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Cancer Pain and You
Managing Your Cancer Pain
Purpose
of This Page
This
Page is about cancer pain and how it can be controlled. Not everyone with cancer
has pain. But those who do can feel better with proper pain treatment. Don't
deny yourself relief. Act Now.
Facts About Cancer Pain Treatment
If
you are being treated for cancer pain, you may have concerns about your medicine
or other treatments. Here are some common concerns people have and the facts
about them.
Concern:
I can only take medicine or other treatments when I have pain.
Fact: You
should not wait until the pain becomes severe to take your medicine. Pain is
easier to control when it is mild than when it is severe. You should take your
pain medicine regularly and as your doctors and nurses tell you. This may mean
taking it on a regular schedule and around-the-clock. You can also use the other
treatments, such as relaxation and breathing exercises, hot and cold packs (see
Non-drug Treatment of Pain), as often as you want to.
Concern:
I will become "hooked" or "addicted" to pain medicine.
Fact:
Studies
show that getting "hooked" or "addicted" to pain medicine is
very rare. Remember, it is important to take pain medicine regularly to keep the
pain under control.
Concern:
If I take too much medicine, it will stop working.
Fact:
The medicine will not stop working, But sometimes your body will get used to the
medicine. This is called tolerance. Tolerance is not usually a problem with
cancer pain treatment because the amount of medicine can be changed or other
medicines can be added. Cancer pain can be relieved, so don't deny yourself pain
relief now.
Concern:
If I complain too much, I am not being a good patient.
Fact:
Controlling your pain is an important part of your care. Tell your doctor or
nurse if you have pain, if your pain is getting worse, or if you are taking pain
medicine and it is not working. They can help you to get relief from your pain.
You do not receive any medals for having pain. So get rid of it.
You
may have concerns about your treatment that were not discussed here. Talk to
your doctor or nurse about your concerns.
Why
Pain Should Be Treated
Pain
can affect you in many ways. It can keep you from being active, from sleeping,
from enjoying family and friends, and from eating. Pain can also make you feel
afraid or depressed.
With
treatment, most cancer pain can be controlled. When there is less pain, you will
probably feel more active and interested in doing things you enjoy.
If
you have cancer and you are feeling pain, you need to tell your doctors and
nurses right away. Getting help for your pain early on can make pain treatment
more effective.
What
Causes Cancer Pain?
There
are many causes of cancer pain. Most of the pain of cancer comes when a tumor
presses on bone, nerves or body organs. Cancer treatment can cause pain, too.
You
may have pain that has nothing to do with your illness or its treatment. Like
everyone else, you can get headaches, muscle strains, and other aches and pains.
Because you may be taking medicine for cancer treatment or pain, check with your
doctors and nurses on what to take for these everyday aches and pains.
Other
conditions, such as arthritis, can cause pain, too. Pain from these other
conditions can be treated along with cancer pain. Again, talk to your doctors
and nurses about your medical history. They will be able to tell you how each
condition can be treated and what is best for you.
Treating
Cancer Pain
Cancer
pain is usually treated with medicine. But surgery, radiation therapy, and other
treatments can be used along with medicine to give even more pain relief (these
treatments are listed in sections below). Ask your doctors and nurses how the
other treatments can help you.
Choosing
the Right Medicine
Pain
treatments work differently for different people. Even when a doctor or nurse
uses the right medicines and treatments in the right way, you may not get the
pain relief you need. While you are being treated for your pain, tell your
doctors and nurses how you feel and if treatments help. The information you give
them will help them to help you get the best pain relief.
Your
doctors and nurses will work to find the right pain medicine and treatments for
you. You can help by talking with them about:
 | Pain
medicines you have taken in the past and how well they have worked for you. |
| Medicines
and other treatments (including health foods, vitamins, and other
"non-medical" treatments) you are taking now. Your doctors and nurses
need to know about other treatments you are trying and other medicines you take.
