Cancer pain: Relief is possible

Not everyone with cancer has cancer pain, but some do. If you have cancer that's spread or recurred, your chance of having pain is higher.

Cancer pain takes many forms. It can be dull, achy, sharp or burning. It can be constant, intermittent, mild, moderate or severe. How much pain you feel depends on a number of factors, including the type of cancer you have, how advanced it is, where it's situated and your pain tolerance.

Most cancer pain is manageable, and controlling your pain is an essential part of your treatment.

What causes cancer pain?

Pain can be caused by the cancer itself. Pain could happen if the cancer grows into or destroys nearby tissue. As a tumor grows, it can press on nerves, bones or organs. The tumor can also release chemicals that can cause pain.

Treatment of the cancer can help the pain in these situations. However, cancer treatments, including surgery, radiation and chemotherapy, also can cause pain.

How do you treat cancer pain?

A number of treatments are available for cancer pain. Your options may depend on what's causing your cancer pain and the intensity of the pain you're feeling. You may need a combination of pain treatments to find the most relief.

Options include:

• Over-the-counter pain relievers. For mild and moderate levels of pain, pain relievers that don't require a prescription may help. Examples include aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others).

• Medications derived from opium (opioids). Opioids are prescription medications used to treat moderate to severe pain. Examples of opioids include morphine (Kadian, Ms Contin, others) and oxycodone (Oxycontin, Roxicodone, others).

  Some opioids are short-acting medicines, so pain relief comes quickly but you may need to take them more often. Other opioid drugs are long-acting medicines, so pain relief takes longer but the medicine doesn't need to be taken as often. Sometimes short-acting and long-acting opioids are used together.

• Other prescription medicines. Other types of medicine can help relieve pain, including antidepressants, anti-seizure drugs and steroids.
• Procedures to block pain signals. A nerve block procedure can be used to stop pain signals from being sent to the brain. In this procedure, a numbing medicine is injected around or into a nerve.
• Integrative therapies. Some people find some pain relief through acupuncture, massage, physical therapy, relaxation exercises, meditation and hypnosis.

Other treatments may be available for your particular situation. In some places, it may be legal to use medical marijuana for cancer pain.

All pain medicines have side effects. Work with your doctor to understand the benefits and risks of each pain treatment and how to manage the side effects. Together you can decide which treatments may be best for you.

What are some reasons for not receiving adequate treatment for cancer pain?

Unfortunately cancer pain is often undertreated. Many factors can contribute to that, some of which include:

• Reluctance of doctors to ask about pain or offer treatments. Health care professionals should ask people with cancer about pain at every visit. Some doctors don't know enough about pain treatment. In that case, request a referral to a palliative care or pain specialist.

  Given current concerns about opioid use and abuse, many doctors might be reluctant to prescribe these medications. Maintaining a close working relationship with your cancer specialists is essential to proper use of these medications.

• Reluctance of people to mention their pain. Some people don't want to "bother" their doctors, or they fear that the pain means the cancer is worsening. Others are worried their doctors will think of them as complainers or that they can't afford pain medications.

• Fear of addiction to opioids. The risk of addiction for people with advanced cancer who take pain medications as directed for cancer pain is low.

  You might develop a tolerance for your pain medication, which means you might need a higher dose to control your pain. Tolerance isn't addiction. If your medication isn't working as well as it once did, talk to your doctor about a higher dose or a different drug. Don't increase the dose on your own.

• Fear of side effects. Some people fear being sleepy, being unable to communicate, acting strangely or being seen as dependent on medications. You might have these side effects when you start taking strong pain medications, but they often resolve once your doctors find the correct level of pain medications for you and once you achieve a steady level of pain medicine in your body.

How can you help your doctor understand your cancer pain?

If the pain interferes with your life or is persistent, report it. It might help to keep track of your pain by jotting down:

• How severe the pain is
• What type of pain (stabbing, dull, achy) you have
• Where you feel the pain
• What brings on the pain
• What makes the pain worse or better
• What pain relief measures you use, such as medication, massage, and hot or cold packs, how they help and any side effects they cause

Using a pain-rating scale from 0 to 10 — with 0 being no pain and 10 being the worst pain imaginable — might help you to report your pain to your doctor.

What steps can you take to ensure you're receiving adequate cancer pain treatment?

First, talk to your doctor or health care provider about your pain.

Second, you and your doctor can set a goal for pain management and monitor the success of the treatment. Your doctor should track the pain with a pain scale, assessing how strong it is. The goal should be to keep you comfortable. If you aren't comfortable, talk to your doctor.

If you're not getting the answers you need, request a referral to a facility skilled in the care of pain. All major cancer centers have pain management programs. The medications and treatment for pain are generally covered by standard insurance.