What Causes Cancer Pain?

If you have cancer pain, the severity and prevalence of your pain may depend on many factors, including the type of cancer, the site (location) and stage (extent) of your disease, and your pain threshold (or tolerance for pain). You may experience pain from the cancer itself, or as a side effect of cancer treatment.

Cancer pain that lasts a few days or longer may result from:

• The tumor causing pressure on tissues, bones, nerves or organs
• Poor blood circulation because the cancer has blocked blood vessels
• Blockage of an organ or tube in the body
• Metastasis – cancer cells that have spread to other sites in the body
• Infection or inflammation
• Side effects from surgery, radiation therapy, chemotherapy or immunotherapy
• Stiffness from inactivity
• Psychological responses to illness, such as tension, depression or anxiety

How is Cancer Pain Treated?

Most cancer pain can be controlled with treatment. Cancer pain may be treated with medication (e.g., analgesics, also called “pharmacological pain relief”), without medication (e.g., non-drug treatments, also called “noninvasive measures”), with other treatments, or using a combination of methods.

Medications for pain

The following list includes a broad group of pain medications: 

• For mild to moderate pain – Nonopioids (e.g., acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen)
• For moderate to severe pain – Opioids (e.g., morphine, hydromorphone, oxycodone, hydrocodone, codeine, fentanyl, methadone)
• For tingling and burning pain – Antidepressants (e.g., amitriptyline, imipramine, doxepin and trazodone) or Antiepileptics (e.g., gabapentin, other medications)
• For pain caused by swelling – Steroids (e.g., prednisone, dexamethasone)

NOTE:  You should always ask your doctor for advice before taking any medication for pain. Medications are safe when they are used properly.

Non-drug treatments for pain

Non-drug treatments may be used to help manage cancer pain. In fact, some people may find that they can take a lower dose of medication by incorporating some of the following techniques:

• Relaxation techniques, meditation, imagery, visualization, distraction
• Deep breathing
• Massage, skin stimulation
• Exercise, physical therapy
• Hypnosis/Hypnotherapy
• Biofeedback
• Cold or Heat
• Transcutaneous Electric Nerve Stimulation (TENS)
• Acupuncture
• Emotional support and counseling
• Spiritual help

NOTE:  You should always report any new pain problems to your doctor before trying to relieve pain with non-drug pain methods. 

Medical treatments that may help relieve pain

• Radiation therapy: Aims to reduce pain by shrinking a tumor.
• Surgery:  When a tumor is pressing on nerves or other body parts, surgery to remove all or part of the tumor can relieve pain.
• Neurosurgery: Pain nerves (usually in the spinal cord) are cut to relieve the pain.
• Nerve blocks (“neurological pain relief”):  Pain medication is injected around a nerve, or into the spine, to block pain messages.

Tips for Understanding Cancer Pain

• The best way to control pain is to stay on top of it.  Pain is best managed and relieved when treated early, rather than waiting until it becomes severe. This means you should notify your doctor as soon as you have any pain. Also, you should take your pain medication as instructed by your doctor. Do not try to "hold off" as long as possible between doses. Pain may get worse if you wait, and it may take longer or require larger doses of medication to get relief. 
  
  
• Everyone experiences pain differently.  Not everyone feels cancer pain in the same way. Others with the same cancer type as you, who are undergoing the same treatment, may experience pain differently. Only you know how much pain you have.
  
  
• You have a right to pain relief and you should insist on it.  You deserve to get relief from pain. You should never view discussing your pain as a sign of weakness. Knowing about your pain will help your doctor better understand how your cancer and cancer treatments are affecting your body.
  
  
• Cancer pain can usually be relieved. There are many different medications and methods available to control cancer pain. Some medications can cause side effects, such as constipation, nausea and vomiting, or drowsiness. However, these problems usually go away after a few days of taking the medication. Your doctor can help you manage any side effects from medication (e.g., by changing the medication, dosage, etc.).