This is important because some treatments and medicines do not work well
together. Your doctors and nurses can find medicines that can be taken
together. |
| Allergies
that you have, including allergies to medicines. |
| Fears
and concerns that you have about the medicine or the treatment. Talk to your
doctors and nurses about your fears and concerns. They can answer your questions
and help you to understand your pain treatment. |
Types
of Pain Medicine
Many
medicines are used to treat cancer pain, and your doctor may give you one or
more of them to take. The list below describes the different types of medicine
that you may be taking and the kind of pain they work on. Ask your doctor or
nurse to tell you more about the medicine you are taking.
Do
not start to take a new medicine without checking with your doctor or nurse
first. Even aspirin can be a problem in some people who are taking other
medicine or having cancer treatment.
| For
mild to moderate pain--
Nonopioids:
Acetaminophen and nonsteroidal anti-inflamatory drugs (NSAIDs), such as aspirin
and ibuprofen. You can buy many of these over-the-counter (without a
prescription). Others need a prescription. |
| For
moderate to severe pain--
Opioids:
Morphine, hydromorphone, oxycodone, and codeine. A prescription is needed for
these medicines. Nonopioids may be used along with opioids for moderate to
severe pain. |
| For
tingling and burning pain--
Antidepressants:
Amitriptyline, imipramine, doxepin, trazodone. A prescription is needed for
these medicines. Taking an antidepressant does not mean that you are depressed
or have a mental illness.
Anticonvulsants:
Carbamazepine and phenytoin. A prescription is needed for these medicines.
Taking an anticonvulsant does not mean that you are going to have convulsions. |
| For
pain caused by swelling--
Steroids:
Prednisone, dexamethasone. A prescription is needed for these medicines. |
For
more information on pain medicines, see Benefits
and Risks of Treatment.
About
Side Effects
All
medicines can have some side effects, but not all people get them. Some people
have different side effects than others. Most side effects happen in the first
few hours of treatment and gradually go away. Some of the most common side
effects of pain medicines are:
| Constipation
(not
being able to have a bowel movement). The best way to prevent constipation is to
drink lots of water, juice, and other liquids, and to eat more fruits and
vegetables. Exercise also helps to prevent constipation. Your doctors and nurses
may also be able to give you a stool softener or a laxative. |
| Nausea
and vomiting
When
this happens, it usually only lasts for the first day or two after starting a
medicine. Tell your doctors and nurses about any nausea and vomiting. They can
give you medicine to stop these side effects. |
| Sleepiness
Some
people who take opioids feel drowsy or sleepy when they first take the medicine.
This usually does not last too long. Talk to your doctor or nurse if this is a
problem for you. |
| Slowed
breathing This
sometimes occurs when the dose of medicine is increased. Your doctor or nurse
can tell you what to watch for and when to report slowed breathing. |
More
serious side effects of pain medicines are rare. As with the more common side
effects, they usually happen in the first few hours of treatment. They include
trouble breathing, dizziness, and rashes. If you have any of these side effects,
you should call your doctor or nurse right away.
How
Pain Medicine Is Taken
Most
pain medicine is taken by mouth (orally). Oral medicines are easy to take and
usually cost less than other kinds of medicine. Most oral medicines are in
tablet form, but sometimes they are liquids that you drink. If it is hard for
you to swallow and you cannot take a tablet or liquid for some other reason,
there are other ways to get these medicines. These include:
| Rectal
suppositories (medicine
that dissolves in the rectum and is absorbed by the body). |
| Patches
that are filled with medicine and placed on the skin (transdermal
patches). |
| Injections.
There are many kinds of injections to give pain relief. Most injections use a
tube or needle to place medicine directly into the body. These include: |
Subcutaneous
injection--medicine
is placed just under the skin using a small needle.
Intravenous
injection--medicine
is placed directly into the vein through a needle that stays in the vein.
Epidural
or intrathecal injections--medicine
is placed directly into the back using a small tube.
Most
of these injections give pain relief that lasts for many hours.
Subdermal
and intramuscular injections--commonly
known as "shots," are injections that are placed more deeply into the
skin or muscle using a needle. These injections are not recommended for
long-term cancer pain treatment. Constantly having shots into the skin and
muscle can be painful. Also, shots take longer to work, and you have to wait for
them.
