Cancer Pain

Overview

Can cancer pain be controlled?

Cancer pain can be controlled in almost every case. This does not mean that you have no pain, but that it stays at a level that you can bear.

Cancer and its treatments can be painful. A tumor that presses on bones, nerves, or organs can cause pain. Surgery for cancer can cause pain. So can chemotherapy and radiation. Some medical tests, such as bone marrow aspiration, can also cause pain. There are a number of ways to control each of these kinds of pain.

You are the only person who can say how much pain you have or if a certain pain medicine is working for you. Telling your doctor exactly how you feel is one of the most important parts of controlling pain.

What does your doctor need to know?

The more specific you can be about your pain, the more your doctor will be able to treat it. It often helps to write everything down. Include:

  • When your pain started, what it feels like, and how long it has lasted.
  • Any changes in your pain.
  • If the pain is constant or if it comes and goes.
  • If you have more than one kind of pain. Use words such as dull, aching, sharp, shooting, or burning.
  • What makes your pain better or worse.
  • A rating of your pain on a scale of 0 to 10, with 10 being the worst pain you can imagine.

Tell your doctor exactly where you feel pain. You can use a drawing. Say if the pain is just in one place, if it is in several places at once, or if it moves from one place to another.

How is cancer pain managed?

Pain control often starts with medicine. Many drugs are used to treat pain. You and your doctor may need to adjust your medicine as your pain changes. Your doctor may suggest different drugs, combinations of drugs, or higher doses.

For a tumor that causes pain, removing or destroying all or part of the tumor, if possible, often helps. Doctors use chemotherapy, radiation, surgery, and other treatments to do this.

For nerve pain, doctors may use nerve blocks. With a nerve block, medicine is injected right into the nerve that affects the painful area. They provide short-term pain relief by preventing the nerve from sending pain signals. Or sometimes medicine is delivered directly to the spine, as with spinal anesthesia or an epidural.

There are many other ways to control cancer pain, including:

  • Heat or cold.
  • Splints or braces.
  • Massage, exercise, and physical therapy.
  • Treatments that help you cope better with the pain, such as relaxation exercises, biofeedback, or guided imagery.
  • Acupuncture .
  • Transcutaneous electric nerve stimulation (TENS) . This uses a mild electrical current from a power pack to relieve pain.

Learning as much as you can about your pain may help. Talking to a counselor can help you manage your cancer pain or the discomfort from cancer treatments. Emotional support from your friends and family may also help.

What is a pain control diary?

This is a record of your pain treatment and how it helped or did not help you. You can write down when you used each treatment, how it worked, and any side effects it caused. Having it written down helps you let your health care team know exactly how well your treatment is working.

Will you get addicted to pain medicine?

Some pain medicines can cause your body to keep expecting the medicine. This is called a drug dependency. Dependency is not the same as addiction. Addiction is a behavioral disorder in which a person has a craving for the drug. This craving may not even be related to the level of pain.

Many people who take pain medicine worry about getting addicted. Addiction to pain medicine is rare if you have not had a problem with addiction in the past and you take your medicine as directed under your doctor’s care.

Do not let your fear about becoming addicted get in the way of pain relief. Ask for pain relief if you need it. Pain is easier to control when you treat it as soon as it starts. You may also be able to predict pain and treat it before it begins, such as before physical activity. Pain is harder to control if you wait until it is bad.

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  Cancer: Controlling cancer pain
  Cancer: Controlling nausea and vomiting from chemotherapy

Cause

Cancer pain may be caused by the cancer or by the treatments and tests used. Pain may also be caused by an infection, such as shingles, that may develop because of the cancer or its treatment. The kind of pain may vary depending on the cause. The first step in managing your pain is understanding what is causing it.

Pain from the cancer itself can happen when:

  • A cancer growth, or tumor, presses on bones, nerves, or organs.
  • Cancer cells spread to the bone and destroy it.
  • 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 bowel obstruction can be caused by a tumor.

Because some cancer spreads far and fast, treatments have to be strong. As a result, they often cause pain and other side effects that require more treatment. Pressure on or damage to a nerve may cause tingling or burning. Treatments such as surgery, radiation, and chemotherapy may also cause pain.

What Does It Feel Like?

