Cancer Pain

by National Cancer Institute

Introduction

This patient summary on pain is adapted from the summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. Pain associated with cancer can be controlled in most patients but is frequently undertreated. This brief summary describes the management of cancer pain with the use of medication, physical methods, and psychological intervention.

Overview

Cancer pain can be managed effectively in most patients with cancer or with a history of cancer. Although cancer pain cannot always be relieved completely, therapy can lessen pain in most patients. Pain management improves the patient's quality of life throughout all stages of the disease.

Flexibility is important in managing cancer pain. As patients vary in diagnosis, stage of disease, responses to pain and treatments, and personal likes and dislikes, management of cancer pain must be individualized. Patients, their families, and their health care providers must work together closely to manage a patient's pain effectively.

Assessment

To treat pain, it must be measured. The patient and the doctor should measure pain levels at regular intervals after starting cancer treatment, at each new report of pain, and after starting any type of treatment for pain. The cause of the pain must be identified and treated promptly.

Patient Self-Report

To help the health care provider determine the type and extent of the pain, cancer patients can describe the location and intensity of their pain, any aggravating or relieving factors, and their goals for pain control. The family/caregiver may be asked to report for a patient who has a communication problem involving speech, language, or a thinking impairment. The health care provider should help the patient describe the following:

Pain: The patient describes the pain, when it started, how long it lasts, and whether it is worse during certain times of the day or night.

Location: The patient shows exactly where the pain is on his or her body or on a drawing of a body and where the pain goes if it travels.

Intensity or severity: The patient keeps a diary of the degree or severity of pain.

Aggravating and relieving factors: The patient identifies factors that increase or decrease the pain.

Personal response to pain: Feelings of fear, confusion, or hopelessness about cancer, its prognosis, and the causes of pain can affect how a patient responds to and describes the pain. For example, a patient who thinks pain is caused by cancer spreading may report more severe pain or more disability from the pain.

Behavioral response to pain: The health care provider and/or caregivers note behaviors that may suggest pain in patients who have communication problems.

Goals for pain control: With the health care provider, the patient decides how much pain he or she can tolerate and how much improvement he or she may achieve. The patient uses a daily pain diary to increase awareness of pain, gain a sense of control of the pain, and receive guidance from health care providers on ways to manage the pain.

Assessment of the Outcomes of Pain Management

The results of pain management should be measured by monitoring for a decrease in the severity of pain and improvement in thinking ability, emotional well-being, and social functioning. The results of taking pain medication should also be monitored. Drug addiction is rare in cancer patients. Developing a higher tolerance for a drug and becoming physically dependent on the drug for pain relief does not mean that the patient is addicted. Patients should take pain medication as prescribed by the doctor. Patients who have a history of drug abuse may tolerate higher doses of medication to control pain.

Management with Drugs

Basic Principles of Cancer Pain Management

The World Health Organization developed a 3-step approach for pain management based on the severity of the pain:

• For mild to moderate pain, the doctor may prescribe a Step 1 pain medication such as aspirin, acetaminophen, or a nonsteroidal anti-inflammatory drug (NSAID). Patients should be monitored for side effects, especially those caused by NSAIDs, such as kidney, heart and blood vessel, or stomach and intestinal problems.

• When pain lasts or increases, the doctor may change the prescription to a Step 2 or Step 3 pain medication. Most patients with cancer-related pain will need a Step 2 or Step 3 medication. The doctor may skip Step 1 medications if the patient initially has moderate to severe pain.

• At each step, the doctor may prescribe additional drugs or treatments (for example, radiation therapy).

• The patient should take doses regularly, "by mouth, by the clock" (at scheduled times), to maintain a constant level of the drug in the body; this will help prevent recurrence of pain. If the patient is unable to swallow, the drugs are given by other routes (for example, by infusion or injection).

• The doctor may prescribe additional doses of drug that can be taken as needed for pain that occurs between scheduled doses of drug.

• The doctor will adjust the pain medication regimen for each patient's individual circumstances and physical condition.

Acetaminophen and NSAIDs

NSAIDs are effective for relief of mild pain. They may be given with opioids for the relief of moderate to severe pain. Acetaminophen also relieves pain, although it does not have the anti-inflammatory effect that aspirin and NSAIDs do. Patients, especially older patients, who are taking acetaminophen or NSAIDs should be closely monitored for side effects. Aspirin should not be given to children to treat pain.

About the Author

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