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Cancer Pain Management
What is cancer pain?
Cancer pain is the way your body responds to tumor growth, or the injury and damage that cancer is causing. There are several different kinds of cancer pain. Some pain lasts only a short time while others kinds last the whole time you have cancer. Everybody reacts to cancer pain in different ways. What you think is painful may not be painful to someone else. But, pain is whatever you say it is!
What causes cancer pain?
Cancer pain can be caused by many things. Some pain is caused by pressure on your organs by a cancer tumor. Other pain is caused when the cancer grows into organs like the liver, lungs, or spine. Neuropathic (new-roh-PAH-thik) pain happens when your nerves get damaged by the cancer, chemotherapy, or a tumor pressing on them. Surgery to remove cancer tumors can also cause pain. Some tests and procedures that are used to help caregivers better understand the progress of your cancer may cause pain.
What are the different types of pain?
- Acute pain: Acute cancer pain is short-lived and usually lasts less than 3 months. It is usually caused by tests, procedures, or surgeries and can usually be controlled or stopped with pain medicine.
- Breakthrough pain: Breakthrough pain is one kind of acute pain. This pain happens because cancer pain is not always steady and does not stay the same. As cancer changes or grows, it may cause pain which usually only lasts about 30 minutes or so. Then it goes away. Strong, short-acting pain medicines work well for breakthrough pain.
- Chronic pain: Chronic cancer pain is pain that lasts longer than three to six months. This kind of pain is often more complex. This is because there are so many different organs in your body that may be affected by the cancer. Chronic pain may happen if you have surgery to remove the cancer and the area heals but still hurts. Caregivers may use many treatments together to control your pain such as medicines, radiation, chemotherapy, and relaxation therapies.
- You have the right to be believed about your pain. You, and only you are the expert on your pain. You are the one who is having the pain, not family or caregivers. So you are the only one who knows what your pain feels like. It is very important that you tell caregivers about your pain so they can treat it.
- You have the right to have your pain treated, no matter how bad it is. The World Health Organization (WHO) says 85 to 97 percent of all cancer pain can be easily treated. You do not need to suffer from cancer pain.
- You have the right to have treatment or procedure pain PREVENTED or at least decreased. People often think they must be strong and cope with pain. But this is not true, and you do not have to suffer. There are many different medicines that can be given before a painful treatment or procedure that will help decrease the pain. There are also non-drug therapies you can learn to help you relax.
- You have the right to be treated with respect at all times. When you need medicine for pain, you should not be treated like a drug abuser or an addict! A drug abuser or addict is someone who takes medicines to "get high". You are not abusing pain medicines if you are taking them to make your pain go away. A person who has diabetes takes his medicines to keep his diabetes in control. It is the same with your pain. You take pain medicines to keep your pain in control and live a normal life.
What is your cancer pain like?
Caregivers want you to talk to them about your cancer pain. The more you can tell them about it, the better. This helps them understand what is causing your pain and how to treat it.
- Keep a pain diary. Sometimes it may be easier to answer caregiver's questions by making a pain diary, calendar, or book. A pain diary or journal will help you remember exactly what happened each day because it is all written down. A diary also helps track pain cycles. This will help you be more aware of when pain is bad and how to make it better. A diary answers caregiver's questions about your pain over time.
- Caregivers may ask you to answer the following questions.
- Where does it hurt? Where does it not hurt? Does the pain move from one area to another?
- How would you rate the pain on a scale of 0 to 10? (0 is no pain, and 10 is the worst pain you ever had.)
- How does the pain feel? Try to choose words that tell caregivers what type of pain you have. Is the pain sharp, cramping, twisting, squeezing, or crushing? Or, is the pain stabbing, burning, dull, numb, or "pins-and-needles" feeling?
- When did the pain start? Did it begin quickly or slowly? Is the pain steady or does it come and go?
- How often does the pain bother you and how long does it last?
- Does the pain affect your daily life? Can you still work in spite of the pain?
- Does the pain wake you from sleep?
- Do certain things or activities cause the pain to start or get worse, like coughing or touching the area?
- Does the pain come before, during, or after meals?
- Does anything decrease the pain like changing positions, resting, medicines, or changing what you eat?
- Women: does your pain change during your menstrual cycle?
Why is cancer pain control important?
Because cancer and its pain affect every part of your life, you may feel it is impossible to get rid of your pain. Cancer and its pain can affect your appetite (ability or desire to eat), how well you sleep, your energy, and your ability to do things. It can also affect your mood (how you feel about things) and relationships with others. This may cause a cycle of suffering, sleeplessness and sadness. If caregivers can help you control your pain, you will suffer less and enjoy your life more.
- The best way to decrease cancer pain is to treat the cause of the pain. Almost all types of cancer pain can be controlled. Getting rid of cancer pain is more than just taking medicines. It may also include radiation, surgery, relaxation therapies, and behavior changes. Because cancer pain is complicated, it may be hard to get your pain to go away completely. But, it is possible to lower your pain to a level you can live with and be comfortable doing everyday things.
- Work with your caregiver to find what pain control treatments are best for you. Always tell your caregiver if the pain gets worse. Ask your caregiver if you want more information on any of the following pain control treatments.