The type of cancer pain you feel depends on the type of cancer you have and how it affects your body. For example:

  • Deep, aching pain. A tumor that presses on your bones or grows into your bones can cause deep, aching pain. Bone pain is the most common type of cancer pain.
  • Burning pain. A tumor that presses on a nerve can cause a burning feeling. Sometimes chemotherapy, radiation, or surgery damages nerves and causes burning pain. Nerve pain is the second most common type of cancer pain.
  • Phantom pain. Pain that is felt in the area where an arm or a breast has been removed is phantom pain. Although 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.

Acute pain is bad pain that lasts a short time. Chronic pain is pain that comes and goes for a long time. It is a side effect of the cancer or treatment. Chronic pain can range from mild to severe.

Not everyone feels pain in the same way. Only you can describe how much pain you have. The key to getting your pain under control is being able to tell your doctor what it feels like and what does and doesn't work for you.

When to Call a Doctor

If you have cancer, call your doctor if any of the following occur:

  • You have new pain.
  • Your drugs or other treatments are no longer working.
  • Your pain medicine is not working long enough after each dose.
  • You have new symptoms, such as having a hard time walking, eating, or urinating.
  • You have side effects, such as nausea or vomiting, constipation, or diarrhea.
  • Your pain makes it hard for you to do your daily activities, such as eating or sleeping.

Who to See

The following health professionals can help treat cancer pain:

Your pain may be managed by a team that may include doctors (including pain 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

You are the only one who knows how your cancer pain feels. You may need different combinations of treatments. Don't be surprised if your pain control plan needs to be changed often. Don't let that discourage you. Be honest and specific about what does and does not work for you. Staying on top of your pain and in control of your pain will improve your quality of life during every stage of your disease.

Nonprescription drugs

Drugs that you can buy without a doctor's prescription may be enough to relieve your pain at times. Acetaminophen, such as Tylenol, relieves pain, while other drugs such as ibuprofen and aspirin relieve pain and also decrease swelling. But talk with your doctor before you take these medicines. And don't take more than the label says unless your doctor tells you to.

Prescription drugs

Drugs that need a doctor's prescription may be stronger or work differently than nonprescription drugs. Follow your doctor's orders about taking them. Prescription drugs include:

Other treatment options

Medical treatments can help relieve pain from tumors and nerve pain.

  • Ways to shrink, remove, or destroy painful tumors include:
  • Ways to treat nerve pain include:
    • Surgery to cut the nerves that relay pain.
    • Nerve blocks to help with very bad pain.
    • Pain medicine delivered to the spine. This can be done by:
      • Spinal anesthesia, which delivers pain medicine directly to the spine.
      • An epidural, which delivers pain medicine to the nerves around the spine.

Non-medical ways to relieve pain are often used along with pain medicine. These include:

For more information about what you can do, see:

Click here to view an Actionset. Cancer: Controlling cancer pain.

What to think about

One of the most important things you can do is to keep track of your pain and how your treatment is working. A pain control diary(What is a PDF document?) can help you do this. It can also help you tell your doctor exactly what your pain is and how it should be treated as it changes.

If you and your doctor are not able to control your pain, ask about seeing a pain specialist. A pain specialist is a health professional who focuses on treating resistant pain.

Many people worry about becoming addicted to narcotic painkillers. Using narcotic painkillers can cause your body to keep expecting the medicine. This is called a drug dependency. Dependency is not the same as addiction. Addiction is a behavioral disorder in which a person has a craving for the drug. This craving may not even be related to the level of pain. But narcotic drugs rarely cause addiction when they are used under a doctor's care. Talk to your doctor if you are worried.

It is not unusual for people who have cancer to become depressed. Your pain may be harder to treat if you are depressed or anxious. Treating your depression will help you be able to manage your pain better. Talk to your doctor about how to relieve stress and anxiety.

For more information about pain, see the following information from the National Cancer Institute:

Pain: Supportive Care – Health Professional Information [NCI PDQ]
Pain: Supportive Care – Patient Information [NCI PDQ]

End-of-life issues

The goal of managing your cancer pain is to be as free from pain as possible and to continue your normal activities, such as work, hobbies, and recreation. But a time may come when treatment of your condition is no longer effective. Your doctor will be able to help you answer questions or address concerns about maintaining your comfort. Hospice workers can care for you in your own home. For more information, see the topic Hospice Care.

