Cancer Pain : Menthol, Acupuncture, Counseling, Nerve Blocks

by National Cancer Institute

(Page 8 of 8)

Menthol

Many menthol preparations are available for pain relief. There are creams, lotions, liniments, or gels that contain menthol. When they are rubbed into the skin, they increase blood circulation to the affected area and produce a warm (sometimes cool) soothing feeling that lasts for several hours.

How to Use Menthol

To use menthol preparations, test your skin by rubbing a small amount of the substance in a circle about the size of a quarter in the area of the pain (or the area to be stimulated). This will let you know whether menthol is uncomfortable to you or irritates your skin. If the menthol does not create a problem, rub some more into the area. The feeling from the menthol gradually increases and remains up to several hours. To increase the strength and length of the feeling, you can open your skin pores with heat (e.g., shower, sun) or wrap a plastic sheet over the area after the menthol application. (Don't use a heating pad because it may cause a burn). If you are concerned about the odor, you can use the menthol when you are alone, or perhaps in the evening or through the night.

Precautions:

• Do not rub menthol near your eyes, over broken skin, a skin rash, or mucous membranes (such as inside your mouth, or around your genitals and rectum).

• Make sure you do not get menthol in your eyes (wash your hands after applying menthol).

• Do not use menthol in the treatment area during radiation therapy.

• If you have been told not to take aspirin, do not use these preparations until you check with your doctor. Many menthol preparations contain an additional ingredient similar to aspirin. A small amount of this aspirin-like substance may be absorbed through the skin.

Transcutaneous Electric Nerve Stimulation (TENS)

This is a technique in which mild electric currents are applied to some areas of the skin by a small power pack connected to two electrodes. The feeling is described as a buzzing, tingling, or tapping feeling. The small electric impulses seem to interfere with pain sensations. The current can be adjusted so that the sensation is pleasant and relieves pain. Pain relief lasts beyond the time that the current is applied. Your doctor or a physical therapist can tell you where to get a TENS unit, and how to use it properly.

Acupuncture

In acupuncture, thin needles are inserted into the body at certain points and at various depths and angles. Each point controls the pain sensation of a different part of the body. When the needle is inserted, a slight ache, dull pain, tingling, or electrical sensation is felt for a few seconds. Once the needles are in place, no further discomfort should be experienced. The needles are usually left in place for between 15 and 30 minutes, depending on the condition treated. No discomfort is felt when the needles are removed. Acupuncture is now a widely accepted and proven method of pain relief. Acupuncture should be performed by a licensed acupuncturist. Ask your doctor, nurse, or social worker where to get acupuncture.

Precautions:

• Make sure your acupuncturist uses sterile needles.

• If you are receiving chemotherapy, talk to your doctor before beginning acupuncture.

Emotional Support and Counseling

If you feel anxious or depressed, your pain may seem worse. Also, pain can cause you to feel worried, depressed, or easily discouraged. Some people feel hopeless or helpless. Others may feel embarrassed, inadequate, or angry, frightened, isolated, or frantic. These are normal feelings that can be relieved.

Finding Support

Try to talk about your feelings with someone you feel comfortable with - doctors, nurses, social workers, family or friends, a member of the clergy, or other people with cancer. You may also wish to talk to a counselor or a mental health professional. Your doctor, nurse or the social services department at your local hospital can help you find a counselor who is specially trained to help people with chronic illnesses.

You may also want to join a support group where people with cancer meet and share their feelings about how they have coped with cancer. For information about support groups, ask your doctor, nurse, or hospital social worker. Also, many newspapers carry a special health supplement containing information about where to find support groups.

Other Pain Relief Methods

Some people have pain that is not relieved by medicine or nondrug techniques. In these cases, other treatments can be used to reduce pain.

Radiation Therapy

Treatment with high-energy rays (called radiation therapy) can reduce pain by shrinking a tumor. Often, only a single dose of radiation is needed to relieve pain.

Surgery

Pain cannot be felt if the nerve pathways that relay pain impulses to the brain are interrupted. To block these pathways, a neurosurgeon may cut nerves, which are usually near the spinal cord. When the nerves that relay pain are destroyed, the sensations of pressure and temperature can no longer be felt. Surgeons with special skills and expertise in pain management, preferably in consultation with other pain specialists, should perform the procedures.

Nerve Blocks

A nerve block is a procedure where a local anesthetic, which may be combined with a steroid, is injected into or around a nerve or into the spine to block pain. After the injection, the nerve is no longer able to relay pain so the pain is temporarily relieved. For longer lasting pain relief, phenol or alcohol can be injected. A nerve block may cause muscle paralysis or a loss of all feeling in the affected area.

End of Life Care

The goal of pain control is usually for a person to be as free from pain as possible and still be able to continue with normal life activities, such as work, hobbies and recreation. However, if a person has only a short time to live - less than 12 months - and has pain that is hard to control, comfort becomes the most important goal. Pain control methods that can cause lasting side effects may need to be used to make a patient comfortable. For example, a nerve block may cause a muscle to become paralyzed. Also, a certain medicine or higher dose of a medicine that may cause side effects, such as sleeping or resting more than usual, may need to be used to control pain or relieve restlessness.

Research on Pain Control Methods

Patient studies - clinical studies or clinical trials - have contributed largely to the decrease in cancer death rates in the United States. Clinical studies have also led to better pain control methods, such as continuous pain-medication infusion pumps (patient-controlled analgesia), first developed in the early 1980s.

In cancer research, a clinical trial is designed to show how a given anticancer strategy - for instance, a promising drug, a new diagnostic test, or a possible way to prevent cancer - affects the people who receive it. "Clinical trial" is a research term that refers to medical studies with people. These studies are the final step in the process of developing new drugs and other means to fight diseases. Once a drug has shown promise, first in the laboratory and then in animal studies, it may move on to studies with people if the U.S. Food and Drug Administration (FDA) approves. Only after a drug proves safe and effective for patients in clinical studies does the FDA grant approval for using the drug as standard treatment.

For more information about current research on pain control methods, contact NCI's Cancer Information Service (CIS) at 1-800-4-CANCER (1-800-422-6237).

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