- Anti-anxiety medicine: This medicine may be given to help you feel less nervous and more relaxed.
- Antidepressants: This medicine is often given to decrease or to prevent the symptoms of depression (sadness). It can also be used to treat certain kinds of chronic nerve pain.
- Anticonvulsant medicine: Anticonvulsants (an-ti-kon-VUL-sants) are given to control seizures (SEE-zhurs). It can also be used to treat certain kinds of chronic nerve pain and may help control mood swings.
- Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and antinausea medicine are often given at the same time.
- Muscle relaxers: This is medicine to help your muscles relax. When your muscles relax, you may move more easily and have less pain.
- Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. Nonsteroidal (non-ster-OID-al) anti-inflammatory (an-tee-in-FLAM-ah-tohr-ee) medicine may help decrease pain and inflammation (swelling). It is very good for chronic bone pain that comes from arthritis or cancer. This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
- Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
- Radiopharmaceuticals and biphosphonates: Radiopharmaceuticals and biphosphonates help decrease cancer growth, pain, and inflammation that happens when cancer gets inside bones.
- Steroids: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling. There are many different reasons to take steroids. This medicine can help a lot but may also have side effects. Be sure you understand why you need steroids. Do not stop taking this medicine without your caregiver's OK. Stopping on your own can cause problems.
How can pain medicine be given?
Following are the many different ways pain medicine can be given, depending on the kind of pain you have.
- By mouth: You may be given pills or liquid to swallow. You may be given a pill or liquid to put under your tongue. A "lollipop type" lozenge may also be given that you suck on.
- Epidural (ep-ih-DER-ull): Medicine is given through a catheter (tube) that caregivers put into epidural space (the areas around the spinal cord).
- Inhaled: Medicine is breathed in through your mouth or nose.
- Nerve block: A shot of medicine is put close to the nerves in the area that hurts to break the pain cycle. The medicine makes the nerves unable to send pain messages to your brain. Nerve blocks give short-term relief of pain so that you can use the painful part and have a more normal life.
- PCA: A PCA is a device to give you pain medicine. PCA stands for patient-controlled analgesia (an-ull-GEE-zee-uh). This is an electric pump with pain medicine which is connected through a tube to an IV (in your vein) or subQ (under your skin). You press a button when you feel pain and you receive medicine from the pump through the tube. Caregivers have set the pump so you cannot get too much medicine. A PCA pump works well to control pain because you can give yourself medicine before the pain gets too bad. Being in control of your pain relief also helps you relax and deal with the pain better.
- Rectal : Medicine in a suppository (suh-PAW-zih-tor-ee) is put into your rectum (rear end).
- Shot: Pain medicine can be given as a shot in an IV, into a muscle, or under the skin (subQ).
- Topical: Medicine in a cream or gel is spread over your skin.
- Transdermal: Some medicine can be given as a patch put on the skin. This medicine is released slowly to give pain relief for days at a time.
How can you take pain medicine safely and make it work the best for you?
- Do not wait until you are in pain to take your medicine if your caregiver has suggested a regular schedule around the clock. If you wait until you feel bad, you will only be "chasing" your pain and not controlling it.
- Sometimes the pain is worse when you first wake up in the morning. This may happen if you did not have enough pain medicine in your bloodstream to last through the night. Caregivers may tell you to take a dose of pain medicine during the night.
- Some pain medicines can make you breathe less deeply and less often. The medicine may also make you sleepy, dizzy, and unsafe to drive a car or use heavy equipment. For these reasons, it is very important to follow your caregiver's advice on how to use this medicine.
- Some foods, alcohol, and other medicines may cause unpleasant side effects when you take pain medicine. Follow your caregiver's advice about how to prevent these problems.
- Do not stop taking pain medicine suddenly if you have been taking it every day for longer than two weeks. Your body may have become used to the medicine. Stopping the medicine all at once may cause unpleasant or dangerous side effects.
- With time, you may feel that the pain medicine is not working as well as it did before. Call your caregiver if this happens. Together you can find new ways to control the pain.
- Pain medicine and NSAIDs can make you constipated (have BMs that are hard, or difficult to pass). Following are some things that you can do to deal with constipation.
- Eat more foods that are high in fiber. Some high fiber foods are raw fruits and vegetables, whole-grain breads and cereals, dried fruits, popcorn, and nuts.
- Drink warm or hot liquids to make your bowels more active.
- Avoid hard cheeses and refined grains, such as rice and macaroni.
- Get more exercise if possible.
- Talk to your caregiver about drinking more liquids and taking a mild laxative (medicine to help you pass BMs).
Other non-drug pain control treatments:
- Acupuncture (ah-q-PUNK-sher) is based on the belief that life forces move through the body in specific paths. These paths are called meridians (mer-IH-dee-uns). With acupuncture, a needle is put into the meridian that runs to the area where you have pain. This needle blocks the meridian which stops or decreases the pain.
- Distraction teaches you to focus your attention on something other than pain. Listening to music, singing, playing cards, walking, watching TV, visiting friends, or breathing exercises may relax you and keep you from thinking about the pain.
