Pain

Pain is a common symptom for those with cancer. Experiencing pain is a helpful indicator that something is wrong. If you have uncontrolled pain that does not allow you to do your daily activities, changes you into a different person, or makes you feel like life is not worth living, talk to your healthcare provider about your options. This tip sheet will provide you the information you need to advocate for better pain control.

 

Types of Pain

  • Acute – Pain that lasts less than 6 months, often associated with an injury. Examples might include pain after surgery or from a broken bone. 
  • Chronic – Pain lasting longer than 6 months and associated with a chronic illness, like cancer.
  • Neuropathic – Pain that is caused by irritation to the nerves. This can be caused by some chemotherapy agents, or when a tumor is located near a nerve.  This pain is described by abnormal sensations like, burning, numbness, pins and needles, ants crawling, etc.
  • Visceral  – Pain related to an organ such as gallbladder pain, liver cancer pain, menstrual cramps, etc.
  • Referred – Pain felt in an area that is not the source of pain. For example, patients with gallbladder pain may feel pain under the shoulder blade, or heart attack pain may go down the left arm.
  • End of dose – Pain that occurs when you are taking a long acting medication and an hour or so before you are due to take the next dose, the pain increases. 
  • Breakthrough – Pain that occurs when your pain is essentially managed by long-acting pain medication and the pain “breaks through.” This may occur if you are doing exercise, or getting in and out of the car.  

 

Describing Pain

This can describe the severity and is often on a scale of 1-10, with 10 being the worst:

  • Mild: 1-3
  • Moderate: 4-6
  • Severe: 7-10

Sharing your level of pain will help your doctor find a pain management solution that works best for you. 

 

Over-the-Counter Medications

  • Tylenol (acetaminophen) – This medication is good for mild to moderate pain and can help to bring down a fever.  When taking any medication, it’s important to read the bottle to make sure you take the appropriate amount and do not take too much. Tylenol can cause liver problems if taken in excess or with alcohol.
  • Non-steroidal anti-inflammatory drug (NSAID) – These are medicines like Advil, Motrin, Aleve and Ibuprofen. These medications can be harmful to the kidney if taken in excess. Check with your healthcare provider on how much you should take and if they might interact with other medications you are taking, including drugs that prevent blood clots.  NSAIDs are good for cancers that have metastasized to bones because they are said to be helpful with managing bone pain. These medications are good for bone metastases because they are antiprostaglandin, and there is a lot of prostaglandins in bone. NSAIDs also come in gel form that can be applied to the skin.
  • CBD products – CBD is a component of the hemp plant, does not contain THC and has been found to help with nausea, sleep, anxiety and pain. This can be used topically, under the tongue, or in pill form. Make sure you are getting it from a reputable distributor.

 

Prescription Drug Medications

Opiates – These medications may only be obtained through a prescription from a doctor.  They help to block feelings of pain. There are many side effects from opiates including sleepiness, nausea, constipation, itching, sweating, and bad dreams. Because of tight regulations, it can be difficult for patients to obtain these medications. Talk to your doctor about your options and, if your oncologist cannot get our pain under control, you may want to see a pain specialist. 

Examples include morphine, dilaudid, oxycodone, opana, methadone, codeine and fentanyl. These act in different ways and are prescribed depending on your needs:

  • Short acting – They work in 20-30 minutes, peak in about 2 hours and wear off in 4-6 hours.
  • Long acting- These are used for patients in constant pain and may last from 8 hours to 3 days. 
  • Rapid acting- these are medications that you put under the tongue or are absorbed in the gums.

 

Side Effects of Prescription Drug Medications

  • Sleepiness – This often happens the first week and then subsides. Your healthcare provider may suggest that you take the medication at bedtime to help your body adjust and not be as sleepy during the day. 
  • Nausea/vomiting – This is often alleviated by taking your medication with food and not on an empty stomach. 
  • Constipation – This is a common side effect of opiates If you are taking opioids daily, especially long acting one, you may need a stool softener or a laxative to help you have regular bowel movements
  • Itching – This may indicate an allergic reaction but not always. Benadryl may help the itching associated with opioids. If itching becomes painful and interferes with daily activities, talk to your doctor.
  • Bad dreams – This is a common side effect of opioids. Vivid dreams, sometimes nightmares, are commonly reported. 

 

Non-Drug Relief

Non-drug pain relief methods can be used along with drugs and other treatments used to manage pain. There are many kinds of non-drug pain relief. Here are a few tips to help you: 

 

Heat

  • May be used for muscle tightness after surgery or arthritic pain. 
  • Heat includes warm to hot baths, heating pads, or hot packs. 
  • Do not place a hot pack directly on your skin because it may burn you. Always wrap a towel or thin cloth around a hot pack.
  • You can make your own hot pack by taking a long sock and filling it with dry rice. Tie the open end of the sock, and heat it by putting it in the microwave for 1-2 minutes. 
  • Safety Tip: Avoid heat to the chest wall and areas that have been exposed to radiation treatment or certain types of chemotherapy. Too much heat to these areas may cause a severe skin reaction.  
  • Avoid heat in your arms, chest or legs if you have any numbness or tingling in the area. 

 

Cold

  • May be used for relief of itching, muscle spasms, nerve pain, and severe pain. 
  • Cold therapy includes ice massage, ice bags, and gel packs. You can get gel packs at the store that are low cost and easy to use. 
  • Ice the painful area until you begin to feel relief.
  • Alternating hot and cold may be more effective than the use of heat or cold alone and may be helpful for severe pain. Alternate every 20 minutes or so between the two. 

 

Lotions

  • Products that contain menthol and provide a feeling of warmth or coolness to an area may help relieve pain. 
  • Lotions such as Ben Gay, Icy Hot and Vicks are often used with sports injuries and are popular home cures.  
  • If you do not have a menthol lotion, you can warm up regular lotions and rub them on the affected area.  
  • Safety Tip: Avoid lotions containing menthol if you have had radiation to the area or if your doctor has told you to avoid the use of aspirin products. 

 

Changing your thinking and behaviors are also helpful in treating pain. These methods help you gain a sense of control and can be good for your mental and physical health. These include: 

  • Aromatherapy – Lavender is relaxing. Ginger helps with nausea. Orange or peppermint are stimulating.
  • Relaxation – Simple relaxation methods, such as deep breathing, may be used for periods of brief pain. 
  • Redirecting thinking and distraction – Thinking about something other than pain or negative feelings that come with pain may help. 
    • Counting, praying, or saying things like “I’ve got this.”
    • Music, television, talking, listening to someone read, or looking at something specific may provide helpful distraction. 
  • Exercise/Stretching – Some individuals find relief in doing yoga or gently stretching and exercising the area in pain. If pain worsens with exercise, do not continue. For individuals  with arthritis, exercise may help keep their joints mobile. If your pain is caused by lymphedema, follow the advice of your doctor or lymphedema specialist for pain management tips.
  • Therapeutic massage, Chiropractor, Acupuncture, Acupressure – These are alternative ways that can help with pain. Finding a practitioner with experience and certification, especially if you have lymphedema, can make a huge difference in your pain levels. 

 

When Do You Need to Seek Help? 

Always talk to your doctor or nurse if the non-drug pain methods are not working. 

 

Useful websites: 

This information was shared by Forge partner and pain management expert Fran Hoh, PhD, APN, ACHPN. She is passionate about helping patients and their families better understand how to manage pain. If you have any questions or concerns, please contact Janet Dees, our Client Services Coordinator, at (205) 990-5367 or [email protected].