You may find it helpful and comforting to state your health care choices in writing, with an advance directive or living will, while you are still able to make and talk about these decisions. Think about your pain control options and which kind of treatment will be best for you. You may wish to choose a health care agent, someone to make and carry out decisions about your care if you become unable to speak for yourself. For more information, see the topic Care at the End of Life.

Keeping a Pain Control Diary

The best way to control cancer pain is to tell your doctor exactly how your pain feels, where it is, and what works or does not work to control it. A written pain control diary will help you do this.

Your family and health care team can help you create a pain control diary(What is a PDF document?) . This diary will help you keep track of when you use each treatment, how it works, and any side effects that you may have. This written record will track your progress, and will help your health care team know what you need. It will be easier for your doctor to see how well your pain treatment is working.

You can also use your pain control diary to write down questions for your doctor, the answers to your questions, and any changes that you and your doctor have made to your treatment. Be sure to include information such as clear instructions about who and when to call if you have problems or questions.

How will I know if I need to change my pain control treatment?

As your disease continues, your pain treatment may need to change. The list below has information that may help you decide whether your needs have changed. Call your doctor if:

  • New pain develops.
  • Your pain treatment no longer works.
  • Your pain treatment wears off too soon between each dose.
  • You have new symptoms, such as problems walking, eating, or urinating.
  • You have more problems with side effects, such as nausea or vomiting, constipation, or diarrhea.
  • Your pain starts to get in the way of daily activities such as eating or sleeping.

For more information about what you can do, see:

Click here to view an Actionset. Cancer: Controlling cancer pain.

Home Treatment

There are many things you can do at home to reduce your cancer pain, manage side effects, and feel better in your mind and body. Follow your doctor's advice. Talk to your doctor about any home treatment you want to try.

You may find that drugs you can buy without a prescription are enough to ease your pain at times. Acetaminophen, such as Tylenol, relieves pain. Anti-inflammatory drugs, such as ibuprofen and aspirin, relieve pain and also decrease swelling. Be sure you know how to safely use these drugs. Talk with your doctor before taking these medicines, especially if you have had kidney or liver disease, gastrointestinal bleeding, or a stomach ulcer. And don't take more than the label says unless your doctor tells you to do so.

Other home treatments for pain include:

Pain medicine can cause many side effects. To help manage these side effects at home, try the following:

For more information about what you can do at home, see:

Click here to view an Actionset. Cancer: Controlling cancer pain.

Medications

Many different drugs are used to treat cancer pain. If you are already taking pain medicine for another problem, tell your doctor how often you are taking it and how well it works.

The key to controlling cancer pain is to take your medicine on a regular schedule. Do not wait until your pain gets bad. Pain is easier to control when you treat it just after it starts. Painkilling drugs work to control cancer pain in most people.1

Nonprescription drugs

Drugs you can buy without a prescription may be enough to relieve your pain at times. Acetaminophen, such as Tylenol, relieves pain. Anti-inflammatory drugs, such as ibuprofen and aspirin, relieve pain and also decrease swelling.

Know how to be careful with these drugs. Talk with your doctor before taking these medicines, especially if you have had kidney or liver disease, gastrointestinal bleeding, or a stomach ulcer. And don't take more than the label says unless your doctor tells you to do so.

Prescription drugs

People with cancer pain often need stronger drugs that their doctors prescribe. Be sure to follow your doctor's orders when you take these stronger drugs. If you still have pain, call your doctor.

Prescription drugs may be used alone or with other drugs. Depending on your pain, some of these drugs work better than others. Prescription drugs include:

  • Anti-inflammatory drugs and corticosteroids (for example, prednisone or dexamethasone). Corticosteroids used to treat cancer and cancer pain are not the same as steroids used by body builders.
  • Narcotic painkillers, such as hydrocodone (for example, Vicodin), oxycodone (for example, Percocet), morphine, methadone, and fentanyl.
  • Bisphosphonates, such as pamidronate and zoledronic acid. These are used to treat bone pain. Cancer cells that have spread to the bone upset the normal activity of your bone cells. These drugs slow the bone changes related to cancer. This relieves pain and helps keep your bones from breaking.
  • Calcitonin may help with certain types of pain, such as phantom pain.1 Phantom pain is a feeling of pain or other uncomfortable sensations in body parts that are no longer there, such as after an amputation. Although the limb is gone, the nerve endings at the site of the amputation continue to send pain signals to the brain that make the brain think the limb is still there. Women who have had a breast removed because of breast cancer may also feel phantom pain.
  • Mouthwashes to relieve pain from mouth sores (mucositis).
  • Antidepressants, to relieve pain and help you sleep.
  • Anticonvulsants, to help control nerve pain like burning and tingling.
  • Skin creams, such as capsaicin cream or lidocaine, to help relieve pain in the skin and surrounding tissues.
  • Chemotherapy , to shrink the cancer that is causing pain. The type of chemotherapy that you receive depends on your cancer diagnosis, the area of your body affected, and your previous use of chemotherapy drugs.

