About Cancer Pain

by National Cancer Institute

(Page 2 of 8)

What Are the Different Types of Pain?

Pain may be acute or chronic. Acute pain is severe and lasts a relatively short time. It is usually a signal that body tissue is being injured in some way, and the pain generally disappears when the injury heals. Chronic or persistent pain may range from mild to severe, and it is present to some degree for long periods of time. Some people with chronic pain that is controlled by medicine can have breakthrough pain - this occurs when moderate to severe pain "breaks through" or is felt for a short time. It may occur several times a day, even when the proper dose of medicine is given for chronic and persistent pain.

What Causes Pain in People With Cancer?

The pain you feel may be from the cancer itself. Whether you have pain and the amount of pain you have may depend on the type of cancer, the stage (extent) of the disease, and your pain threshold (tolerance for pain). Most of the pain comes when a tumor presses on bones, nerves, or body organs. It can also be caused by the treatment or procedures for diagnosing cancer. Or you may have pain that has nothing to do with your illness or treatment. Like anyone, you can get headaches, muscle strains, and other aches and pains.

Pain From Procedures

Some methods used to diagnose cancer and to see how well the treatment is working are painful. If you and your doctors agree that a diagnostic procedure is necessary, concern about pain should not prevent you from having the procedure. Usually any pain you have during and after the procedure can be relieved. The needs of the person and the type of procedure to be done determine the kinds of medicine that can be given 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 feel the need.

Phantom Pain

If you have had an arm or leg removed by surgery, you may still feel pain or other unusual or unpleasant sensations as if they were coming from the absent (phantom) limb. Doctors are not sure why this occurs, but phantom limb pain is real; it is not "in your mind." This pain can also occur if you have had a breast removed - you may have a sensation of pain at the site of the missing breast.

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 are having phantom pain, ask your doctor, nurse, or pharmacist about what can be done.

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 the compression is usually back and/or neck pain. It is often made worse by coughing, sneezing, or other movements. If you have this pain, it is important to notify your doctor right away. Your doctor can treat the cause of the pain and also give you medicine to relieve the pain. If you receive treatments for the compression soon after the pain occurs, complications such as bladder or bowel problems can usually be avoided. Treatments usually involve radiation therapy to shrink the tumor or surgery to remove the tumor followed by radiation.

How Is Cancer Pain Treated?

Cancer pain is usually treated with medicine (also called analgesics) and with nondrug treatments such as relaxation techniques, biofeedback, imagery, and others. Ask your doctor, nurse, or pharmacist for advice before you take any medicine for pain. Medicines are safe when they are used properly. You can buy some effective pain relievers without a prescription or doctor's order. These medicines are also called nonprescription or over-the-counter pain relievers. For others, a prescription from your doctor is necessary.

For the small number of people for whom medicine and nondrug treatments do not work, other treatments are available: radiation therapy to shrink the tumor; surgery to remove part or all of the tumor; nerve blocks whereby pain medicine is injected into or around a nerve or into the spine to block the pain; and neurosurgery, where pain nerves are cut to relieve the pain.

Developing a Plan for Pain Control

The first step in developing a plan is talking with your doctor, nurse, and pharmacist about your pain. You need to be able to describe your pain to your health professionals as well as to your family or friends. You may want to have your family or friends help you talk to your health professionals about your pain control, especially if you are too tired or in too much pain to talk to them yourself.

Using a pain scale is helpful in describing how much pain you are feeling. 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 is getting worse. A 10 means the pain is as bad as it can be.

You may wish to use your own pain scale using numbers from 0 to 5 or even 0 to 100. Be sure to let others know what pain scale you are using and use the same scale each time, for example, "My pain is a 7 on a scale of 0 to 10."

You can use a rating scale to describe:

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

Tell your doctor, nurse, pharmacist and family or friends:

• Where you feel pain.
• What it feels like - sharp, dull, throbbing, steady.
• How strong the pain feels.
• How long it lasts.
• What eases the pain, what makes the pain worse.
• What medicines you are taking for the pain and how much relief you get from them.

Your doctor, nurse, and pharmacist may also need to know:

• What medicines you are taking now and what pain medicines you have taken in the past, including what has worked and not worked. You may want to record this information on the charts, "Medicines Taking Now" and "Pain Medicines Taken in the Past,".

• Any known allergies to medicines.

Questions to ask your doctor or nurse about pain medicine:

• How much medicine should I take? How often?
• If my pain is not relieved, can I take more? If the dose should be increased, by 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 my medicine with food?
• How much liquid should I drink with the medicine?
• How long does it take the medicine to start working (called "onset of action")?
• Is it safe to drink alcoholic beverages, drive, or operate machinery after I have taken pain medicine?
• What other medicines can I take with the pain medicine?
• What side effects from the medicine are possible and how can I prevent them?

Keeping Track of Details About the Pain

You may find it helpful to keep a record or a diary to track the pain and what works best 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. You may wish to use copies of the "Pain Control Record" to record this information. Your records can include:

• Words to describe the pain.
• Any activity that seems to be affected by the pain or that increases or decreases the pain.
• Any activity that you cannot do because of the pain.
• The name and the dose of the pain medicine you are taking.
• The times you take pain medicine or use another pain-relief method.
• The number from your rating scale that describes your pain at the time you use a pain-relief measure.
• Pain rating 1 to 2 hours after the pain-relief method.
• How long the pain medicine works.
• Pain rating throughout the day to record your general comfort.
• How pain interferes with your normal activities, such as sleeping, eating, sexual activity, or working.
• Any pain-relief methods other than medicine you use such as rest, relaxation techniques, distraction, skin stimulation, or imagery.
• Any side effects that occur.

What If I Need to Change My Pain Medicine?

If one medicine or treatment does not work, there is almost always another one that can be tried. Also, if a schedule or way that you are taking medicine does not work for you, changes can be made. Talk to your doctor or nurse about finding the pain medicine or method that works best for you. You may need a different pain medicine, a combination of pain medicines or a change in the dose of your pain medicines if:

• Your pain is not relieved.
• Your pain medicine does not start working within the time your doctor said it would.
• Your pain medicine does not work for the length of time your doctor said it would.
• You have breakthrough pain.
• You have side effects.
• You have serious side effects such as trouble breathing, dizziness, and rashes. Call your doctor right away if these occur. Side effects such as sleepiness, nausea, and itching usually go away after your body adjusts to the medication. Let your doctor know if these bother you.
• The schedule or the way you are taking the medicine does not work for you.
• Pain interferes with your normal activities, such as eating, sleeping, working, and sexual activity.

To help make the most of your pain control plan:

• Take your pain medicine on a regular schedule (by the clock) to help prevent persistent or chronic pain.

• Do not skip doses of your scheduled medicine. Once you feel the pain, it is harder to control.

• If you experience breakthrough pain, use your short-acting medicine as your doctor suggests. Don't wait for the pain to get worse - if you do, it may be harder to control.

• Be sure only one doctor prescribes your pain medicine. If another doctor changes your medicine, the two doctors should discuss your treatment with each other.

• Never take someone else's medicine. Medicines that worked for you in the past or that helped a friend or relative may not be right for you.

• Pain medicines affect different people in different ways. A very small dose may work for you, while someone else may need to take a much larger dose to obtain pain relief.

• Remember, your pain control plan can be changed at any time.

About the Author

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