this with their physician.

Dr. Schapira: Eliciting the story of pain really requires that the clinician listen very actively to what the patient is saying. We ask patients to rate their pain on a scale of 1 to 5, or 1 to 10, just to give us an idea of how serious or severe it is. Basically, if the pain is rated as a 10, we treat it as an emergency. But there is no laboratory test for pain. It's really what the patient tells us it is. It's very important for the clinician to understand how the patient is experiencing that pain, whether it is intolerable or mild, and also to understand what it is that the patient is willing to do to control that pain. Just as it is very important to have a precise diagnosis for cancer, and to put together a personalized treatment plan, it's really important to listen to the patient's story of pain and also use that information to put together a very good--and precise--treatment plan. And that may involve medications, but it may also involve non-pharmacological treatments.

Voiceover: The more the health care team knows about a patient's pain, the more they can do to to try to personalize a plan that's tailored to help each individual patient. Treatment can include over-the-counter drugs, prescription medications, or treatments that don't use medicines, or a combination of these approaches.

Dr. Schapira: Cancer clinicians are constantly trying to put together the right kind of medication recipe for each patient. And that often involves using different medications--some of them are anti-inflammatories, some of them are anti-convulsants, drugs that work very well for instance, for helping deal with pain that comes from nerves. But at the end of the day, when the pain is really severe, we need opioids. And these days, it's become a little bit more difficult and more challenging, with all the societal concern about the abuse and misuse of opioids. But opioids are really important for controlling cancer pain, and we as cancer clinicians are still absolutely using them to help our patients, and providing safe instructions for how to better use them.

Sometimes, we need to add medications that address some elements of anxiety, and sometimes we can even help improve pain with non-pharmacological therapies, behavioral therapies, that may allow a person to soothe themselves in the face of pain. Sometimes just learning how to take breaths or even harness the power of their own mind to help themselves, perhaps, feel less anxious and responsive to pain. We need to figure out what makes the pain better, and often put together a series of resources—some are medical, some may be behavioral, some may just be related to helping the patient feel supported—that help him or her bear the pain and make it more tolerable.

Voiceover: Pain tolerance, and the desire to take pain medication, is different for every patient. So it's important for patients to not only describe their pain, but also talk with their doctor about what their pain threshold is and whether they are open to taking certain pain medications that can have side effects of their own.

Dr. Schapira: What we really are looking for with each patient is to find a place where they feel comfortable managing their pain. And some people may accept more pain in order to take fewer medications, whereas others may need their pain totally controlled, because they may be very anxious, or may not be able to bear it. And it's not for the clinician to say, when the pain is better controlled. We're often chasing the side effects of the medications we're using to treat pain, and that's another reason why it's really important for us to hear from the patients.

And sometimes it's not really the patient, but the family caregiver who really wants to let us know that the medication is not well-tolerated. It's usually pain, perhaps some nausea, constipation, or drowsiness that result from the pain medication, and it requires paying meticulous attention to the symptoms, responding very quickly, and making modifications to basically handle the situation of controlling the pain. And that includes managing the side effects of the pain medications themselves.

Voiceover: Your treatment for cancer pain can require changes or adjustments over time. This is why ongoing communication between the patient and the health care team about side effects is so important throughout cancer treatment.

Dr. Schapira: This is an area of medicine we really need to work together, to work collaboratively, clinician and patient. If we make a change, for instance, in the dose of the medication, we increase it in response to more pain, we need to know if that works or not. So it's really important to have the information go back and forth in a timely manner. This is a perfect example of where having input from the patient, perhaps telling us if the increase in dose or decrease in dose actually did the job or not, so that we can quickly respond and patients don't have to wait until their next appointment to have this done.

Managing pain really requires also, an effort on the part of patients and families. At Cancer.Net, we provide information to help patients and family members manage their pain, by understanding how to track pain, by understanding how we assess pain, and also help them to communicate with their clinicians, on their symptoms, so that they may get fast relief.

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Cancer.Net: Doctor-Approved Patient Information from ASCO®

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