For more information, see:

Click here to view an Actionset. Cancer: Controlling cancer pain.

What to think about

Medicines that are used to treat cancer pain rarely cause addiction. Many people worry that they will become addicted to painkillers or that they will become immune to them. Their fears stop them from taking their medicine. As a result, their cancer pain goes needlessly untreated.

Using narcotic painkillers can cause your body to keep expecting the medicine. This is called a drug dependency. Dependency is not the same as addiction. Addiction is a behavioral disorder in which a person has a craving for the drug. This craving may not even be related to the level of pain.

Addiction to pain medicine is rare if you have not had a problem with addiction in the past and you take your medicine as directed under your doctor’s care. If you are worried about addiction or anything else, talk to your doctor.

Pain medicine works best when it is used at the time it is needed in the dose prescribed. If you know that your pain will be worse at a certain time, such as with activity, you can take your pain medicine in advance.

Some people may be able to use a patient-controlled analgesia (PCA) pump to control their pain medicines. A PCA pump is a computerized machine that contains your medicine. You press a button whenever you feel pain or are uncomfortable, and the machine gives you more medicine.

Medicines that are used to treat cancer pain can be very expensive. Talk to your doctor if financial concerns prevent you from taking your medicine as often as you need it. Schedule an appointment with someone in patient and financial support services at your cancer treatment center. Many organizations provide resources to help you with the cost of your medicine. Often a less expensive drug will work as well as a more expensive one. For more information, contact your local chapter of the American Cancer Society or call 1-800-227-2345 (1-800-ACS-2345).

Surgery

Surgery is sometimes used to relieve cancer pain. Removing a tumor that is pressing on nerves, bones, or your spinal cord can help your pain. Surgery can also remove tumors that block the intestine and cause pain. The type of surgery that you may have depends on the type of cancer you have, which parts of your body are affected, and what treatments you have had before.

For more information, see:

Click here to view an Actionset. Cancer: Controlling cancer pain.

What to think about

Although surgery to control pain does not cure cancer, it can help you feel more comfortable. Talk to your doctor about the benefits and risks of surgery.

Other Treatment

When medicines are not enough to relieve cancer pain or when they cause troublesome side effects, other treatments may help.

  • Radiation is the use of X-rays to destroy cancer cells and shrink tumors. It is used to destroy cancer growths that press on your nerves, bones, or spinal cord. The type of radiation that you receive depends on your cancer diagnosis, the area of your body that is affected, and your previous history of radiation therapy. Destroying growths relieves pressure on organs and nerves and reduces pain.
  • A pump that is placed under your skin may be used to deliver pain medicine directly to your spine. Because the drug goes right to your spinal column, not as much of it is needed. That usually means that side effects are not as severe.
  • Nerve blocks usually are used only after other treatments have not worked. A nerve block is a drug that is injected into or around a nerve to temporarily prevent the nerve from telling your brain about the pain. In some cases, deadening the nerve may not only reduce the pain but also lower the amount of medicine you need.
  • Transcutaneous electric nerve stimulation (TENS) . This uses a mild electrical current from a power pack to relieve pain.

Exercise can help reduce pain and fatigue. It can also prevent muscle spasms and stiffness in your joints. But be sure to talk to your doctor before increasing your level of physical activity.

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

Short-term crisis counseling or cognitive-behavioral therapy (CBT) may help you manage cancer pain or the discomfort from cancer treatments. Counseling may also help your partner or family members.

For more information, see:

Click here to view an Actionset. Cancer: Controlling cancer pain.

What to think about

Radiation treatments may cause side effects, such as diarrhea and fatigue. The type of side effects that may develop depend on your cancer diagnosis, the area of your body that is affected, and the type of radiation that you have. You can use home treatment measures for diarrhea and fatigue to help you manage these side effects.

Nerve blocks can cause loss of feeling or, in rare cases, paralysis in the affected area or in the tissue surrounding the area.

