Controlling Cancer Pain Part 1

Facts about cancer pain treatment

This information is written to help people with cancer learn about pain control. Reading this can help you:

  • Work with your doctors, nurses, and pharmacists to find the best ways to control your pain.
  • Know about different types of pain and how each type is treated.
  • Learn about different types of pain medicines.
  • Know about other ways to help manage pain.
  • Take your medicines safely.
  • Talk with your cancer care team about your pain and how well your pain treatment plan is working.

Having cancer does not always mean having pain. But for people who do have pain, there are many different kinds of medicines, different ways to take the medicines, and non-drug methods that can help relieve pain.

Pain can affect all parts of your life. If you have pain, you may not be able to take part in your normal day-to-day activities. You may have trouble sleeping and eating. You may be irritable with the people you love. It’s easy to get frustrated, sad, and even angry when you’re in pain. Family and friends don’t always understand how you’re feeling, and you may feel very alone in your distress.

You should never accept pain as a normal part of having cancer. All pain can be treated, and most pain can be controlled or relieved. When pain is controlled, people can sleep and eat better, enjoy being with family and friends, and continue with their work and hobbies.

Only you know how much pain you are in. Telling your cancer care team when you’re in pain is very important because pain is easier to treat when it first starts. Pain can also be an early warning sign of the side effects of cancer treatment or some other problem. Together, you and your cancer care team can talk about how to best treat your pain. You have the right to be treated for cancer pain, and you should insist on it

Facts about cancer pain treatment 

Cancer pain can almost always be relieved or lessened.
There are many medicines and methods that can be used to control cancer pain. You should expect your cancer care team to work with you so that you can be as comfortable as possible. But even though a lot of progress has been made, some doctors and nurses don’t know the best ways to treat cancer pain.
If you’re in pain and your doctor has nothing more to offer, ask to see a pain specialist or have your doctor consult with a pain specialist. Pain specialists may be oncologists, anesthesiologists, neurologists, neurosurgeons, other doctors, nurses, or pharmacists. A pain control team may also include psychologists and social workers.

If you have trouble finding a pain specialist, contact a cancer center, a hospice, or the oncology department of your local hospital or medical center. They should be able to recommend someone to you.

Controlling your pain is part of your cancer treatment.
Your cancer care team wants and needs to hear about what works for your pain and what doesn’t. Knowing about the pain will help them know more about how the cancer and the treatment are affecting you. Talking about pain won’t distract your cancer care team from treating the cancer.

Keeping pain from starting and keeping it from getting worse are the best ways to control it.
Pain is best relieved when treated early. Don’t try to hold off as long as possible between doses of pain medicine. Pain may get worse if you wait. Then it may take longer for the medicine to work, or you may need larger doses.

You have a right to ask for pain relief.
Talking about your pain is not a sign of weakness. Not everyone feels pain in the same way. There’s no need to “tough it out” or be “brave.” In fact, as soon as you have any pain you should speak up. Remember, it’s easier to control pain right when it starts rather than waiting until it becomes severe.

People who take cancer pain medicines the way the cancer care team tells them to rarely become addicted to them.
Addiction is a common fear of people taking pain medicine. Such fear may keep you from taking the medicine. Or it may cause family members to encourage you to hold off as long as you can between doses.

Addiction is defined as uncontrollable drug craving, seeking, and continued use. When opioids (also known as narcotics) – the strongest pain relievers available – are taken for pain, they rarely cause addiction as defined here. When you’re ready to stop taking opioids, the doctor will lower the amount of medicine you’re taking over a few days or weeks. By the time you stop using it completely, your body has had time to adjust. Talk to your cancer care team about how to take pain medicines safely and about any concerns you have about addiction.

Most people do not get “high” or lose control when they take cancer pain medicines the way they’re told to.

Some pain medicines can cause you to feel sleepy when you first start taking them. This feeling usually goes away within a few days. Sometimes you become drowsy because now that the pain is under control, you’re able to get the much-needed sleep you missed when you were in pain.

Sometimes, people get dizzy or feel confused when they take pain medicines. Tell your cancer care team if this happens to you. Changing your dose or type of medicine can often solve these problems.

