Living with cancer

Pain

For many people one of the scariest parts of a cancer diagnosis is the fear of experiencing pain. However many people undergo cancer treatment without ever having pain. You can be an active partner by learning how to communicate about pain if, and when it occurs, and how to manage any discomfort before you become distressed.

Cancer can cause pain in a number of different ways. People with cancer may have pain as a result of the cancer pressing on an organ. In this case pain may be relieved by using surgery to remove or debulk (to reduce the size or amount of) the cancer or by using radiotherapy or chemotherapy to shrink it.

Cancer may also cause pain if it spreads into the bones and causes damage. Treating the bone with palliative radiotherapy frequently relieves this type of pain.

Pain can also occur when cancer presses on a nerve. This pain is often described as burning, tingling or shooting pain. Sometimes a nerve block, which makes the whole nerve numb can be used to treat this type of pain.

Unfortunately some cancer treatments can also cause pain and discomfort. Some chemotherapy drugs can cause neuropathy (numbness or tingling) which usually affect the hands or feet. Radiotherapy or chemotherapy can cause damage to the lining of the oesophagus (gullet) or stomach resulting in pain and discomfort.

You can be an active partner in managing any pain you experience by communicating as clearly as possible with your healthcare team. You do not have to suffer pain and if you can describe your pain to your health care team they will be able to advise you.

How is pain measured?

Pain may be hard to describe, but no-one else can judge how you feel. Thinking about the following factors might help you:

  • Severity
    How bad is the pain? You may be asked to rate your pain on a scale of 0-1- with 0 being no pain and 10 being the worst pain you have ever felt.
  • Frequency
    How often do you feel the pain, for how long and at what time of the day is it usually the least or worst.
  • Location
    Is the pain in one place or several places? Can you pinpoint where the pain is?
  • Quality 
    Try to describe the pain – is it burning, sharp, stabbing or is it more of an ache?
  • Change 
    What makes the pain better or worse?

How can pain be treated?

The goal of pain management for people with cancer is prevention or complete control of the pain. Significant advances in pain management have been made over the last decade and many treatment options are available. Most people are treated with medications initially, but other options include surgery, radiotherapy or neurosurgery. Most people diagnosed with cancer will have complete relief of pain with appropriate management.

Working together with your healthcare team will achieve the best result for you. Once the reason for you pain has been identified the first step is usually choosing the correct medication. There may be a period of trial and error while your healthcare team tries to find the right medication and dose for you. The many medications available range in strength and may be short-acting, lasting just a few hours, or long acting lasting 24 hours or more. Pain medications may be given as pills, liquids, suppositories, skin patches, lozenges or injections.

For mild pain, an over the counter medicine such as aspirin, paracetamol or ibuprofen may be sufficient. You should check with your healthcare team before taking any medication including those which don’t need a prescription as some should be avoided with certain cancer treatments.

If the pain is not relieved with over the counter medications the next step is a stronger medication such as an opioid in addition to aspirin, paracetamol or ibuprofen. Opioids include medications such as codeine, morphine, fentanyl and palladone.

Many pain medications contain a combination of weak pain medication with an opioid. The dose of the opioid can be increased until pain is relieved or troublesome side effects develop. All your medications should be regularly reviewed (including over the counter ones) with your healthcare team to ensure there are no risks in combinations and the amounts of medicines.

If you are experiencing severe pain and previously tried treatments have not helped you can ask your healthcare team about referral to a pain specialist. Health professional who have specialist experience in pain management include palliative care teams and Macmillan nurses. Some areas also have specialist pain clinics.

For some people with cancer certain non-drug treatments can be effective in relieving pain. Techniques such as visualisation, relaxation and breathing exercises, massage, acupuncture, light exercise, music therapy and psychological support may help. Theses do not treat the pain itself but promote relaxation which increases your ability to cope with distressing symptoms.

Transcutaneous electrical nerve stimulation (TENS) units may also be used in some circumstances. TENS involves giving small non-painful electrical bursts to specific areas in the skin. Hot or cold packs may also provide relief from discomfort.

The Maggie’s team can help you to find out more about pain management specialists and non drug treatments.

What about side effects from pain medications?

Pain medication can cause side effects, most commonly drowsiness, nausea (feeling sick) and constipation. These are particularly associated with stronger pain medication such as opioids. Drowsiness usually lessens over a number of days so that it becomes less of a problem but nausea and constipation can persist. Your healthcare team can advise you about anti-sickness medication, the use of stool softeners and/or laxatives to prevent constipation, and any alternative pain medications you might try. You might also find dietary changes and relaxation techniques helpful in managing nausea and constipation. You can read more about these in the ‘gastrointestinal side effects” and “emotional distress” sections of this blog.

Will I become addicted to pain medication?

Addiction to pain medication is very rare in people with cancer. However people with cancer are frequently concerned about taking too much medication and “becoming addicted” This myth often prevents people form getting the pain relief that they need. Poorly managed pain will increase anxiety and distress, which will in turn intensify feelings of pain. This can create a vicious cycle of pain and distress.

If you are struggling with pain ask you healthcare team about specialist health professionals or pain clinics. pain is a medical condition that can and should be treated – admitting that you are in pain is not a sign of weakness. You can be an active partner by telling your healthcare team exactly how you are feeling.

Things to do

  • Take your pain medication before the pain becomes severe.
  • Take anti-sickness and stool softeners and/or laxatives recommended by your healthcare team.
  • Communicate clearly with your healthcare team about your pain. Learn how to describe your pain to make it easier for them to understand how you are feeling.
  • Keep a side effects tracking log to not your medications and the level of your pain.
  • Tell your healthcare team about any side effects you experience.
  • Always let your healthcare team know if the pain is worsening or if you develop bowel or bladder problems.
  • Try non-drug techniques or diversional activities.
  • Practice relaxation techniques.

Things to avoid

  • Waiting until the pain is unbearable before reporting it or taking your pain medication. It is easier to prevent pain or to relieve it when it starts than it is to treat pain once it becomes severe.
  • Missing medication doses.
  • Constipation.
  • Losing sleep.
  • Wearing shoes that are too tight or extreme temperatures. If you have neuropathy you may not be able to judge pressure or temperature accurately.