Introduction
Cancer pain can be managed. Having cancer doesn’t mean that you’ll have pain. But if you do, you can manage most of your pain with medicine and other treatments.
This article will show you how to work with your doctors, nurses and others to find the best way to control your pain. It will discuss causes of pain, medicines, how to talk to your doctor and other topics that may help you.
Your “health care team” can help you manage cancer pain. In this article, your “health care team” can mean any of the professionals you see as part of your medical care. These may include your oncologist, your family doctor, nurses, physical therapists, pharmacists, oncology social workers, clergy members and others.
What You Should Know About Treating Cancer Pain
You don’t have to accept pain. People who have cancer don’t have pain always. Everyone is different. But if you do have cancer pain, you should know that you don’t have to accept it. Almost always, cancer pain can be relieved.
The key messages to learn are:
- Your pain can be managed.
- Controlling pain is part of your cancer treatment.
- Talking openly with your doctor and health care team will help them manage your pain.
- The best way to control pain is to stop it from starting or keep it from getting worse.
- There are many different medicines to control pain. Everyone’s pain control plan is different.
- Keeping a record of your pain will help create the best pain control plan for you.
- People who take cancer pain medicines as prescribed rarely become addicted to them.
- Your body does not become immune to pain medicine. Stronger medicines should not be saved for “later.”
Pain Specialists Can Help
Cancer pain can be reduced so you can enjoy your normal routines and sleep better. It may help to talk with a pain specialist. These may be oncologists, anesthesiologists, neurologists, surgeons, other doctors, nurses or pharmacists. If you have a pain control team, it also may include psychologists and social workers.
Pain and palliative care specialists are experts in pain control. Palliative care specialists treat the symptoms, side effects and emotional problems of both cancer and its treatment. They will work with you to find the best way to manage your pain. Ask your doctor or nurse to suggest someone. Or contact one of the following for help finding a pain specialist in your area:
- Cancer center
- Your local hospital or medical center
- Your primary care provider
- People who belong to pain support groups in your area
- The Center to Advance Palliative Care, www.getpalliativecare.org (for lists of providers in each state)
| When cancer pain is not treated properly, you may be: | When cancer pain ismanaged properly, you can: |
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Types and Causes of Cancer Pain
Cancer pain can range from mild to very severe. Some days it can be worse than others. It can be caused by the cancer itself, the treatment or both.
You also may have pain that has nothing to do with your cancer. Some people have other health issues or headaches and muscle strains. But always check with your doctor before taking any over-the-counter medicine to relieve everyday aches and pains.
Different Types of Pain
Here are the common terms used to describe different types of pain:
- Acute pain ranges from mild to severe. It comes on quickly and lasts a short time.
- Chronic pain ranges from mild to severe. It either won’t go away or comes back often.
- Breakthrough pain is an intense rise in pain that occurs suddenly or is felt for a short time. It can occur by itself or in relation to a certain activity. It may happen several times a day, even when you’re taking the right dose of medicine. For example, it may happen as the current dose of your medicine is wearing off.
What Causes Cancer Pain?
Cancer and its treatment cause most cancer pain. Major causes of pain include:
- Pain From Medical Tests: Some methods used to diagnose cancer or see how well treatment is working are painful. Examples may be a biopsy, spinal tap or bone marrow test. If you are told you need the procedure, don’t let concerns about pain stop you from having it done. Talk with your doctor ahead of time about what will be done to lessen any pain you may have.
- Pain From a Tumor: If the cancer grows bigger or spreads, it can cause pain by pressing on the tissues around it. For example, a tumor can cause pain if it presses on bones, nerves, the spinal cord or body organs.
- Spinal cord compression: When a tumor spreads to the spine, it can press on the spinal cord and cause spinal cord compression. The first sign of this is often back or neck pain, or both. Coughing, sneezing or other motions may make it worse.
- Pain From Treatment: Chemotherapy, radiation therapy, surgery and other treatments may cause pain for some people. Some examples of pain from treatment are:
- Neuropathic Pain Test: This is pain that may occur if treatment damages the nerves. The pain is often burning, sharp or shooting. The cancer itself also can cause this kind of pain.
- Phantom Pain: You still may feel pain or other discomfort coming from a body part that has been removed by surgery. Doctors aren’t sure why this happens, but it’s real.
How much pain you feel depends on different things. These include where the cancer is in your body, what kind of damage it is causing and how you experience the pain in your body. Everyone is different.
| Listen to your body |
| If you notice that everyday actions, such as coughing, sneezing or moving, cause new pain or your pain to get worse, tell your doctors right away. Also let them know if you have unusual rashes or bowel or bladder changes. |
Talking About Your Pain
Pain control is part of treatment. Talking openly is key.
Controlling pain is a key part of your overall cancer treatment. The most important member of the team is you. You’re the only one who knows what your pain feels like. Talking about pain is important. It gives your health care team the feedback they need to make you feel better.
Some people with cancer don’t want to talk about their pain. They think that they’ll distract their doctors from working on ways to help treat their cancer. Or they worry that they won’t be seen as “good” patients. They also worry that they won’t be able to afford pain medicine. As a result, people sometimes get so used to living with their pain that they forget what it’s like to live without it.