Side effects from pain medicines can be managed and often prevented.
Some pain medicines can cause nausea and vomiting, itching, constipation, or drowsiness. A few can cause liver or kidney damage. (We talk about side effects in more detail in the sections on the different types of pain medicines commonly used.) Your cancer care team can help you manage these side effects. Some of these problems go away after a few days of taking the medicine. Many side effects can be managed by changing the medicine, the dose, or the times when the medicine is taken. Others, like constipation, can often be prevented with stool softeners and other measures.

Your body does not become immune to pain medicine.
Pain should be treated early, and stronger medicines should not be saved for later. It’s important to take whatever medicine is needed when it’s needed. Your body may get used to the medicine you’re taking, so over time the medicine may not relieve the pain as well as it once did. This is called tolerance. Tolerance is seldom a problem with cancer pain treatment because your cancer care team can increase the amount of medicine you’re taking or add other medicines. Some people are alarmed by this because they think it means they’re addicted, but it’s not the same thing. It only means that your body has learned to adjust to the drug over time.

When pain is not relieved, you may feel:

  • Tired
  • Depressed
  • Angry
  • Worried
  • Lonely
  • Stressed

When cancer pain is relieved, you’re more able to:

  • Enjoy being active.
  • Sleep better.
  • Enjoy family and friends.
  • Eat better.
  • Enjoy sexual intimacy.
  • Prevent depression.

What causes pain in people with cancer? 

Pain is most often caused by the cancer itself. But pain can also be caused by cancer-related treatment or tests. You may also have pain that has nothing to do with the cancer or its treatment. Like anyone, you can get headaches, muscle strains, and other aches and pains.

Pain from the cancer
Whether you have pain and the amount of pain you have depends on the type of cancer, its stage (extent), and your pain threshold (tolerance for pain). People with advanced cancer are more likely to have pain.
Pain from the cancer can be caused by a tumor pressing on bones, nerves, or body organs.

Spinal cord compression
When a tumor spreads to the spine, it can press on the spinal cord. This is called spinal cord compression. The first sign of compression is usually back and/or neck pain, sometimes with pain, numbness, or weakness in an arm or leg. Coughing, sneezing, or other movements often make it worse. If you have this pain, get help right away. This compression must be treated quickly to keep you from losing control of your bladder or bowel or being paralyzed.

Your cancer care team can treat the cause of the pain and give you medicine to help relieve the pain. If you’re treated for the compression soon after the pain begins, you can usually avoid serious outcomes. Treatments usually involve radiation therapy and steroids to shrink the tumor. Or you may have surgery to remove a tumor that’s pressing on the spine, which may then be followed by radiation.

Bone pain
This type of pain can happen when cancer spreads to the bones. Treatment may be aimed at controlling the cancer, or it can focus on protecting the affected bones. External radiation may be used to treat the weakened bone. Sometimes a radioactive medicine is given that settles in the affected areas of bone and helps to make them stronger. Bisphosphonates are other medicines that can help make diseased bones stronger and help keep bones from breaking. These are examples of treatments that are aimed at stopping the cause of the bone pain. You may still need pain medicines, but sometimes these treatments can greatly reduce your pain.

Pain from procedures and surgery

Procedures and testing
Some tests used to diagnose cancer and see how well treatment is working are painful. If such a procedure is needed, concern about pain should not keep you from having it done. Any pain you have during and after the procedure can usually be relieved. Your needs and the type of procedure to be done should dictate the kinds of medicine you get for the pain. You may be told that the pain from the procedure can’t be avoided or that it won’t last long. Even so, you should ask for pain medicine if you need it.

Surgical pain
Surgery is often part of the treatment for cancers that grow as solid tumors. Depending on the kind of surgery you have, some amount of pain is usually expected. You’ll be given pain medicines so you won’t be in pain when your surgery is over. Pain due to surgery can last from a few days to a few weeks, depending on the type of surgery.

Phantom pain
Phantom pain is a longer-lasting effect of surgery, beyond the usual surgical pain. If you’ve had an arm, leg, or even a breast removed, you may still feel pain or other unusual or unpleasant feelings that seem to be coming from the absent (phantom) body part. Doctors are not sure why this happens, but phantom pain is real; it’s not “all in your head.”
No single pain relief method controls phantom pain in all patients all the time. Many methods have been used to treat this type of pain, including pain medicine, physical therapy, antidepressant medicines, and transcutaneous electric nerve stimulation (TENS). If you’re having phantom pain, ask your cancer care team what can be done.