When
to Take Your Pain Medicine
To
help your pain medicine work best:
| Take
your pain medicine on a regular schedule (by the clock). Taking medicine
regularly and as your doctor tells you will help to keep pain under control. Do
not skip a dose of medicine or wait for the pain to get worse before taking your
medicine. |
| Ask
your doctor or nurse how and when to take extra medicine. If some activities
make your pain worse (for example, riding in a car), you may need to take extra
doses of pain medicines before these activities. The goal is to PREVENT the
pain. Once you feel the pain, it is harder to get it under control. This
medication is called "break through" pain reliever. |
Treating
pain is important, and there are many medicines and treatments that can be used.
If one medicine or treatment does not work, there is another one that can be
tried. Also, if a schedule or way that you are taking the medicine does not work
for you, changes can be made. Talk to your doctor or nurse because they can work
with you to find the pain medicine that will help you the most.
It
may be helpful for you to keep a record of how the medicine is working. Keeping
a record
(see Pain Control Record and Pain
scale and chart) and sharing it with your doctor or nurse will help to make
your treatment more effective.
Other
Treatments
Your
doctor or nurse may recommend that you try other treatments along with your
medicine to give you even more relief. Relaxation exercises help reduce pain
(see Slow Rhythmic Breathing for Relaxation below). Many people find that cold
packs, heating pads, massage, and rest help to relieve pain. Music or television
may distract you from the pain. Your family members may want to help you to use
these treatments. These treatments will help to make your medicines work better
and relieve other symptoms, but they should not be used instead of your
medicine.
Non-Drug
Treatments of Pain
Here
are a few examples of treatments that can help to relieve your pain. You may use
these treatments along with your regular medicine:
| Biofeedback. |
| Breathing
and relaxation. |
| Imagery. |
| Massage,
pressure, vibration. |
| Transcutaneous
electrical nerve stimulation (TENS). |
| Music |
| Hot
or cold packs. |
| Rest. |
Talk
to your doctors and nurses about these treatments. They will be able to give you
more information.
Also, see the counseling and support groups listed on the Resources
page they may be able to help you more.
When Medicine is Not Enough
Some
patients have pain that is not relieved by medicine. In these cases other
treatments can be used to reduce pain.
| Radiation
therapy This
treatment reduces pain by shrinking a tumor. A single dose of radiation may be
effective for some people. |
| Nerve
blocks Pain
medicine is injected directly around a nerve or into the spine to block the
pain. |
| Neurosurgery
In
this treatment pain nerves (usually in the spinal cord) are cut to relieve the
pain. |
| Surgery
When
a tumor is pressing on nerves or other body parts, operations to remove all or
part of the tumor can relieve pain. |
Talk
to your doctor about other pain treatments that will work for you.
The
First Step
The
key to getting the best pain relief is talking with your doctors and nurses
about your pain. They will want to know how much pain you feel, where it is, and
what it feels like. Answering the questions below may help you describe your
pain. You may wish to write your answers in the space after each question.
Where
is the pain? You
may have pain in more than one place. Be sure to list all of the painful areas.
________________________________________________________
________________________________________________________
________________________________________________________
What
does the pain feel like? Does
it Ache? Throb? Burn? Tingle? You may wish to use other words to describe your
pain.
________________________________________________________
________________________________________________________
________________________________________________________
How
bad is the pain? You
can also use a number scale and rate your pain from 0 to 5: 0 means no pain and
5 means the worst pain. You may want to use the pain
intensity scale to put a number to your pain. You can also describe your
pain with words like none, mild, moderate, severe, or worst possible pain.
_______________________________________________________
________________________________________________________
________________________________________________________
What
makes the pain better or worse? You
may have already found ways to make your pain feel better. For example, using
heat or cold, or taking certain medicines. You may have also found that sitting
or lying in certain positions or doing some activities affects the pain.
________________________________________________________
________________________________________________________
________________________________________________________
If
you are being treated for pain now, how well is your treatment working? You
may want to describe how well the treatment is working by saying how much of the
pain is relieved --all, almost all, none, etc?
