Managing Cancer Pain – Help Through Difficult Times

Cancer pain management is an important part of your treatment when you are fighting cancer. Despite many available pain relief-options, cancer pain is often under-treated. There are several reasons for this. Some people are shy to mention the pain to their doctor. They don’t want to be viewed as “drug-seeking” or they fear addiction to painkillers. Additionally, some doctors are not trained to treat cancer pain and may avoid bringing it up. That’s why it helps to have a pain specialist on your team. Pain specialists are doctors that are trained to manage cancer pain.

What causes cancer pain?

In the early stages of cancer, you may not have any pain. However, once tumors grow in size, your chance of having pain increases. A return of cancer after an initial remission is yet another cause for pain. Treatments like surgery, chemotherapy, and radiation can cause a new-onset pain that is temporary, or even permanent.

Here are some examples of cancer-related pain:

• Pressure from a tumor. As a tumor grows, it presses on or destroys nearby tissue such as nerves, bones, and organs (lungs, liver). Tumors can also release chemicals that trigger pain.
• Surgery. Removing a tumor can cause pain in the area of the surgery, due to nerve injury and scar formation. People who have a limb or breast removed may feel as though that body part is still there (phantom pain).
• Radiation therapy. Radiation causes mouth sores, skin redness/burning, and muscle pain.
• Chemotherapy. Chemo may cause nerve pain (neuropathy). Infections are also common and may include pneumonia, bronchitis, and herpes.
• Blood draws. Repeated blood draws for lab tests, can be painful. The needles and tubing required for giving chemotherapy directly into the veins may also hurt.

What does cancer pain feel like?

Pain differs, depending on the cancer type, how advanced it is, and where the cancer is growing. A person’s pain tolerance also determines the level of pain that they feel. Cancer pain can be dull, achy, sharp, or burning. It can be constant, episodic, mild, moderate, or severe.

Some examples:

• Nerve pain – This pain feels like a burn or a shock that travels in a band-like pattern in your body. It can start after chemotherapy or due to a tumor that presses on a nerve.
• Somatic pain – This intense pain can be superficial (on the skin, lips, nose) or deep (in the joints, bones, tendons, or muscles). This pain can last longer than expected and become chronic. Examples: headaches (due to brain tumors) and back pain (due to bone cancer).
• Visceral pain – This type of pain is common with cancer. Visceral pain comes from internal organs like the liver, bladder, prostate, or blood vessels. It is often described as “squeezing” and it’s hard to pinpoint exactly where it starts. It starts when a tumor presses on an organ or when it stretches the abdominal cavity.

Your support team

Many health professionals treat cancer patients. It’s worth knowing what each of them does:

• Oncologist – Oversees your treatment plan and coordinates chemotherapy and radiation treatments.
• Pain specialist – Treats the pain that results from tumor growth, treatment side effects, or surgery.
• Radiologist – Reads Computerized Tomography (CT) scans, Magnetic Resonance Imaging (MRI), or Positron Emission Tomography (PET) scans, to find cancer in the body.
• Surgeon – Removes tumors and organs affected by cancer and takes biopsies.
• Palliative care nurse – Skilled care-taker for cancer patients in the late stages of the disease.
• Pharmacist – Checks the safety of chemotherapy drugs and painkillers, ensuring that they can be taken together.
• Other important members of your care team are your family, clergy, counselors, physical therapists.

What to expect on a visit to your pain specialist

• Pain Evaluation. On the first visit, your pain specialist asks where your pain starts, where it travels to, and what makes it worse or better. You learn how to use a scale of 0-10 to rate the level of your pain at different times during the day. This is useful information your pain specialist can use to dose your medications.
• Exam. Your doctor performs a thorough physical exam focused on the neurologic system (reflexes, strength, and balance).
• Review imaging tests. Your pain specialist reviews your X-rays, CTs, MRIs. This helps to plan future procedures for pain relief, such as stimulator and pump implants.
• Follow-up. During follow-up visits, your pain specialist sees if your current medications are helping. Cancer pain changes quickly, as treatments start working and tumors shrink. However, increases in pain may be a sign of a cancer recurrence.

Treating cancer pain

Treatments from your pain specialist are meant to ease your pain so you can stay active, perform everyday activities, and enjoy family time. Treatment is tailored to your needs and based on the type of pain you have. It usually involves a combination of pain-relief medications and procedures that reduce or eliminate the pain.

Medications that treat cancer pain

Pain-relief medications, also called analgesics or pain killers, are often the first-line treatment for cancer pain. The type that can help you, depends on the kind and amount of pain you have. Whether the pain is mild or severe, there are several options, including anti-inflammatories, nerve medications, muscle relaxants, and opioids.

Ongoing or severe pain such as bone pain from cancer metastases requires stronger medications, such as opioids.

Some tips for taking your pain-relief medications:

• Avoid swinging between taking nothing and then taking a large dose of pain medication because you have severe pain. Some people avoid taking their prescribed medications until they absolutely have to. Unfortunately, this only leads to pain spikes that are hard to control. It’s better to take your medications as soon as you feel pain. This will help you take fewer medications in the long run and it will control your pain better.
• You might develop a tolerance for your pain medications if they stop working at the dose that covered your pain well in the past. This is not the same as addiction. If your medication isn’t working as well, talk to your doctor about increasing the dose and adding an adjuvant (helper) drug.
• Make sure to take your adjuvant (helper) medications, as prescribed by your doctor, along with your opioid medications. Some types of pain (nerve pain, inflammation) don’t respond well to opioids and may improve only when you take “helper” medications. Examples: steroids, antidepressants, anti-seizure medications, local anesthetics.

Procedures and devices that treat cancer pain

• Intrathecal (IT) pump. Your pain specialist places a small medical device in your body, where it releases medications directly to your spinal cord. Medications (such as opioids) delivered here can go a long way in reducing your pain. Side effects are considerably lowered.
• Nerve block. Your pain specialist injects a pain-numbing medicine around a painful nerve to block pain messages from reaching the brain. This treatment is used when a tumor presses on a nerve, causing pain. For example, a celiac nerve block can help relieve pain in people with stomach cancer. If the first numbing injection helps you, your pain specialist can offer longer-lasting procedures (nerve ablations).
• Spinal cord stimulator. Your pain specialist places a special device in your back area, close to the spinal cord. It delivers light and non-painful electrical bursts, to block pain signals. This treatment is effective for neuropathic pain, a type of pain that usually requires special treatment.
• Transcutaneous electric nerve stimulation (TENS). This treatment involves a small device that sends mild current through patches that are placed over your painful area. It stays outside your body and it looks like a remote control, with settings that you adjust. You can carry it with you in your pocket or in a small pouch.

Alternative treatments

These treatments ease cancer pain and keep up your energy levels. They include acupuncture, acupressure, massage, physical therapy, relaxation, meditation, and others. They can be used alongside the treatments offered by your pain specialist. However, make sure to check with your pain specialist and oncologist before starting an alternative treatment.

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Overview

Cancer is a major challenge in your life and that of your family. Controlling cancer pain early on will help you reduce the dose of strong medications you have to take. It will help you sleep better and have more energy for your chemotherapy or radiation sessions. Maintain a close working relationship with your pain specialist, to ensure a safe and efficient treatment for your cancer pain.