Tips for Managing Cancer Pain

• Talk about your pain. Keep your doctor fully informed about the details of your pain. Only you know where your pain is located, how it feels, how much it hurts and what makes it better. Your doctor needs to know right away if you have any new pain, if your pain is getting worse, or if your pain medication is not working. If you are seeing more than one provider, be sure all parties are aware of the medications you are taking. 
• Develop a plan for pain management. Work with your doctor to develop a pain management plan that meets your needs. You and your doctor should discuss your pain control activities; including a schedule for when and how to take your medication, and other methods you can incorporate to alleviate your pain.
• Take your pain medication on a regular schedule as instructed by your doctor. Do not skip doses of your medication, or wait for the pain to get worse before taking your medication. This usually means taking it on a regular schedule, and around-the-clock, even when you are not feeling the pain. Once you feel the pain, it is harder to get it under control.
• Keep track of your pain.  You may find it difficult to communicate your pain experience to your doctor. To help you describe your pain, keep a record or a journal to track your pain. This will help your doctor figure out what method of pain control works best for you. Your records may include information about the following:

• Location of your pain. It may be in more than one place. Try to determine all of the painful areas.
• How your pain feels. Does it ache, burn, or tingle? Is it sharp, dull, throbbing, or steady? There are various methods used to rate pain. One method is to describe your pain in words, such as “none," "mild,” “moderate,” "severe,” or “worst possible pain.” A number scale rates pain from 0 to 10, where 0 means no pain and 10 means the worst pain you can imagine. Practitioners also use picture scales that illustrate facial expressions to assess pain levels.
• What makes your pain feel better or worse. You may have found ways to make your pain feel better (e.g., using heat or cold, taking certain medications, etc.). Try to keep track of which activities affect your pain (e.g., sitting or lying in certain positions, walking up or down stairs, etc.). 
• The effectiveness of your pain treatment. Keep track of the name and dose of your pain medication, the times you take it, any side effects, and any other pain relief methods you use. Think about how much of your pain is relieved with your pain treatment.
• If your pain has changed.  You may notice that your pain gets better, worse, or different over time. Keep track of how pain changes in response to treatment, activities, or time of day.
  

Pain Management at CTCA

At Cancer Treatment Centers of America (CTCA), we are here to help you fight cancer by treating your whole-person, not just the disease. Aside from offering cutting-edge cancer treatment options for you, we strive to address the factors that could inhibit your treatment. We understand that unrelieved pain can affect your eating, sleeping, activity, mood, concentration and even your immune system. That is why we developed a separate Pain Management Program—to give pain the recognition and attention it needs.

Upon your arrival one of our CTCA hospitals, you will have an initial evaluation by one of our pain management practitioners, including an assessment of your pain. Since each person experiences cancer differently (i.e., patients vary in diagnosis, stage of disease and responses to treatments), we manage cancer pain on an individual basis. Your pain management practitioner will work closely with you to develop a pain management plan tailored to your unique needs.

Your personalized pain management plan will include techniques to help control your cancer pain and/or alter your perception of it. This may include pharmacological pain control, non-pharmacological pain control, or other pain relief methods. Because of the complex nature of cancer-related pain, successful pain management usually involves a combination of techniques. 

At CTCA, your pain management practitioner will work closely with you throughout your care to help relieve your pain. You will also have access to educational resources to help you better understand cancer pain. Furthermore, your pain management practitioner will consult regularly with other members of your care team to balance pain medication with supportive options, such as oncology rehabilitation, mind-body medicine and spiritual support. For instance, our mind-body medicine team offers relaxation techniques, guided imagery, visualization and other pain relief methods. 

Our pain management team aims to empower you to make judgments and decisions free from the distraction of pain. We aim to not only bring you relief from pain, but also to help improve your overall sense of well-being and quality of life.  At CTCA, your fight is our fight.

I hope this information has helped you in some way. I will check in with you again next month. In the meantime, stay strong and hopeful.