- Guided imagery teaches you to put pictures in your mind that will make the pain less intense. With guided imagery, you learn how to change the way your body senses and responds to pain.
- Heat and cold can help decrease pain. Some types of pain improve best using heat while other types of pain improve most with cold. Caregivers will tell you if hot or cold packs will help your pain.
- Individual therapy: This is a time for you to meet alone with your therapist. During this time you and your therapist may talk about how to cope with your cancer and the pain it brings.
- Family meetings: These are times when your caregivers will meet with you and your family. Together, you will talk about how your family may help you cope with your cancer and it's pain at home.
- Physical therapy can be helpful with pain that was caused by not moving one part of your body. Stretching the muscles and making them stronger around the injured area can help the pain go away.
- Radiation can be used to decrease the size of a cancer tumor that is pressing on nerves and causing pain. Radiation can also help decrease bone pain.
- Relaxation and biofeedback teach your body to respond in a different way to the stress of being in pain. Normally, when pain starts, the body responds with tensing muscles, a faster heartbeat, and higher blood pressure. Your breathing also gets faster and more shallow. These responses can make the pain worse. Relaxation helps make the pain less by changing these responses.
- Caregivers may use a biofeedback machine so that you know right away when your body is relaxed.
- Massage is often used to help a person become more relaxed. Have someone gently massage your back, shoulders, and neck. Massage can be even more effective if you also use guided imagery or breathing exercises.
- Being in a quiet place may make it easier for you to deal with the pain. Avoiding bright lights or loud noisy places may help you control your pain. Make sure your home is not too hot or too cold.
- Self-hypnosis is a way to change your level of awareness. This means that by focusing your attention you can move away from your pain. You make yourself open to suggestions like ignoring the pain or seeing the pain in a positive way. It is not known exactly how hypnosis helps pain. But, hypnosis can give long-lasting relief of pain without affecting your normal activities. Self-hypnosis gives you better control of your body. You may feel less hopeless and helpless because you are doing something to decrease the pain.
- Surgery may be done to stop chronic pain. Caregivers may do surgery to cut the nerves to the painful area. The goal of this surgery is to stop the pain without losing feeling or movement in the area. In some people the pain can come back after surgery or the pain may even be worse. For these reasons, surgery is usually not considered until all other pain control treatments have been tried.
- TENS is short for transcutaneous (trans-q-TAIN-ee-us) electrical nerve stimulation (stim-u-LAY-shun). A TENS unit is a portable, pocket-sized, battery-powered device which attaches to the skin. The TENS unit uses mild, safe electrical signals to help control pain.
- Spinal cord stimulation , or SCS, is a nerve stimulation technique that is similar to TENS. The difference is that in SCS an electrode (a metal wire) is put near the spinal cord during surgery. SCS also uses mild, safe electrical signals to help control pain.
Tips to help you manage chronic pain:
- Set pain management goals and follow through on them. Pick your greatest pain problems and set goals to focus on each one.
- Check your progress. Use a chart or log to mark your progress as you meet each goal.
- Write yourself a contract. By making a contract with yourself, you can keep promises to manage your pain. A pain control contract works just like other legal kinds of agreements in your life. You set up pain goals, and dates to meet those goals.
- Plan each day. Use a schedule or a "to-do" list for exercise and other activities. This will help you to meet your goals.
- Keep your environment healthful and stay positive. Get rid of things in your home that might cause you to go back to unhealthy habits. Make sure your house shows your positive attitude. This will keep your spirits up and help you work with and manage your pain.
- Seek and accept support. Support from friends, family, and your caregivers can help keep you on track and help on difficult days.
- Work as a team with your caregivers. Keep your caregivers updated on your progress. This way you can work together to overcome problems when they happen.
- Prepare for difficult situations. Make a list of trouble areas with your pain and create a plan. Planning will decrease surprise when something happens. You will be prepared and that will decrease your stress.
- Reward yourself. Treat yourself to something you like each time you reach a goal or complete a pain strategy or plan. This will strengthen your positive attitude and successes.
- American Cancer Society
Web Address: http://www.cancer.org
- American Pain Society
4700 W. Lake Avenue
Glenview, IL 60025
Web Address: http://www.ampainsoc.org
- National Cancer Institute
Web Address: http://www.cancer.gov
- National Chronic Pain Outreach Association
PO Box 274
Millboro, VA 24460
Web Address: www.chronicpain.org
- American Chronic Pain Association
P.O. Box 850
Rocklin, CA 95677
Web Address: http://www.theacpa.org
- The medicine you are taking makes you sleepier than usual or confused.
- You have more stomach upset since you have been taking new medicines.
- You have new rashes or a lot of itching.
- You have a new pain or the pain seems different than before.
- You have constipation that is not decreased with the treatments described above.
- You feel very anxious, "antsy", or agitated after you take your medicines.
- You have nausea or vomiting (throwing up) after you take your medicines.
- You start to have trouble urinating or trouble controlling your bowel or bladder.
You have the right to help plan your care. To help with this plan, you must learn about your pain, what is causing it, and how it can be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.