Cancer Pain Management
Nearly half of cancer patients experience pain, which can show up in various ways. It may be short-lived or long-lasting, mild or severe, or even affect one or a few organs and bones. Since your pain is unique, we tailor treatment plans for cancer pain management to address your needs.
Causes of 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 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 is often a result of these therapies.
Post-operative pain: Relieving pain resulting from surgery helps people recuperate more quickly and heal more effectively.
Treating Pain
Cancer pain is very treatable. About nine out of 10 cancer pain patients 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 and may require a prescription.
Mild to moderate pain
Non-opioids: Examples are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), like 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: An example is 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 either in pill or liquid form. Oral medications are easy to take and usually cost less than other kinds of medicine. Other methods for administering pain drugs include:
- Rectal suppositories
- Transdermal patches
- Injections
- 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 Treatment Options
Your doctor or nurse may recommend non-drug treatments for managing your cancer pain in addition to your pain medication. These treatments will help 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 shift 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 assist with 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
You may have pain that is not relieved by medicine. If so, consider these methods 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.
As a cancer patient, your top priority is to survive, so you may not think about mentioning any pain associated with your disease or treatment to your care team.
“Many patients aren’t aware of the medications and procedures that can improve their quality of life,” says Salahadin Abdi, M.D., Ph.D., professor and chair of Pain Medicine. Education and communication are key to ensure you get all of the cancer pain management help you need from your care team.
Here, Abdi shares advice for discussing your cancer pain so that you can find relief.
Speak up about your cancer pain
It’s important to know you’re not alone in experiencing cancer pain. “Pain is very common, even in the early stages of the disease,” Abdi says. He advises patients not to wait to speak up.
As cancer progresses, the pain associated with the cancer itself or the treatment becomes more significant. That’s why it’s important to notify your care team early on to ensure a better quality of life.
Include your family in cancer pain management
Cancer pain affects not only the cancer patient, but also the patient’s family. Sometimes patients feel as though people don’t believe their pain exists so they feel isolated. “I like when patient and the caregivers come to see me together so that everyone’s on the same page, everyone is educated and understands cancer pain,” Abdi says.
In addition, caregivers should stay open to what patients have to say. Showing compassion and just listening to them is part of the healing processes, Abdi says.
Communicate your cancer pain management goals
When meeting with your cancer pain care provider, be open about your expectations. You and your doctor should set a realistic goal for your pain relief to help guide decision-making. It’s possible your goal will change as your treatment plan changes, but here are a few examples:
- walking with reduced discomfort
- sleeping through the night
- returning to work
“It’s about being functional, enjoying life and doing things that you normally like to do,” Abdi says.
Finding relief for your cancer pain
There are many ways to address the various types of cancer pain, and not every approach uses medication.
For mild pain, your care provider may suggest non-opioids such as acetaminophens or ibuprofen.
For more intense pain, you may also be prescribed opioids such as morphine or codeine. Some patients fear addiction to opioids, but Dr. Abdi says those cases are rare if you follow your doctor’s recommendation and it shouldn’t discourage you from discussing your concerns with your doctor.
Other types of cancer pain include swelling, tingling and burning, which all have medications available to help relieve your discomfort.
There are also treatments techniques that don’t use medication. Examples of non-drug treatments include:
- breathing exercises
- massage therapy
- ice and/or heating pads
- prayer and meditation
- acupuncture
- physical therapy
- transcutaneous electrical nerve stimulator (TENS)
Your doctor may prescribe one of the methods above or a combination, depending on the type of pain, your goals and the location and severity of your pain.
Address psychosocial issues, too
Many times, physical pain isn’t the only side effect that patients experience. Many chronic pain patients also experience some degree of depression, anxiety or fear. If you feel blue, anxious or worried, Abdi recommends speaking with your care team about these issues no matter how minor they may seem.
