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 three months). It is usually a signal that body tissue is being injured in some way, and it generally disappears when the injury heals. Chronic pain may range from mild to severe, and is present to some degree for longer periods of time (generally lasting longer than three months).

With cancer, will I have pain?

Many people believe individuals with cancer must be in pain. This is not necessarily the case. Further, even if  pain cannot be prevented, it can often be reduced or alleviated. Pain management is an important topic to discuss with your doctor as soon as a diagnosis of cancer is made or suspected.

Pain may occur as a result of cancer, cancer treatment, or both. Pain may also occur for other reasons. It is normal to have occasional general discomfort, headaches, pains, and muscle strains in daily life, even without cancer. But, 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 individual's threshold (tolerance) for pain.

What should I do if I am in pain?

A test cannot be performed to measure different levels of pain. So that any pain you may be experiencing can be reduced or eliminated, you will need to talk to your doctor about the pain and provide specific details about your level of discomfort.

According to the National Cancer Institute, the answers you give to the following questions can help your doctor locate the cause of the pain and develop a plan to provide you with 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 accurately answer this, your doctor 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 are experiencing pain?

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

  • Have you taken any medications to relieve the pain, or tried any other approaches to reduce the pain? Have you experienced any relief?

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

You may want to make some notes so that when your doctor asks specific questions about your pain, you will be able to provide 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 medication

  • Time pain medication was taken

  • How well pain responded to medication taken

  • Any other pain relief methods attempted

Your doctor may need to refer to your diary when making a plan to relieve your pain and make you more comfortable, therefore, be sure to bring it with you to your doctor visits.

How can I describe my pain?

When your doctor or nurse 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 terminology 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 medication for chronic pain, moderate to severe pain that occurs between doses (pain that "breaks through").

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 doctor based on the following:

  • Your age, overall health, and medical history

  • Type of cancer

  • Extent of disease

  • Your tolerance for specific medications, 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. 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 medications. Oncology clinics usually offer several pain management options for any procedure that may be painful, such as a bone marrow aspiration or lumbar puncture. There are many types of medications and several methods used for administration, from very temporary (10 minute) mild sedation, to full general anesthesia (where you are in a deep sleep) in the operating room.

Pain medication 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 on the skin

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

  • By inserting rectal suppositories

Examples of pharmacological pain relief include the following:

  • Analgesics (for mild to severe pain relief)

  • Sedation (usually given for relief of pain during a procedure)

  • Anesthesia (usually given for relief of pain during a procedure)

  • Topical anesthetics (cream, gel, or liquid applied to the skin to numb the area)

  • Other pain relievers

Some people can build up a tolerance to pain relievers. Over time, doses or types of medication used for pain relief may need to be increased or changed. Fear of addiction to opioids is common, although, in most cases, it is rarely a problem. It is important to understand that the ultimate goal is comfort, which means taking appropriate measures to alleviate your pain.

Questions to ask about your pain medication

Each time a pain medication is prescribed by your doctor, consider seeking answers to the following questions:

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

  • 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 medication be taken with food or on an empty stomach?

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

  • How long does it take the medication to start working?

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

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

  • Are there any side effects associated with this medication? 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 medication you have been prescribed, consult your doctor or cancer treatment team. There may be other ways to alleviate the pain, including switching to a different pain medication. Changes may also be recommended regarding the way you are taking the medication.

Be sure to talk with your doctor if you are uncomfortable, as a different pain medicine, different dose, or different combination of pain medications may be required if:

  • Your pain continues.

  • Your pain medication does not start working within the time frame specified by your doctor.

  • Your pain medication does not work for the length of time specified by your doctor.

  • 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 occur, call your doctor immediately. Side effects such as sleepiness, nausea, and itching usually resolve after your body adjusts to the medication. However, call your doctor if you are experiencing any side effects from your pain medication.

What is nonpharmacological pain management?

Nonpharmacological pain management is the management of pain without medications. 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 in detail, utilizing simple pictures or diagrams when available.

    • Meet with the person who will be performing 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 usually 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 utilize alternative therapies, such as 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:

    • Aquatherapy

    • Tone and strengthening

    • Desensitization

  • Psychosocial therapy or counseling. Psychosocial therapy or counseling may involve the following:

    • Individual counseling

    • Family counseling

    • Group counseling

  • Neurostimulation. Neurostimulation may involve the following:

    • Transcutaneous electrical nerve stimulation

    • Acupuncture

    • Acupressure