Pain from other cancer treatments
Some of the side effects that occur with chemotherapy and radiation treatments may cause pain for some people. Pain can even cause some people to stop treatment if it’s not managed. Talk to your cancer care team about any changes you notice or any pain you have.
Here are some examples of pain caused by cancer treatment:

Peripheral neuropathy (PN)
This condition refers to pain, burning, tingling, numbness, weakness, clumsiness, trouble walking, or unusual sensations in the hands and arms and/or legs and feet. Peripheral neuropathy is due to nerve damage caused by certain types of chemotherapy, by vitamin deficiencies, cancer, and other problems. Be sure to tell your doctor right away if you notice these kinds of problems.
You can learn more about peripheral neuropathy online at www.cancer.org, or call us at 1-800- 227-2345 to have free information sent to you.

Mouth sores (stomatitis or mucositis)
Chemotherapy can cause sores and pain in the mouth and throat. The pain can cause people to have trouble eating, drinking, and even talking.

Radiation mucositis and other radiation injuries
Pain from external radiation depends on the part of the body that’s treated. It can cause skin burns, mucositis (mouth sores), and scarring – all of which can result in pain. The throat, intestine, and bladder are also prone to radiation injury, and you may have pain if these areas are treated.

Types of pain

The type of pain you have affects the treatment you will need. Pain may be acute or chronic:
Acute pain is severe and lasts a fairly short time. It’s most often a sign that the body is being injured in some way. This pain generally goes away as the injury heals.

Chronic or persistent pain lasts for long periods of time. It may range from mild to severe. You’ll notice that here we talk mostly about chronic pain, because it can disrupt your life if it’s not well treated.

There’s a third type of pain that’s very important in managing chronic cancer pain. Some people with chronic pain that’s mostly controlled by medicine can have breakthrough pain. This is when moderate to severe pain “breaks through” the medicine that’s giving pain relief and is felt for a short time.

Breakthrough painbreak-thru-pain
People with cancer pain often notice that their pain changes throughout the day. Many people with chronic cancer pain (pain that lasts longer than 3 months) have 2 types of pain – persistent or chronic pain and breakthrough pain. Chronic pain doesn’t go away, but it can usually be controlled by taking pain medicines on a regular schedule. Breakthrough pain is pain that’s not controlled by the regular doses of pain medicines.

Breakthrough pain is a flare of pain that happens even though you’re taking pain medicine regularly for chronic pain. It’s called breakthrough pain because it “breaks through” the pain relief you get from the regular pain medicine.Breakthrough pain may be different for each person, and the person usually can’t tell when it will happen. As a rule, it comes on quickly, lasts as long as an hour, and feels much like chronic pain except that it’s more severe or intense. It may happen many times a day, even when the chronic pain is controlled by the regular pain medicine.

Breakthrough pain is shown in the picture above as spikes through the relief provided by the around-the-clock analgesic (pain medicine taken regularly to treat chronic pain). Breakthrough pain varies in intensity and usually can’t be predicted.

Breakthrough pain often has the same cause as chronic pain. It may be the cancer itself, or it may be related to cancer treatment. Some people have breakthrough pain during a certain activity, like walking or dressing. For others, it happens unexpectedly without any clear cause.

Treating cancer pain

Your doctor will want to find out more about what’s causing your pain because that will affect how it’s treated. Drugs, procedures, cancer treatments, or even surgeries may be used in special ways to manage your pain.

If you have severe pain, your cancer care team will try to find the treatment plan that best relieves your pain with the fewest side effects. You’ll need to stay in touch and let them know how the pain treatment is working and how you’re doing day to day. The goal is an effective pain control plan that works for you.

Cancer pain is usually treated with drugs called analgesics, also known as pain relievers. Many pain relievers are available without a prescription (for example, aspirin, acetaminophen, or ibuprofen). These medicines are called non-prescription or over-the-counter (OTC) analgesics. OTC pain medicines can be used alone for mild pain, and along with other medicines for more severe pain. For other pain medicines, you’ll need a prescription.

