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Pain Management

Facts about cancer and cancer pain

Having cancer does not always mean having pain. However, for those who do experience pain, you do not have to accept it as a normal part of having cancer. There are many different methods to control cancer pain. When you are free of pain, you can sleep and eat better, enjoy the company of family and friends, and continue your work and hobbies. Tell your doctor and nurse when you have pain, since only you know how much pain you have.

Cancer pain can almost always be relieved

There are many medicines and cancer treatments and ways of administering them, as well as interventional procedures and surgical techniques that can relieve pain. You should expect your care providers to attempt to relieve your pain. However, if you are in pain and your physician seems to have no other options, ask to see a pain specialist. Pain specialists may be oncologists, anesthesiologists, neurologists, or neurosurgeons, other doctors, nurses or pharmacists. A pain control team may also include psychologists and social workers.

Controlling your pain is part of the overall treatment for cancer treatment

Discussions about pain are a vital part of your cancer treatment t . Tell your doctor about what seems most effective in controlling your pain, and what doesn't work. Sometimes the cancer itself as well as its treatment causes pain. Be sure to tell your doctor what kind of pain you're experiencing, so that he or she can better understand how the cancer and cancer treatments are affecting your body.

Preventing pain is easier than treating pain when it becomes severe

Pain is most easily relieved when it is treated early. You may hear some people refer to this as "staying on top" of the pain. Do not try to tolerate the pain or hold off as long as possible between doses of pain medicine. The pain may get worse if you wait, and it may take longer or require larger doses for your medicine to give you relief if not consistently treated.

You have a right to ask for pain relief

Not everyone feels pain in the same way. There is no need to be "stoic" or "brave" if you have more pain than others with the same kind of cancer. As soon as you have any pain, please speak up, let us know. Telling the doctor or nurse about pain is not a sign of weakness. Remember, it is easier to control pain when it starts rather than waiting until it becomes severe.

People who take narcotics for cancer pain rarely become addicted

Addiction is a common fear of people taking pain medicine, and such fear may prevent people from taking their medicine. Unfortunately, this fear sometimes causes family members to encourage you to "hold off" as long as possible between doses. Addiction is defined as uncontrollable drug craving, seeking and use. When narcotics such as morphine are taken for pain, they rarely cause addiction. When you are ready to stop taking narcotics, the doctor will lower the amount of medicine you are taking step-by-step. By the time you stop using narcotics completely, the body has had time to adjust and you will not go through a painful narcotic withdrawal. Talk to your doctor, nurse or pharmacist about how to use pain medicines safely and about any concerns you have about addiction.

People do not get "high" or lose control when they take cancer pain medicines as prescribed by the doctor.

Some pain medicines may cause you to feel sleepy or intoxicated when you first take them. This feeling usually disappears within a few days. Sometimes, as you become drowsy from the pain medicine, you are able to catch up on the sleep you missed when you were in pain. On occasion, people feel confused or out of control when they take pain medicines. Tell your doctor or nurse if this happens to you. Changing your dose or type of medicine can usually resolve the problem.

Side effects from cancer pain medicines can be managed

Some medicines used for cancer pain control can cause constipation, nausea and vomiting, or drowsiness. Your doctor or nurse can help you manage these side effects. These problems usually resolve after a few days of taking the medicine. Most side effects can be managed simply by changing the medicine or the dose or times when the medicine is taken.

When pain is not treated properly, you may be:

  • Tired
  • Depressed
  • Angry
  • Worried
  • Lonely
  • Stressed

When cancer pain is managed properly, you can:

  • Enjoy being active
  • Sleep better
  • Enjoy family and friends
  • Improve your appetite
  • Enjoy sexual intimacy
  • Prevent depression

Surgical, radiation and anesthetic procedures for cancer pain

Surgery, radiation, and anesthetic techniques may be useful in the treatment some forms of cancer pain. Surgery may be used to reduce the size of tumors, move the tumor out of the path of obstructing the digestive system, alleviate pressure on nerves, or drain fluids related to cancer growth (ascites). Sometimes surgery is also used to stabilize bones that have been treated by radiation or chemotherapy to reduce the pain from bony or spinal metastases.

Neurological surgery techniques may also be used in order to relieve cancer pain. These procedures fall into 3 main categories: 1) pain pumps; 2) stimulators; 3) ablative procedures.