_______________________________________________________
________________________________________________________
________________________________________________________
Has
the pain changed? You
may notice that your pain changes over time. It may get better or worse or it
can feel different. For example, the pain may have been a dull ache at first and
has changed to a tingle. It is important to report changes in your pain. Changes
in pain do not always mean the cancer has come back or grown. Describe how the
pain was before and how it is now.
________________________________________________________
________________________________________________________
________________________________________________________
After talking with you about your pain, your doctor or nurse may want to examine
you or order x-rays or other tests.
These
tests will help the doctor or nurse find the cause of your pain.
Having
a Plan
You
can work with your doctor or nurse to write a pain control plan to meet your
needs. In a pain control plan, you and your doctor or nurse plan your pain
control activities. This will include when to take your medicine, how and when
to take extra medicine, and other things you can do to ease and prevent your
pain. Your doctor or nurse may also list the medicines and other treatments you
can use to help you with any side effects or other aches and pains, such as
headaches. A sample pain control plan that you
can use.
Making
the Plan Work
Some
people find that the first pain control plan does not work for them. You and
your doctor or nurse can change your pain control plan at any time. Here are
some questions to ask yourself about the pain plan:
Is
the pain plan hard to follow?
_______________________________________________________
________________________________________________________
________________________________________________________
Is
there any part of the plan that is hard to understand?
________________________________________________________
________________________________________________________
________________________________________________________
Are
you pleased with the pain control?
________________________________________________________
________________________________________________________
________________________________________________________
Are you having trouble getting the medicine?
________________________________________________________
________________________________________________________
________________________________________________________
Are you having trouble taking the medicine?
________________________________________________________
________________________________________________________
________________________________________________________
Are you having side effects from the medicine?
________________________________________________________
________________________________________________________
________________________________________________________
Is the medicine or the treatment causing a problem for you or your family?
________________________________________________________
________________________________________________________
________________________________________________________
Are the non-drug treatments working for you?
________________________________________________________
________________________________________________________
Write any other questions you have for your doctor or nurse below.
________________________________________________________
________________________________________________________
________________________________________________________
Benefits
and Risks of Treatment
This
page talks about many different treatments for cancer pain. It also talks about
side effects of medicines. Information about benefits and risks (side effects)
of medicines may be important to you. The list below describes the benefits and
risks of different types of medicines described earlier in the Types of Pain
Medicine section.
Non-opioids:
Benefits:
Control
mild to moderate pain. Some can be bought without a prescription.
Risks:
Some
of these medicines can cause stomach upset. They can also cause bleeding in the
stomach, slow blood clotting, and cause kidney problems. Acetaminophen does not
cause these side effects, but high doses of it can hurt the liver.
Opioids:
Benefits:
These
medicines control moderate to severe pain and do not cause bleeding.
Risks:
May
cause constipation, sleepiness, nausea, and vomiting. Opioids sometimes cause
problems with urination or itching. They may also slow breathing, especially
when they are first given, but this is unusual in people who take opioids on a
regular basis for pain.
Antidepressants:
Benefits:
Antidepressants
help control tingling or burning pain from damaged nerves. They also improve
sleep.
Risks:
These
medicines may cause dry mouth, sleepiness, and constipation. Some cause
dizziness and lightheadedness when standing up suddenly.
Anticonvulsants:
Benefits:
Help
to control tingling or burning from nerve injury.
Risks:
May
hurt the liver and lower the number of red and white cells in the blood. It is
important to have regular blood tests to check for these effects.
Steroids:
Benefits:
Help
relieve bone pain, pain caused by spinal cord and brain tumors, and pain caused
by inflammation. Steroids also increase appetite.
Risks:
May cause fluid to build up in the body. May also cause bleeding and irritation
to the stomach. Confusion is a problem for some patients when taking steroids.
Counseling and Peer Support
Pain
may make you feel many emotions. You may feel sad, helpless, vulnerable, angry,
depressed, lonely, isolated, or other emotions. Lots of people feel these things
when they are in pain. Often, when the pain is successfully treated, these
feelings lift. Many people who have had cancer feel that counseling, religious,
and other support groups have helped them to get back a sense of control and
well being.
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