Pain

Overview

Pain remains one of the most common and feared symptoms of cancer. However, modern pain medications can control your pain. The type of pain medication that is prescribed by your doctor depends on the severity of your pain. Other methods of controlling pain include acupuncture, massage and others. You may also find that exercise helps reduce your pain.

What is pain?

Pain may be a side effect of cancer treatment or may be caused by the cancer itself. If not adequately managed, pain may have a tremendous effect on quality of life. Fortunately, there are many effective treatments for pain and most of your pain should be controlled with these treatments. You should always notify your doctor if you have pain or if your existing pain increases so that steps can be taken to find the medication or combination of medications and dose that will control it. Also, take your medication as prescribed.

How is pain treated?

The type of pain medication you are prescribed depends on how severe your pain is. Pain is rated on a scale of 1-10, with 0 being no pain and 10 the worst pain imaginable.

The World Health Organization recommends the following approach for relief of cancer pain:

Mild to Moderate Pain (1-3) For pain at the low end of the 1-10 scale, you will be prescribed over-the-counter medications, such as acetaminophen (Tylenol®) or a non-steroidal anti inflammatory drug (NSAID), such as ibuprofen (Advil®, Motrin®, etc.).

Moderate to Severe Pain (4-6) If over-the-counter medication did not relieve your pain, or you have moderate to severe pain, you will be prescribed one of the many types of opioids. Also known as narcotics, these drugs are similar to natural substances produced by the body to control pain, called endorphins, and are the strongest pain relievers available . Opioids prescribed for moderate to severe pain may include dihydrocodeine, propoxyphene and tramadol. Tylenol® or an NSAID may be added to the opioid, as in the drugs labeled codeine, oxycodone and hydrocodone.

Severe Pain (7-10) For severe pain or pain that was not relieved from one of the above opioids and/or over-the-counter medication, you will likely receive a stronger opioid. Opioids for severe pain may include morphine, oxycodone, hydromorphone, methadone, levophanol or fentanyl. A non-opioid analgesic and/or adjuvant drug may be added as circumstances require.

How is pain medication given?

Pain medication may be given in many different ways, including:

  • Orally as a pill or liquid
  • Topically as an ointment or patch
  • Rectally as a suppository
  • Intravenous (IV injection into your vein)

If your doctor gives you pain medication with instructions to “take as needed”, remember to take it before the pain becomes severe. If you wait, it may take a long time before the medication begins to work, causing unnecessary discomfort.

If your pain relief is not lasting long enough, ask your doctor about extended-release medicines, which can control your pain for a longer period of time. Morphine and oxycodone are made in extended-release forms. Also, a skin patch that releases the opioid fentanyl can be used.

If your pain is controlled most of the time, but occasionally gets bad enough that your medication does not appear to work, your physician may prescribe a rapid-acting medicine, such as immediate-release morphine, to give you more pain relief when it is needed.

Your dose may need to be adjusted as you get used to the medication. You may build a tolerance to the pain medication, which means that you are not getting the same relief from your medication. If this happens, your dose may be increased or you may be prescribed a new medication.

Will I become addicted to pain medication?

Pain medication was developed for controlling the type of pain that cancer patients frequently encounter. You should not worry about becoming addicted to pain medication when taking it for the purpose it was designed. Usually, pain medication is only necessary for a short period of time, such as while you are healing from treatment. In some circumstances, you may be taking pain medication daily for a longer period of time. Even in these circumstances, you will not become addicted; you are taking pain medication for a very different purpose than someone who is addicted and trying to get “high”. Talk to your doctor, nurse or pharmacist about how to use pain medicines safely and about any concerns you have regarding addiction.

Does pain medication have side effects?

Pain medication may make you feel sleepy, cause you to become constipated, or cause nausea and vomiting. Below are a few tips on dealing with these common side effects of pain medication.

Sleepiness: Try planning a rest time just after you take your pain medication to deal with the sleepiness that it may cause. Sleepiness may be relieved by taking a caffeine drink with your pain medication.

Constipation: Increase fluid and fiber intake to prevent constipation.  Go to the section on Constipation for more information.

Nausea and vomiting: Drugs that can relieve your nausea and vomiting are available. Go to the section on Nausea and Vomiting for more information.

Not everyone experiences these side effects and not every pain medication causes them to the same degree. Talk to your doctor if you experience these or other side effects with your pain medication.

Are there non-drug treatments for pain?

There are many additional techniques for controlling pain that you may wish to try to see if they work for you. Some are described below.

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 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.

Biofeedback: Learning this technique requires the help of a licensed biofeedback technician. With the help of special machines, people can learn to control certain body functions, such as heart rate, blood pressure and muscle tension. Biofeedback is sometimes used to help people learn to relax. You can use biofeedback techniques to help you relax and to help you cope with pain. This technique is usually used with other pain relief methods.

Emotional support and counseling: Anxiety or depression may make your pain seem worse. Also, pain can cause you to feel worried, depressed or easily discouraged. These are normal feelings that can be relieved. 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. Go to the sections on Anxiety and Depression for more information.

Imagery: Imagery involves using your imagination to create mental pictures of situations. The way imagery relieves pain is not completely understood. Imagery can be thought of as a deliberate daydream that uses all of your senses — sight, touch, hearing, smell and taste. Some people believe that imagery is a form of self-hypnosis.

Massage: There are many forms of massage that may help reduce pain. Some massage therapists specialize in chronic pain. Or, you can ask friends or family members to help. You may also be able to do massage on yourself. Try using a slow, steady, circular motion. Massage over or near the area of pain with just your bare hand or with hand lotion or warm oil. Check with your doctor before getting a massage to make sure that it is acceptable for your condition.

Meditation: Meditation is the practice of quieting the mind and focusing it on the breath or a mantra. Meditation may help you learn to focus your mind on something other than the pain and give you the strength to better cope with pain.

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.

What else can I do about pain?

It’s hard to be motivated to exercise when you are in pain. In fact, it’s probably the very last thing you want to do! However, regular exercise can help you combat your pain in a variety of ways. Exercise prompts your body to release special chemicals, called endorphins, that actually block pain signals from reaching your brain. These chemicals also help alleviate anxiety and depression, conditions that can make your pain more difficult to control. Regular exercise can also improve your sleep and gives you more energy to cope with your pain.

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