“You’re not in this alone. Telling your care team about your anxiety or fear will help us relieve it that much sooner and improve your quality of life,” Abdi says. At the MD Anderson Pain Management Center, our pain psychologist can help you develop strategies to cope with the emotional and psychological challenges of cancer treatment and pain. So can our Psychiatric Oncology Center and your social work counselor.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Patient Tip
Nearly half of cancer patients experience pain caused by the cancer itself, cancer treatment or factors that aren’t related to cancer. When pain isn’t treated properly, it can interfere with sleep, quality of life and even how effective your treatment is.
Although cancer pain is common, there’s a lot of misunderstanding surrounding pain and the options for managing it. Here are four cancer pain management misconceptions Uzondu Osuagwu, M.D., commonly hears.
Myth: Pain is just a physical issue.
Truth: Pain can often coexist with anxiety, stress or depression. Patients who face these emotional side effects of cancer may experience chronic joint pain, back pain or gastrointestinal issues. So pain is not just a physical health issue.
“If pain is keeping you from doing the things you enjoy or impacting your sleep, you may experience mood changes or increased anxiety,” Osuagwu says. “It’s important to tell your care team about any pain and mental health challenges you’re experiencing, so they can recommend the right treatment plan for you.”
A therapist or social work counselor can help you navigate some of the causes of your stress and anxiety -- such as transportation issues, financial and family concerns -- and develop strategies to cope with them. If you’re an MD Anderson patient, you can request a referral to our pain psychologist for help addressing the causes of your pain.
Myth: Medication is the only option for cancer pain relief.
Truth: There are a lot of options when it comes to managing pain without medication. “The goal of pain management is to improve your quality of life,” Osuagwu says. “Whether you want to be able to simply get out of bed without pain or go on a trip with your family, there are many different options we can use help you achieve those goals.”
Physical therapy, oncology massage, deep breathing, yoga and acupuncture may relieve your symptoms. MD Anderson patients can access these clinical services and others through our Integrative Medicine Center.
If you have more serious pain that isn’t relieved by these techniques or medications, your doctor may recommend another approach, such as a neurolytic procedure. With this method, the nerves that are causing pain are chemically or thermally impaired to prevent them from sending pain messages to the brain. This treatment may relieve pain for several months, but the pain will return when the nerves grow back.
Spinal cord stimulation is another option for patients with severe pain, like a pinched nerve or chronic back pain. Using a battery-operated implant similar to a pacemaker, spinal cord stimulation targets pain with a mild electrical current that prevents nerve triggers from reaching the brain.
Myth: Once I’ve completed cancer treatment, my pain will stop.
Truth: It’s not always possible to reach a point where you have no pain. Depending on your type of cancer and treatment, some pain may never go away.
It’s important to speak with your care team often to discuss potential side effects you may experience during and after treatment – and when and how long you can expect these.
For example, many chemotherapy drugs -- like cisplatin, taxol and vincristine – can cause neuropathy, which is numbness, tingling or shooting pain resulting from nerve damage. While most patients will have complete relief or experience only mild tingling after completing treatment, it can be difficult to predict how long nerve pain or neuropathy caused by cancer treatment may last. Unfortunately, neuropathy symptoms may not ever improve for some patients.
“While we may not always be able to make the pain go away, medications and physical therapy can help you maintain normal function,” Osuagwu says.
It’s important to work with your doctor to set a personal pain goal – that is, the level of pain you can manage and still perform your daily activities. Identifying your personal pain goal will help you and your health care team make decisions about your pain management options.
“Your ability to function in the context of that pain is what’s most important,” adds Osuagwu.
Myth: The only pain my care team can help manage is cancer pain.
Truth: You may have pain that has nothing to do with cancer but that affects your comfort during cancer treatment. This may include headaches, muscle strains, or something more severe like back pain or arthritis.
Most of the time, these issues can be treated along with the cancer. Ask your care team what you can take for these everyday aches and pains. Depending on the severity of your pain, your doctor may prescribe a muscle relaxer or suggest a non-steroidal anti-inflammatory drug.
“We’re here to make your experience as comfortable as possible,” Osuagwu says. “There’s no need to suffer. If you’re experiencing pain, we’re here to help.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.