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. 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, or surgery to do this.
There
are many other ways to control cancer pain, including:
Heat or cold.
Splints or
braces.
Massage.
Treatments that help you cope better
with the pain, such as relaxation exercises, biofeedback, or guided imagery.
Drugs you can buy without a prescription, such as ibuprofen,
aspirin, or acetaminophen.
Stronger drugs your doctor can
prescribe. These include:
Drugs that relieve pain and swelling.
Mouthwashes that help with mouth sores.
Very strong
painkillers.
Drugs used to treat depression. These drugs can
relieve pain and help you sleep.
Some of the drugs used to treat
seizures. These drugs help control burning and tingling pain caused by nerve
damage.
Skin creams that help relieve pain.
Nerve blocks may help with very bad
pain. Drugs are injected right into the nerve that affects the painful area.
They provide short-term pain relief by preventing the nerve from sending pain
signals.
Learning as much as you can about your pain may help.
Emotional support from your friends and family may also help. Many people use
other kinds of treatment, such as acupuncture and
aromatherapy.
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 if it is used for
longer than a week or so. 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.
Health Tools
Health Tools help you make wise health decisions or take action to improve your health.
Actionsets are designed to help people take an active role in managing a health condition.
Cancer pain may be caused by the cancer
or by the treatments and tests used. Cancer treatment does not always cause
pain. But out of every 10 adults with cancer, between 1 and 3 of them report
having pain caused by the treatment. Out of every 10 children with cancer, as
many as 6 report having pain caused by treatment.1
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 or Panadol, relieves
pain, while
other drugs such as ibuprofen and aspirin relieve pain
and also decrease swelling.
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:
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.
Many people worry about becoming addicted to narcotic painkillers. If
narcotic painkillers are used for longer than a week or so, they 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.
Your pain may be harder to treat if you are depressed or anxious. Talk to
your doctor about how to relieve stress and anxiety.
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 provides 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.
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 or Panadol, relieves
pain.
Anti-inflammatory drugs, such as ibuprofen and
aspirin, relieve pain and also decrease swelling.
If you have had
kidney or liver disease, gastrointestinal bleeding, or a stomach ulcer, talk to
your doctor before you take any of these drugs. Be sure you know
how to safely use these drugs.
Home treatment for diarrhea includes
resting your stomach and watching for signs of dehydration. Talk to your doctor
before using any medicine for diarrhea.
Home treatment for constipation includes gentle exercise along with drinking enough liquids
and eating lots of fruits, vegetables, and fiber. Many pain drugs can cause
constipation or make it worse. Check with your doctor before using a
laxative.
Home treatment for fatigue includes
making sure you get extra rest. Let your symptoms be your guide. You may be
able to stick to your usual routine and just get some extra sleep.
For more information about what you can do at home,
see:
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.2
Nonprescription drugs
Drugs you can buy without a
prescription may be enough to relieve your pain at times.
Acetaminophen, such as Tylenol or Panadol, relieves
pain.
Anti-inflammatory drugs, such as ibuprofen and
aspirin, relieve pain and also decrease swelling.
Know
how to be careful with these drugs. If you have had kidney or liver disease,
gastrointestinal bleeding, or a stomach ulcer, talk to your doctor before you
take any of these drugs.
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.2 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).
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.
Drugs 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.
If narcotic painkillers are used for longer
than a week or so, they 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.
Drugs 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.
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 drugs are not enough to relieve
cancer pain or when they cause troublesome side
effects, treatments such as radiation and nerve blocks 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.
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
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 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.
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 Hospice and Palliative Care
Organization
1700 Diagonal Road
Suite 625
Alexandria, VA 22314
Phone:
1-800-658-8898 (703) 837-1500
Fax:
(703) 837-1233
E-mail:
nhpco_info@nhpco.org
Web Address:
www.nhpco.org
The U.S. National Hospice and Palliative Care Organization (NHPCO)
offers information on local hospice and palliative care programs across
America. NHPCO is committed to improving end-of-life care and expanding access
to hospice care with the goal of improving quality of life for dying people and
their loved ones.
National Institutes of Health: Health
Information
9000 Rockville Pike
Bethesda, MD 20892
Phone:
(301) 496-4000
TDD:
(301) 402-9612
E-mail:
NIHinfo@od.nih.gov
Web Address:
http://health.nih.gov
The U.S. National Institutes of Health (NIH) conducts
and supports medical research to improve people's health and save lives. NIH
provides access to health and wellness information, free newsletters, current
research, health databases, fact sheets, and many other resources.
Foley KM (2000). Controlling cancer pain.
Hospital Practice (Office Edition), 35(4):
101-112.
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 (2007). 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
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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://www3.who.int/whosis/factsheets_hiv_nurses/fact-sheet-8/.
National Cancer Institute (2000). Pain Control: A Guide for People With Cancer and Their Families. Washington,
DC: U.S. Department of Health and Human Services. Also available online:
http://www.cancer.gov/cancerinfo/paincontrol.
National Cancer Institute (2000). Understanding Cancer Pain. Washington, DC: U.S. Department of
Health and Human Services. Also available online:
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This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Foley KM (2000). Controlling cancer pain.
Hospital Practice (Office Edition), 35(4):
101-112.
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.
