Cancer Pain

Overview

Can cancer pain be controlled?

Cancer pain can be controlled in almost every case. This doesn't mean that you have no pain. It means that the pain stays at a level that you can bear. The key to pain control is telling your doctor what your pain feels like and what relieves it for you.

Different types of pain

Common types of cancer pain include:

• Bone pain, which is often a deep, aching pain.
• Nerve pain, which is often a burning feeling.
• Phantom pain, which is felt in the area where a body part has been removed.

Cancer pain may be:

• Acute. This is bad pain that lasts a short time.
• Chronic. This is mild-to-intense pain that comes and goes over a long time.
• Breakthrough. This is sudden, severe pain that lasts for a short time while you are taking medicines that usually control your pain.

How is it treated?

Pain control often starts with medicine. Both prescription and over-the-counter medicines may be used. Your doctor may suggest different drugs, different combinations, or different doses as your pain changes.

A doctor may use treatments such as radiation or surgery. These treatments can remove, destroy, or shrink a tumor that causes pain. For nerve pain, a doctor may give a shot of numbing medicine into the nerve. Or sometimes medicine is put directly into the spine.

Some people use other treatments along with medical treatments. These include:

• Home treatments, such as heat and cold packs or distraction.
• Complementary therapies. These include acupuncture and meditation.

How can a pain control diary help you and your doctor?

Your doctor needs to understand your pain to treat it effectively. You can help by telling your doctor where you feel pain, what your pain feels like, and what makes it better or worse. It often helps to write everything down. Some people use a pain diary for this.

Cause

Cancer pain may be caused by the cancer or by the treatments and tests used. The kind of pain may vary depending on the cause. The first step in managing cancer pain is understanding the cause.

Pain from the cancer itself can happen when:

• A tumor presses on bones, nerves, or organs.
• A tumor presses on the spinal cord, causing pain in the back, legs, or neck.
• A tumor causes organs to swell or be blocked. For example, a tumor can cause a bowel obstruction.
• Cancer cells spread to the bone and destroy it.

Treatments such as surgery, radiation, and chemotherapy may also cause pain. Cancer treatments have to be strong. As a result, they often cause pain and other side effects. Some medical tests, such as bone marrow aspiration, may cause pain too.

What Does It Feel Like?

The type of pain depends on how cancer or cancer treatment affects your body. Common types include:

Bone pain.

For example, a tumor that presses on your bones or grows into your bones can cause deep, aching pain.

Nerve pain.

A tumor that presses on a nerve can cause a burning feeling. Sometimes chemotherapy, radiation, or surgery damages nerves and causes nerve pain.

Phantom pain.

This is felt in the area where a body part such as an arm or a breast has been removed. Even though the body part is gone, nerve endings at the site still send pain signals to the brain. The brain thinks the body part is still there.

Cancer pain may be:

Acute.

This is bad pain that lasts a short time.

Chronic.

This is pain that comes and goes over a long time. Chronic pain can range from mild to severe.

Breakthrough.

This is severe pain that occurs while you are taking medicines that usually control your pain. Breakthrough pain usually starts suddenly and lasts for a short time.

When To Call

Call your doctor now or seek immediate medical care if:

• You have severe pain.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You have new or worse pain.
• You do not get better as expected.

Who To See

The following health professionals can help treat cancer pain:

• Internist
• Family medicine physician
• Surgeon
• Medical oncologist
• Radiation oncologist
• Anesthesiologist
• Nurse practitioner
• Physician assistant
• Neurologist

Your pain may be managed by a team that may include doctors (including pain specialists or palliative care specialists), nurses, psychologists, social workers, and pharmacists. Be sure that all the members of your health care team know about any changes in your pain control diary. You may wish to use one person, such as your medical oncologist, as a team leader who will make sure that all team members share information.

Treatment Overview

There are many ways to treat cancer pain. You may need different combinations of treatments to get the best results.

Pain medicines.

Pain control often starts with medicine. Both prescription and over-the-counter medicines may be used. Your doctor may suggest different drugs, different combinations, or different doses as your pain changes.

• Over-the-counter pain relievers include acetaminophen and anti-inflammatory medicines like ibuprofen.
• There are many prescription options. Examples include steroid medicines and opioid pain relievers.

Treatments other than medicines.

You may have other options when medicines are not enough to relieve your pain. These include:

• Treatments for painful tumors, such as surgery, chemotherapy, or hormone therapy.
• Treatments for nerve pain, such as surgery or nerve blocks.

Nonmedical treatments.

There are other treatments that can help you manage cancer pain. They are often used along with medicines or other medical treatments.

Some examples include:

• Cognitive-behavioral therapy.
• Complementary therapies, such as acupuncture and meditation.

Discuss the pros and cons of these treatments with your doctor before you try them.

Home treatments.

Home treatments may reduce cancer pain and help you feel better. Talk to your doctor about any home treatments you want to try.

Things you can try at home to relieve cancer pain include:

• Heat and cold packs.
• Gentle massage.
• Distraction.

Keeping a Pain Control Diary

Your doctor needs to understand your pain to treat it effectively. The more specific you can be about your pain, the better. It often helps to write everything down. Some people use a pain diary for this.