Check with your cancer care team before you take any medicine for pain, even OTC medicines, because some of them can interact with cancer drugs or worsen certain problems. Medicines are mostly safe when they’re used properly, but they can be very harmful if not managed carefully.

In some cases, medicines and non-medical treatments may not work well. But there are special pain treatments that can often be used for these kinds of cancer pain. For instance, things like:

  • Radiation to shrink the tumor
  • Surgery to remove all or part of the tumor
  • Nerve blocks, in which medicine is injected into or around a nerve or into the spine to block the pain
  • Neurosurgery, where nerves are cut to relieve the pain

There are other methods that may be used, too. See the section called “Other medical methods to relieve pain” for details.
You may also use non-medical treatments such as relaxation techniques, biofeedback, guided imagery, and others along with the medicines. See the section called “Non-medical treatments for pain.”

Developing a plan for pain control

The first step in developing a pain control plan is talking with your cancer care team about your pain. You need to be able to describe your pain to your family or friends, too. You may want to have your family or friends help you talk to your cancer care team about your pain, especially if you’re too tired or in too much pain to talk to them yourself.

Using a pain scale is a helpful way to describe how much pain you’re feeling. To use the Pain Intensity Scale shown here, try to assign a number from 0 to 10 to your pain level. If you have no pain, use a 0. As the numbers get higher, they stand for pain that’s getting worse. A 10 means the worst pain you can imagine.

For instance, you could say, “Right now, my pain is a 7 on a scale of 0 to 10.”

faces-pain-scale

You can use the rating scale to describe:

  • How bad your pain is at its worst
  • What your pain is like most of the time
  • How bad your pain is at its least
  • How your pain changes with treatment

Tell your cancer care team and your family or friends:

  • Where you feel pain
  • What it feels like – for instance, sharp, dull, throbbing, gnawing, burning, shooting, steady
  • How strong the pain is (using the 0 to 10 scale)
  • How long it lasts
  • What eases the pain
  • What makes the pain worse
  • How the pain affects your daily life
  • What medicines you’re taking for the pain and how much relief you get from them Your cancer care team may also need to know:
  • All the medicines you’re taking now, including vitamins, minerals, herbs, supplements, and non-prescription medicines
  • The pain medicines you’ve taken in the past, including what has and has not worked for you
  • Any known allergies to medicines, foods, dyes, or additives

When working on a pain control plan, it helps to take all your medicines, vitamins, minerals, herbs, and non-prescription drugs with you. Show them to your cancer care team and explain how you take them.

Questions you may want to ask about pain medicine include:

  • How much medicine should I take? (What’s the dose?)
  • How often can I take it?
  • How do I take it?
  • If my pain is not relieved, can I take more? If so, how much?
  • Should I call you before increasing the dose?
  • What if I forget to take it or take it too late?
  • Should I take the pain medicine with food?
  • How much liquid should I drink with the medicine?
  • How long does it take the medicine to start working?
  • Is it safe to drink alcohol, drive, or operate machinery after I’ve taken this pain medicine?
  • What other medicines can I take with the pain medicine?
  • What medicines should I stop taking or not take while I’m taking the pain medicine?
  • What side effects from the medicine are possible? How can I prevent them? What should I do if I have them?

Keep a record of your pain

You may find it helpful to keep a record or a diary to track details about your pain and what works to ease it. You can share this record with those caring for you. This will help them figure out what method of pain control works best for you. Your records can include:

  • Words to describe the pain
  • Any activity that seems to increase or decrease the pain
  • Any activity that you can’t do because of the pain
  • The name, dose, and time you take your pain medicines
  • The times you use other pain-relief methods (such as relaxation techniques, distraction, or imagery)
  • The number you rate your pain at the time you use a pain-relief measure (medicine or method to reduce pain)
  • Your pain rating 1 to 2 hours after using the pain-relief measure
  • How long the pain medicine works
  • Your pain rating throughout the day (to get an idea of your general comfort)
  • How pain interferes with your normal activities, such as sleeping, eating, sex, or work
  • Any side effects you have that may be from the medicines

Source: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/pain/paindiary/pain-control-toc

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