Facts About Cancer Pain Part 1: Managing and Treating Pain

Having cancer does not always mean having pain. for those with pain, there are many different kinds of medicines, ways to receive the medicine, and non-medicine methods that can relieve the pain you may have. You should not accept pain as a normal part of having cancer. When you are free of pain, you can sleep and eat better, enjoy the company of family and friends, and continue with your work and hobbies (see Table 1).

Table 1: Effects of pain management

Only you know how much pain you have. Telling your doctor and nurse when you have pain is important. Not only is pain easier to treat when you first have it, but pain can be an early warning sign of the side effects of the cancer or the cancer treatment. Together, you, your nurse, and your doctor can talk about how to treat your pain. You have a right to pain relief, and you should insist on it.

Cancer pain can almost always be relieved

There are many different medicines and methods available to control cancer pain. You should expect your doctor to seek all the information and resources necessary to make you as comfortable as possible. However, no one doctor can know everything about all medical problems. If you are in pain and your doctor suggests no other options, ask to see a pain specialist or have your doctor consult with a pain specialist. Pain specialists may be oncologists, anesthesiologists, neurologists, or neurosurgeons, other doctors, nurses, or pharmacists. A pain control team may also include psychologists and social workers.

If you have trouble locating a pain program or specialist, contact a cancer center, a hospice, or the oncology department at your local hospital or medical center. The National Cancer Institute’s Cancer Information Service and other organizations can give you a list of pain management facilities. The American Cancer Society and other organizations may also be able to provide names of pain specialists, pain clinics, or programs in your area.

Controlling your cancer pain is part of the overall treatment for cancer

Your doctor wants and needs to hear about what works and what doesn’t work for your pain. Knowing about the pain will help your doctor better understand how the cancer and the treatment are affecting your body. Discussions about pain will not distract your doctor from treating the cancer.

Preventing pain from starting or getting worse is the best way to control it

Pain is best relieved when treated early. You may hear some people refer to this as "staying on top" of the pain. Do not try to hold off as long as possible between doses. Pain may get worse if you wait, and it may take longer, or require larger doses, for your medicine to give you relief.

You have a right to ask for pain relief

Not everyone feels pain in the same way. There is no need to be "stoic" or "brave" if you have more pain than others with the same kind of cancer. In fact, as soon as you have any pain you should speak up. Telling the doctor or nurse about pain is not a sign of weakness. Remember, it is easier to control pain when it just starts rather than waiting until after it becomes severe.

People who take cancer pain medicines rarely become addicted to them

Addiction is a common fear of people taking pain medicine. Such fear may prevent people from taking the medicine. Or it may cause family members to encourage you to "hold off" as long as possible between doses. Addiction is defined by many medical societies as uncontrollable drug craving, seeking, and use. When opioids (also known as narcotics)—the strongest pain relievers available—are taken for pain, they rarely cause addiction as defined here. When you are ready to stop taking opioids, the doctor gradually lowers the amount of medicine you are taking. By the time you stop using them completely, the body has had time to adjust. Talk to your doctor, nurse, or pharmacist about how to use pain medicines safely and about any concerns you have about addiction.

Most people do not get "high" or lose control when they take cancer pain medicines as prescribed by the doctor.

Some pain medicines can cause you to feel sleepy when you first take them. This feeling usually goes away within a few days. Sometimes you become drowsy because, with the relief of the pain, you are now able to catch up on the much needed sleep you missed when you were in pain. On occasion, people get dizzy or feel confused when they take pain medicines. Tell your doctor or nurse if this happens to you. Changing your dose or type of medicine usually can solve the problem.

What is drug tolerance?

People who take opioids for pain sometimes find that over time they need to take larger doses. This may be due to an increase in the pain or the development of drug tolerance. Drug tolerance occurs when your body gets used to the medicine you are taking, and your medicine does not relieve the pain as well as it once did. Many people do not develop a tolerance to opioids. If tolerance does develop, usually small increases in the dose or a change in the kind of medicine will help relieve the pain.

Increasing the doses of opioids to relieve increasing pain or to overcome drug tolerance does not lead to addiction.

Side effects from medicines can be managed or often prevented

Some medicines can cause constipation, nausea and vomiting, or drowsiness. Your doctor or nurse can help you manage these side effects. These problems usually go away after a few days of taking the medicine. Many side effects can be managed by changing the medicine or the dose or times when the medicine is taken.

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.

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.

How is cancer pain treated?

Cancer pain is usually treated with medicine (also called analgesics) and with non-drug 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 non-drug 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 (see Table 2). 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.

Table 2: Communicating with your caregivers

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

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. 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 1-2 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 first.
  • 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.

Medicines used to relieve pain

The type of medicine and the method by which the medicine is given depend on the type and cause of pain. For example, constant, persistent pain is best relieved by methods that deliver a steady dose of pain medicine over a long period of time, such as a patch that is filled with medicine and placed on the skin (skin patch) or slow-release oral tablets. Table 3 summarizes the types of medicines commonly used to relieve pain.

Table 3: Types of medicines used to relieve pain

[Part 2 of this series, which will appear with the March issue of Alternative Medicine Alert, will examine non-drug methods of pain relief.]

Source: National Institutes of Health, National Cancer Institute. Available at: www.cancer.gov/cancertopics/paincontrol. Accessed Jan. 19, 2005.