You can help by telling your doctor:

• Exactly where you feel pain. Is the pain just in one place? Is it in several places at the same time? Or is it moving from one place to another?
• What your pain feels like. Use words such as dull, aching, sharp, shooting, or burning.
• When your pain started and how long it has lasted.
• How bad it is on a scale of 0 to 10, with 10 being the worst pain you can imagine.
• If the pain is constant or if it comes and goes.
• What makes your pain better or worse.
• About any changes in your pain.

Self-Care

Home treatment may help to reduce cancer pain and improve your physical and mental well-being. Be sure to talk to your doctor about any home treatment you may use.

Here are some things you can try at home to relieve cancer pain.

Heat and cold

Heat and cold treatments can help with mild to moderate pain from cancer. Heat may relieve sore muscles. Cold may ease pain by numbing pain sensations. Try alternating heat and cold. After a heat or cold treatment, try some gentle massage for relaxation and pain relief.

Talk to your doctor before you try either heat or cold during chemotherapy or radiation treatments.

Be careful when using heat or cold treatment:

• Don't apply heat or cold to skin that may be red or tender from radiation treatment.
• Don't apply heat to an area where the skin is broken or injured. Heat can increase bleeding.
• Don't apply heat or cold packs directly to bare skin. Put a thin towel or pillowcase between the pack and your skin.
• Don't use heat or cold in an area where you have poor blood flow.

Gentle massage

Simple touch or gentle massage may help reduce pain and ease tension. You could ask someone else to rub your shoulders or back. You can massage your own feet, hands, or neck. Self-massage works best if you are in comfortable clothes and are sitting or lying in a comfortable position. Use oil or lotion to massage bare skin.

Avoid massage in any areas where you have visible tumors, open wounds, skin that is tender from radiation, or a blood clot in a vein.

Distraction

Distraction can help you focus your attention on something other than pain. Paying attention to something other than pain may make the pain easier to handle. Distraction can be useful whenever you are waiting for pain medicines to start working.

Physical activity

Physical activity can help reduce pain and fatigue. It can also prevent muscle spasms and stiffness in your joints. Stretching and range-of-motion exercises can help you stay strong, flexible, and mobile.

Being physically active also can help with your emotional and mental health. It may be hard to be active when you don't feel well. But if you are able, going for a walk or a swim may help you feel better, especially during cancer treatment.

Be sure to talk to your doctor before you increase your level of physical activity.

Medicines

Many different medicines are used to treat cancer pain. Over-the-counter medicines may relieve your pain at times. But you may need stronger medicines that your doctor prescribes. These may be used alone or with other medicines.

Over-the-counter pain relievers.

These include:

• Acetaminophen, such as Tylenol.
• Anti-inflammatory medicines, such as ibuprofen.

Talk with your doctor before you take these medicines. Don't take more than the label says unless your doctor tells you to.

Prescription medicines.

These include:

• Anti-inflammatory medicines and steroid medicines.
• Medicines to treat bone pain.
• Opioid pain relievers.
• Antidepressants. They can relieve pain and help you sleep.
• Certain seizure medicines. They help control nerve pain.

These medicines may be stronger or work differently than over-the-counter medicines. Be sure to follow your doctor's instructions when you take these medicines.

Some may work better than others. It depends on the type of pain you have.

Other Medical Treatments

Many medical treatments can be used to manage cancer pain. Other treatments may help when medicines are not enough to relieve pain or when medicines cause unpleasant side effects.

Treatments for painful tumors

These include:

Surgery.

A doctor may remove a tumor that is pressing on nerves, bones, or your spinal cord.

Chemotherapy, hormone therapy, or immunotherapy.

These treatments may shrink a tumor.

Radiation.

It can destroy cancer growths and relieve pressure on organs and nerves.

Radiofrequency ablation.

This treatment uses heat to destroy a tumor.

Treatments for nerve pain

These include:

Surgery.

A doctor may cut the nerves that relay pain.

Nerve blocks.

A numbing medicine is injected into or around a nerve. This temporarily prevents the nerve from relaying pain. In some cases, numbing the nerve may not only reduce the pain but also lower the amount of medicine you need.

A nerve block may help with severe pain. Nerve blocks are usually used only after other treatments have not worked.

Medicine delivered to the spine.

This may be spinal anesthesia, which puts pain medicine directly into the spine. Or it may be an epidural, which sends pain medicine to the nerves around the spine.

Transcutaneous electric nerve stimulation (TENS).

This uses mild electrical current from a power pack to relieve pain. Current is delivered through electrodes placed on the skin near the source of pain.

Complementary Treatment

Some people use other treatments along with medical treatment to relieve symptoms and help them cope with cancer pain.

Cognitive-behavioral therapy or short-term crisis counseling may help you manage cancer pain or the discomfort from cancer treatments. Counseling may also help your family.

Complementary medicine is the term for a wide range of practices that may be used along with pain medicine or other treatments. It includes:

Meditation.

This usually involves slow, regular breathing and sitting quietly for at least 15 to 20 minutes.

Acupuncture.

Very thin needles are inserted into the skin at certain points on the body.

Biofeedback.

This method uses the mind to help control a body function that the body normally controls on its own. These functions include muscle tension and blood pressure.

Before you try a complementary treatment, talk to your doctor. These treatments aren't meant to take the place of standard medical treatment.