About one-third of patients being treated for cancer experience pain, which can take many forms. It may be short-lived or long-lasting, mild or severe, or affect one or a few organs, bones or organ systems. Since each patient’s pain is unique, cance pain management treatment plans must be tailored to address individual needs.
Causes of Cancer Pain
Pain from the tumor: Most cancer pain occurs when a tumor presses on bone, nerves or organs. The pain may vary according to location. For example, a small tumor located near a nerve or the spinal cord may be very painful, while a larger tumor elsewhere may not cause discomfort.
Treatment-related pain: Chemotherapy, radiotherapy and surgery can cause pain. Also, certain painful conditions are more likely to occur in patients with a suppressed immune system, which often results from these therapies.
Post-operative pain: Acute, short-term pain resulting from surgery. Relieving post-op pain helps people recuperate from surgery more quickly and heal more effectively.
Treating Cancer Pain
Cancer pain is very treatable. About nine out of 10 cancer pain patients will find relief using a combination of medications. Many medicines are used for cancer pain management. Some drugs are general pain relievers, while others target specific types of pain. Most pain drugs require a prescription.
Mild to moderate pain
Non-opioids: Examples are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Most non-opioids can be purchased over-the-counter without a prescription.
Moderate to severe pain
Opioids: Examples are morphine, hydromorphone, oxycodone, hydrocodone, codeine, fentanyl and methadone.
Tingling & burning pain
Antidepressants: Examples are amitriptyline, imipramine, doxepin and trazodone. Taking an antidepressant does not mean that you are depressed or have a mental illness.
Antiepileptics: Examples include gabapentin. Taking an antiepileptic does not mean that you are going to have seizures.
Pain caused by swelling
Steroids: Examples are prednisone and dexamethasone.
How Pain Medicine is Taken
Most pain medicine is taken by mouth (orally). Oral medicines, either in pill or liquid form, are easy to take and usually cost less than other kinds of medicine. Other methods for administering pain drugs include:
- Rectal suppositories
- Transdermal patches
- Subcutaneous - medicine is placed just under the skin using a small needle
- Subdermal and intramuscular - Injections are placed more deeply into the skin or muscle; not recommended for long-term cancer pain treatment
- Intravenous - medicine is placed directly into a vein through a needle that stays in the vein, allowing patients to adjust how much medicine they receive
- Epidural or intrathecal - medicine is placed directly into the spine using a small tube, providing relief for several hours
Non-Drug Pain Treatments
Your doctor or nurse may recommend certain non-drug treatments for cancer pain management to supplement your pain medication. These treatments will help make your medicines work better and relieve other symptoms, but they should not be used instead of medication.
Biofeedback: A technique that makes the patient aware of bodily processes normally thought to be involuntary (blood pressure, skin temperature and heart rate). Patients can gain some conscious voluntary control of these processes, which can influence their level of pain.
Breathing and relaxation exercises: These methods focus the patient’s attention on performing a specific task, instead of concentrating on the pain.
Distraction: A method used to divert the patient’s attention to a more pleasant event, object or situation.
Heat or cold: Using temperature to facilitate pain control with packs or heating pads.
Hypnosis: A focused state of consciousness that allows the patient to better process information.
Imagery: Using soothing, positive mental images that allow the patient to relax.
Massage, pressure and vibration: Physical stimulation of muscles or nerves can facilitate relaxation and relieve painful muscle spasms or contractions.
Transcutaneous electrical nerve stimulation (TENS): A mild electric current is applied to the skin at the site of the pain.
When Medicine Is Not Enough
Some patients have pain that is not relieved by medicine. In these cases the following treatments for cancer pain management can be used to reduce pain:
Radiation therapy: This treatment reduces pain by shrinking a tumor. A single dose of radiation may be effective for some people.
Nerve blocks/implanted pump: Certain nerve blocks, temporary or permanent, may help relieve some painful conditions. Implanted pain pumps can also provide relief in some patients.
Neurosurgery: nerves (usually in the spinal cord) are cut to relieve the pain.
Surgery: When a tumor is pressing on nerves or other body parts, operations to remove all or part of the tumor can relieve pain.