Cancer Pain

Overview

Can cancer pain be controlled?

Cancer pain can be controlled in almost every case. This does not mean that you have no pain, but it does mean that the pain stays at a level that you can bear.
Cancer and its treatments can be painful. A tumor that presses on bones, nerves, or organs can cause pain. Surgery for cancer can cause pain. So can chemotherapy and radiation. Some medical tests, such as bone marrow aspiration, can also cause pain. There are a number of ways to control each of these kinds of pain.
There are different kinds of cancer pain. These include:

• Acute pain. This is bad pain that lasts a short time.
• Chronic pain. This is mild-to-intense pain that comes and goes over a long time.
• Breakthrough pain. This is sudden, severe pain that lasts for a short time while you are taking medicines that usually control your pain.

There are a number of ways to control each of these kinds of pain.
You are the only person who can say how much pain you have or if a certain pain medicine is working for you. Telling your doctor exactly how you feel is one of the most important parts of controlling pain.

What does your doctor need to know?

The more specific you can be about your pain, the more your doctor will be able to treat it. It often helps to write everything down. Include:

• When your pain started, what it feels like, and how long it has lasted.
• Any changes in your pain.
• If the pain is constant or if it comes and goes.
• If you have more than one kind of pain. Use words such as dull, aching, sharp, shooting, or burning.
• What makes your pain better or worse.
• A rating of your pain on a scale of 0 to 10, with 10 being the worst pain you can imagine.

Tell your doctor exactly where you feel pain. You can use a drawing. Say if the pain is just in one place, if it is in several places at the same time, or if it moves from one place to another.

How is cancer pain managed?

Pain control often starts with medicine. Many drugs are used to treat pain. You and your doctor may need to adjust your medicine as your pain changes. Your doctor may suggest different drugs, combinations of drugs, or higher doses.
For a tumor that causes pain, removing or destroying all or part of the tumor, if possible, often helps. Doctors use radiation, surgery, and other treatments to do this.
For nerve pain, doctors may use nerve blocks. With a nerve block, medicine is injected right into the nerve that affects the painful area. They provide short-term pain relief by preventing the nerve from sending pain signals. Or sometimes medicine is delivered directly to the spine, as with spinal anesthesia or an epidural.
There are many other ways to control cancer pain, including:

• Heat or cold.
• Massage, exercise, and physical therapy.
• Relaxation exercises, biofeedback, or guided imagery.
• Acupuncture.

Older adults are at risk for not getting enough pain medicine. If you are a caregiver for an older adult who has cancer, talk with that person to make sure that the pain is under control. Talk with the person's doctor, too, about a pain management plan.
Learning as much as you can about your pain may help. Talking to a counselor can help you manage your cancer pain or the discomfort from cancer treatments. Emotional support from your friends and family may also help.

What is a pain control diary?

This is a record of your pain treatment and how it helped or did not help you. You can write down when you used each treatment, how it worked, and any side effects it caused. Having it written down helps you let your health care team know exactly how well your treatment is working.

Will you get addicted to pain medicine?

Many people who take pain medicine worry about getting addicted. Addiction to pain medicine is rare if you have not had a problem with addiction in the past and you take your medicine as directed under your doctor's care. When you no longer need these medicines, your doctor will slowly lower the amount you are getting until your body no longer needs the medicine.
Do not let your fear about becoming addicted get in the way of pain relief. Ask for pain relief if you need it. Pain is easier to control when you treat it as soon as it starts. You may also be able to predict pain and treat it before it begins, such as before physical activity. Pain is harder to control if you wait until it is bad.

Treatment Overview

You are the only one who knows how your cancer pain feels. You may need different combinations of treatments. Don't be surprised if your pain control plan needs to be changed often. Don't let that discourage you. Be honest and specific about what does and does not work for you. Staying on top of your pain and in control of your pain will improve your quality of life during every stage of your disease.

Nonprescription drugs

Drugs that you can buy without a doctor's prescription may be enough to relieve your pain at times. Acetaminophen, such as Tylenol, relieves pain, while other drugs such as ibuprofen and aspirin relieve pain and also decrease swelling. But talk with your doctor before you take these medicines. And don't take more than the label says unless your doctor tells you to.

Prescription drugs

Drugs that need a doctor's prescription may be stronger or work differently than nonprescription drugs. Follow your doctor's orders about taking them. Prescription drugs include:

• Anti-inflammatory drugs and corticosteroids.
• Bisphosphonates and other medicines, to slow bone changes related to cancer.
• Opiate pain relievers.
• Drugs for depression, to treat burning pain. Plus they can help you sleep.
• Certain drugs for seizures, to help control nerve pain, like burning and tingling.

Medicines for breakthrough pain

This is extra medicine for when strong pain comes on suddenly. These prescription medicines are usually fast-acting opioids given by mouth, such as morphine or oxycodone. Or you may be given fentanyl in a nasal spray or in lozenges that dissolve under your tongue.

Other treatment options

Medical treatments can help relieve pain from tumors and nerve pain.

• Ways to shrink, remove, or destroy painful tumors include:
  • Surgery.
  • Chemotherapy.
  • Radiation.
  • Hormone therapy.
  • Radiofrequency ablation, which uses heat to destroy the tumor.
• Ways to treat nerve pain include:
  • Surgery to cut the nerves that relay pain.
  • Nerve blocks to help with very bad pain.
  • Pain medicine delivered to the spine. This can be done by:
    • Spinal anesthesia, which delivers pain medicine directly to the spine.
    • An epidural, which delivers pain medicine to the nerves around the spine.

Non-medical ways to relieve pain are often used along with pain medicine. These include:

• Physical treatments, such as physical therapy, light massage, heat or cold, and braces or splints. Other treatments include transcutaneous electric nerve stimulation (TENS), in which a mild electrical current from a power pack is used to relieve pain.
• Stretching, yoga, and exercises to help you keep your strength, flexibility, and mobility.
• Behavioral treatments, such as cognitive-behavioral therapy (CBT), relaxation, biofeedback, meditation, or guided imagery.
• Short-term crisis therapy or cognitive-behavioral therapy (CBT) with a counselor. This may help you manage your cancer pain or the discomfort from cancer treatments.
• Education and emotional support. Your doctor can refer you to the social services department of your local cancer treatment center or hospital.
• Complementary therapies, such as acupuncture, aromatherapy, prayer, and humor therapy.

For more information about what you can do, see:

Cancer: Controlling Cancer Pain.

For more information about pain, see the following information from the National Cancer Institute:

Pain (PDQ): Supportive Care – Health Professional Information [NCI]

Pain (PDQ): Supportive Care – Patient Information [NCI]

Palliative care

Your doctor may talk to you about palliative care. This is medical care that provides an extra layer of support for people who have serious and chronic illnesses. It can improve quality of life for you and your family. With palliative care, you have the help of a medical team to manage your symptoms, pain, and stress.