But your health care team needs to know details about your pain and whether it’s getting worse. This helps them understand how the cancer and its treatment are affecting your body. And it helps them figure out how to best control the pain.
Try to talk openly about any other medical problems and fears you have. And if money worries are stopping you, be sure to speak with your physician. There may be ways to help you get the medicine you need.
Tell your health care team if you’re:
- Taking any medicine to treat other health problems
- Taking more or less of the pain medicine than prescribed
- Allergic to certain drugs
- Using any over-the-counter medicines, home remedies, or herbal or alternative therapies
This information could affect the pain control plan your doctor suggests for you. If you feel uneasy talking about your pain, bring a family member or friend to speak for you. Or let your loved one take notes and ask questions. Remember, open communication between you, your loved ones, and your health care team will lead to better pain control.
Talking About Your Pain
The first step in getting your pain under control is talking honestly about it. Try to talk with your health care team and your loved ones about what you are feeling. This means telling them:
- Where you have pain
- What it feels like (sharp, dull, throbbing, constant, burning or shooting)
- How strong your pain is
- How long it lasts
- What lessens your pain or makes it worse
- When it happens (what time of day, what you’re doing and what’s going on)
- If it gets in the way of daily activities
Describe and Rate Your Pain
You will be asked to describe and rate your pain. This provides a way to assess your pain threshold and measure how well your pain control plan is working.
Your doctor may ask you to describe your pain in a number of ways. A pain scale is the most common way. The scale uses the numbers zero to 10, where zero is no pain, and 10 is the worst. You also can use words to describe pain, like pinching, stinging or aching. Some doctors show their patients a series of faces and ask them to point to the face that best describes how they feel.
No matter how you or your doctor keep track of your pain, make sure that you do it the same way each time. You also need to talk about any new pain you feel.
It may help to keep a record of your pain. Some people use a pain diary or journal. Others create a list or a computer spreadsheet. Choose the way that works best for you.
Your record could list:
- When you take pain medicine
- Name and dose of the medicine you’re taking
- Any side effects you have
- How long the pain medicine works
- Other pain relief methods you use to control your pain
- Any activity that is affected by pain, or makes it better or worse
- Things that you can’t do at all because of the pain
Share your record with your health care team. It can help them figure out how helpful your pain medicines are, or if they need to change your pain control plan.
Here are some ways your health care team may ask you to describe or rate your pain:
Some people don’t want to take medicine, even when it’s prescribed by the doctor. Taking it may be against religious or cultural beliefs. Or there may be other personal reasons why someone won’t take medicine. If you feel any of these ways about pain medicine, it’s important to share your views with your health care team. If you prefer, ask a friend or family member to share them for you. Talking openly about your beliefs will help your health care team find a plan that works best for you.
Your Pain Control Plan
| “It took a few visits to my health care team to get my pain under control. But by trying different medicines and doses, I now have a pain plan that works for me.” – Michelle |
Make your pain control plan work for you. Your pain control plan will be designed for you and your body. Everyone has a different pain control plan. Even if you have the same type of cancer as someone else, your plan may be different.
Take your pain medicine dose on schedule to keep the pain from starting or getting worse. This is one of the best ways to stay on top of your pain. Don’t skip doses. Once you feel pain, it’s harder to control and may take longer to get better.
Here are some other things you can do:
- Bring your list of medicines to each visit.
- If you are seeing more than one doctor, make sure each one sees your list of medicines, especially if he or she is going to change or prescribe medicine.
- Never take someone else’s medicine. What helped a friend or relative may not help you. Do not get medicine from other countries or the Internet without telling your doctor.
- Don’t wait for the pain to get worse.
- Ask your doctor to change your pain control plan if it isn’t working.
Stop the Pain Before It Gets Worse
The best way to control pain is to stop it before it starts or prevent it from getting worse. Don’t wait until the pain gets bad or unbearable before taking your medicine. Pain is easier to control when it’s mild. And you need to take pain medicine often enough to stay ahead of your pain. Follow the dose schedule your doctor gives you. Don’t try to “hold off” between doses. If you wait:
- Your pain could get worse
- It may take longer for the pain to get better or go away
- You may need larger doses to bring the pain under control
Keep a List of All Your Medicines
Make a list of all the medicines you are taking. If you need to, ask a member of your family or health care team to help you. Bring this list of medicines to each visit. You can take most pain medicines with other prescription drugs. But your health care team needs to know what you take and when. Tell them each drug you are taking, no matter how harmless you think it might be. Even over-the-counter medicines, herbs, and supplements can interfere with cancer treatment.
| How to tell when you need a new pain control plan
Here are a few things to watch out for and tell your health care team about:
The schedule or the way you take the medicine doesn’t work for you |
| If you have trouble breathing, dizziness or rashes, call your doctor right away. You may be having an allergic reaction to the pain medicine. |
Don’t give up hope. Your pain can be managed.
If you still are having pain that is hard to control, you may want to talk with your health care team about seeing a pain or palliative care specialist. Whatever you do, don’t give up. If one medicine doesn’t work, there is almost always another one to try. Also, new medicines are created all the time. And unlike other medicines, there is no “right” dose for many pain medicines. Your dose may be more or less than someone else’s. The right dose is the one that relieves your pain and makes you feel better.
Source: National Cancer Institute, National Institutes of Health
Updated: January 2008