Neurosurgical techniques

Pain Pumps - In some instances of cancer pain management, pain cannot be well controlled by narcotics, or the narcotics cause undesirable side effects such as drowsiness that cannot be controlled. In some of these cases, catheters placed into the spinal fluid spaces in the lower spine or brain can deliver narcotic pain relievers such as morphine directly into the spinal fluid, producing excellent pain relief without the side effects of systemic (oral or intravenous) narcotics. These pumps are inserted into the spinal fluid by a neurological surgeon and then loaded with a narcotic, such as morphine, directly delivering the drug into the spinal fluid, producing pain relief.

Stimulators - In some cancer patients, a tumor invading nerves or post-surgical nerve pain cannot be well controlled with any form of narcotics. This type of regional pain may be controlled by placing a small electrode on a peripheral nerve, the spinal cord or the brain. The electrode allows the passage of an electrical current around the nerve or spinal cord, which can interrupt the passage of pain sensation from the nerve to the brain. Instead of a painful sensation, the patient usually feels numbness or tingling over the affected area.

Ablative Procedures - Sometimes, none of these techniques are capable of controlling severe cancer pain. In these circumstances, ablative techniques, in which nerves, spinal cord or brain tissue are purposefully destroyed, may be used. In these cases, procedures such as neurectomy, cordotomy or cingulotomy (referring to anatomical location of tissues in the nervous system), may be used to ablate, or remove, tissues involved in the transmission or perception of pain.

Palliative Radiation

In some cases of cancer pain, tumors generate pain by invading and expanding bone, or pressing on nerves, causing severe pain. Radiation therapy can temporarily shrink the tumor, relieving the pressure on the bone or nerve. As the tumor shrinks, the pain resolves, or becomes more manageable with narcotic pain medicines.

Anesthetic Procedures

Anesthetic procedures is a catch-all term that includes a variety of pain-relieving techniques. These usually involve placement of a needle through the skin to deliver a drug, or a catheter or electrode through the skin.

Nerve blocks - Nerve blocks involve the injection of anesthetic medication into specific areas of the body where pain is experienced, notably the nerves. Medications sometimes used for nerve blocks include lidocaine or bupivacaine, used alone or in combination with corticosteroids. The effectiveness of nerve blocks is usually tested by doing what is called a "temporary block" first and if this brings relief, then a "permanent" nerve block may be performed. Permanent blocks are not usually permanent, but may provide three to six months of pain relief.

Radiofrequency ablation - While the patient is sedated, a radiologist uses X-ray guidance (fluoroscopy) to place a special needle to deliver radiofrequency current into a nerve. The radiofrequency current heats and destroys the nerve tissue, providing pain relief in a fashion similar to that provided by surgical nerve severing procedures (neurectomy). This procedure has few side effects and can provide pain relief for some kinds of pain for several months. It can also be repeated when necessary.

Epidural catheters - These techniques are similar to the pain pump procedures described above. An anesthesiologist places a catheter (a small tube) adjacent to the spinal cord into the epidural space. Narcotics, local anesthetics or corticosteroids can then be delivered into this spaced, providing pain relief.

Adjuncts to cancer pain therapy: Non-drug approaches

These are methods that can help supplement pain medications and other forms of pain relief, and are generally not intended to resolve pain all by themselves.

  • Heat: Heat can relax muscles and ease spasms, as well as encourage circulation in the body. Warm packs and heating pads can bring comforting relief. Be sure not to apply heat to tumor sites or to areas that have recently been radiated. Apply heat for 10-20 minutes, then remove it for the same amount of time before applying again, if needed.
  • Cold: Cold, usually in the form of a cold pack wrapped in one or more layers of cloth to prevent direct contact with the skin, is excellent for reducing inflammation and can help ease nerve pain. Use cold packs carefully, keeping them applied to the body for no more than 10-20 minutes at a time, repeating as needed after rest periods of the same amount of time.
  • TENS: TENS stands for transcutaneous electrical nerve stimulation. This is a low voltage current that is transmitted to the body via electrodes placed on the skin. A portable battery is used as the power source. A tingling sensation is felt (and may be adjusted in intensity, for comfort). Often, the tingling sensation over the site of pain can reduce the amount of pain perceived. A health care professional can instruct you in placing the electrodes and using the equipment.
  • Positioning: Using orthotic devices can immobilize and support painful or weakened areas of the body. Examples of orthotic devices include a splint on a painful limb or a collar for patients with neck or back pain. When cancer has weakened bones, positioning can provide relief in some instances.

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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