Other Places To Get Help

Organizations

American Cancer Society (ACS)
Phone: 1-800-ACS-2345 (1-800-227-2345)
TDD: 1-866-228-4327 toll-free
Web Address: www.cancer.org
 

The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.


Caring Connections
1700 Diagonal Road
Suite 625
Alexandria, VA  22314
Phone: 1-800-658-8898 help line, 1-877-658-8896 multilingual line
(703) 837-1500
Fax: (703) 837-1233
E-mail: caringinfo@nhpco.org
Web Address: www.caringinfo.org
 

Caring Connections, a program of the U.S. National Hospice and Palliative Care Organization (NHPCO), seeks to improve care at the end of life. Caring Connections provides free resources, including educational brochures, advance directives and hospice information, and a toll-free help line for people looking for quality end-of-life information.


National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD  20892-8322
Phone: 1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD: 1-800-332-8615
E-mail: cancergovstaff@mail.nih.gov
Web Address: www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)
 

The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people with cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.


National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse
P.O. Box 7923
Gaithersburg, MD  20898
Phone: 1-888-644-6226
(301) 519-3153 for international calls
Fax: 1-866-464-3616 toll-free
TDD: 1-866-464-3615 toll-free
E-mail: info@nccam.nih.gov
Web Address: www.nccam.nih.gov/health/clearinghouse (or www.nccaminfo.org/livehelp/ for live help online)
 

The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) explores complementary and alternative healing practices in the context of rigorous science, trains complementary and alternative medicine researchers, and gives out authoritative information. Send all requests for information and questions about NCCAM to the NCCAM Clearinghouse.


National Pain Foundation
300 East Hampden Avenue
Suite 100
Englewood, CO  80113
Web Address: www.nationalpainfoundation.org
 

Through information, education, and support, the National Pain Foundation (NPF) promotes the recovery of persons in pain. The NPF Web site provides information and resources in an interactive way that encourages patients to take an active role in managing their chronic pain. The My Pain section of the Web site includes a Personal Inventory section to help pain patients identify the information they need to manage their pain. The NPF has information about pain conditions such as arthritis, back and neck pain, and cancer pain. The NPF addresses the many approaches to pain management, such as medicines, injections, surgery, acupuncture, biofeedback, chiropractic, and physical therapy. The NPF also provides support for the special needs of children in pain and information about psychological factors related to pain. The Web site also provides information on clinical trials that are studying pain management and treatment.


References

Citations

  1. Foley KM (2005). Management of cancer pain. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 2615–2649. Philadelphia: Lippincott Williams and Wilkins.

Other Works Consulted

  • Agency for Healthcare Research and Quality (2001). Management of Cancer Pain: Summary. Evidence Report/Technology Assessment No. 35 (AHRQ Publication No. 01-E033). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.ahrq.gov/clinic/epcsums/canpainsum.htm.
  • Agency for Healthcare Research and Quality (2002). Management of Cancer Symptoms: Pain, Depression, and Fatigue. Evidence Report/Technology Assessment No. 61 (AHRQ Publication No. 02-E032). Rockville, MD: Agency for Healthcare Research and Quality.
  • American Cancer Society (2009). Coping With Physical and Emotional Changes. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/MBC/MBC_0.asp.
  • Cox KA, Fausett HJ (2002). Patient-controlled analgesia. In CA Warfield, HJ Fausett, eds., Manual of Pain Management, 2nd ed., pp. 270–272. Philadelphia: Lippincott Williams and Wilkins.
  • Lindsey E, et al. (2000). Fact Sheet 8: HIV palliative and terminal care. Fact Sheets on HIV/AIDS for Nurses and Midwives. Geneva, Switzerland: World Health Organization (WHO). Available online: http://library.unesco-iicba.org/English/HIV_AIDS/cdrom%20materials/WHO/WHOhtml%208.htm.
  • National Cancer Institute (2008). Pain Control: Support for People With Cancer. Washington, DC: U.S. Department of Health and Human Services. Also available online: http://www.cancer.gov/cancertopics/paincontrol.
  • National Comprehensive Cancer Network (2009). Adult cancer pain. NCCN Clinical Practice Guidelines in Oncology, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/pain.pdf.

Credits

Author Bets Davis, MFA
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Michael S. Rabin, MD - Medical Oncology
Last Updated October 30, 2009

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