Patient education: Managing pain when you have cancer (The Basics)

What can cause pain in people with cancer? — People with cancer can have pain from the cancer or from the cancer treatments. People can also have pain from other conditions, such as arthritis, that have nothing to do with their cancer.

Is there anything I can do on my own to feel better? — Yes. To feel better, first try to avoid doing the things that make your pain worse. It can also help to try to find different ways to relax. For example, you can do relaxation exercises or meditate.

If you have pain, it's important to keep track of your pain and how you treat it. That way, your doctor can use this information to treat your pain better. Keep a list of the medicines you take, how much they ease the pain, and how long the pain relief lasts. When you describe your pain, you can give it a number from 1 to 10. 1 would be "no pain," and 10 would be "unbearable" (the worst pain ever) (figure 1).

When should I call my doctor or nurse? — Call your doctor or nurse if you have:

●Any change in the type of pain you have or where the pain is located

●Pain that is new

●Long-term pain that gets worse or does not get better with treatment

Which medicines work best on cancer pain? — Doctors usually use medicines called "opioids" to treat cancer pain. These include morphine (sample brand names: MS Contin, MSIR), oxycodone (sample brand names: OxyContin, Oxy IR), and fentanyl (sample brand names: Duragesic, Fentora).

Opioids work in different ways. Depending on the specific type, they can:

●Start to work slowly and have effects that last a long time, treating pain over many hours – These medicines usually come as a slow-acting (called "sustained release") pill, or as a patch that goes on the skin.

●Start to work quickly and have effects that last a short time, to treat pain that starts or gets worse suddenly – These medicines usually come as a fast-acting (called "immediate release") pill, liquid, tablet that melts under the tongue, or spray that can be used under the tongue or in the nose.

Doctors usually prescribe both types of opioids to treat long-term or "chronic" pain in people with cancer. Most people use a slow-acting opioid every day to prevent pain. If they have episodes of pain (sometimes called "breakthrough pain") while they are taking the slow-acting opioid, then they can also take a fast-acting opioid to control the pain.

Depending on your symptoms and other conditions, your doctor might prescribe other types of medicines to treat pain. Most of the time, people take these medicines in addition to their opioids. Other medicines can include:

●Acetaminophen (brand name: Tylenol) or a group of medicines called "NSAIDs" – NSAIDs include ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand names: Aleve, Naprosyn).

●Medicines that are usually used for other conditions – Some medicines that treat other issues can also help with certain types of cancer pain. Examples include steroids, antidepressants, and medicines used to treat bone problems. These medicines are usually used along with opioids in people with cancer pain, but sometimes they can be used without opioids.

What else should I know about my pain medicines? — You should know that:

●It's important to take your slow-acting opioids as prescribed, even if you aren't in pain. The goal of treatment is to keep your pain under control all the time, and not just treat it when it happens. If you aren't in pain, it means that the pain medicines are working.

●You need to let your doctor or nurse know if your medicine isn't helping enough with your pain, or if the effect isn't lasting long enough between doses. Your doctor can increase your dose, increase how often you take your medicine, or prescribe a different medicine.

●Opioids can have side effects. Common side effects include constipation, sleepiness, and nausea. Let your doctor or nurse know if you have any side effects. That way, they can treat your side effects or change your medicine.

●Taking opioids for a long time might increase your risk of getting certain infections. Your doctor can talk to you about your risk and whether there are things you can do to help prevent infection.

●Store your opioids in a safe place, such as a locked cabinet. This will prevent children, teenagers, or anyone else from getting to them.

●You will not get addicted to your opioids. People often worry that they are getting addicted to their medicine when they need higher and higher doses to treat their pain. This can be a concern for people who use opioids inappropriately. But it is not the case for people who need treatment for cancer-related pain. Your body might need higher doses because your condition is getting worse, or because you have a higher "tolerance" for the medicine. Tolerance is when a body gets used to a medicine, so the medicine doesn't work as well as it used to. Tolerance is not the same as addiction.

Are there other kinds of treatments that can help with pain? — Yes. If your medicines don't ease your pain enough, talk with your doctor or nurse about other possible treatments. Depending on your symptoms and the cause of your pain, they might recommend a procedure. This could include getting a shot of medicine into the painful area, or a procedure to "deaden" the nerve that leads to the painful area.

They might also recommend that you work with a physical therapist, mental health expert, or "alternative medicine" expert. Alternative medicine approaches that might be helpful include treatments such as acupuncture and massage.

More on this topic

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