CANCER PAIN

Today, there is no reason why cancer pain should go untreated or unchecked. Advancements in treatment have led to a wide variety of safe, effective options for the management of pain. If cancer pain is left unattended, it can affect your ability to work, enjoy normal activities, as well as your quality of life.

The following information will help you work with your doctor to manage any pain you may experience from cancer or cancer treatment.

Cancer Pain: What Is It?

First, it is important to recognize that not all people with cancer experience pain. If pain is present, it can be caused by a variety of factors, including some that have nothing to do with cancer. It is not necessary for you to know the cause of your pain to receive treatment, but knowing more may help you to feel in control of the situation. Alerting your doctor immediately about any pain you are having makes treatment more effective.

Cancer Related Pain

Pain caused by the actual cancer generally falls into two categories. Nociceptive pain is caused by damage to tissue. It is usually described as sharp, aching, or throbbing pain. It is often due to cancer that is growing larger, cancer that has spread to the bones, muscles or joints, or a blockage of an organ or blood vessels. Neuropathic pain happens when there is actual nerve damage. It may be caused by a tumor pressing on a nerve or a group of nerves. People sometimes describe this pain as a burning or heavy sensation, or numbness.

One goal of surgery, radiation and chemotherapy is to lessen and control pain caused by tumors by removing or reducing the size of the tumor, thus removing the source of the problem. Pain medications are also used to control pain caused by cancer.

Treatment-Related Pain

Sometimes the solution for treating your cancer might cause discomfort. Immediate (acute) pain from surgery is commonly treated with medications and may go away quickly, such as after the surgical incision heals. Long term (chronic) pain related to surgery, possibly resulting from nerve damage or other associated body changes, needs to be treated according to individual needs.

Chemotherapy at times causes pain in a variety of ways. Some chemotherapy drugs can harm tissues if they leak out of the vein. Special catheters are now used to help prevent this problem. It helps if you report any burning or pain you experience while the chemotherapy is being given to you. The repeated needle sticks required for chemotherapy bother some people. You should ask your doctor whether you are a candidate to receive a port, which is a type of access device placed just under the skin through a minor outpatient procedure. The port only requires a single stick, and is also used for blood draws. Other side effects such as mouth sores, peripheral neuropathy (tingling or numbness in the hands and feet), and nausea can effectively be controlled through medications and modifying your drug regimen. It is most important that you inform your doctor or nurse immediately if you experience any side effects from treatment.

Sometimes the effect of radiation treatment on normal cells causes pain and discomfort. Skin dryness, difficulty swallowing, or skin sores may develop. Ask your radiation therapy nurse to recommend a skin care program to help alleviate these reactions.

Why Is It Sometimes Difficult to Get Treatment for Pain?

With increased knowledge about pain control, it is becoming easier for patients with pain to get the relief they are entitled to. However, there are still some barriers to good pain management that you may need to overcome. You may have to advocate for yourself to get good pain control. Remember that your comfort is an important part of health. Pain relief should be treated as a priority.

What are some of these barriers?

* Not all health care professionals have adequate knowledge about pain control. Requesting a consultation with a clinician who is a specialist in pain management may get you on the right track.

* Insurance companies may not reimburse for pain treatment, or you may lack insurance and pain management may cost too much. Make your doctor aware of any financial considerations, as he/she may be able to prescribe an equally effective treatment that costs less. Also, most drug companies have assistance programs for people who cannot afford medications. For more information, see a local social worker or call The Cancer Care Counseling Line at 1-800-813-HOPE.

* State laws restricting and regulating controlled substances (opioids) may make it difficult for your doctor to prescribe medications. Contacting your state representative and voicing your concern over this issue will help them better understand its importance.

* People are sometimes reluctant to discuss their pain for many reasons:

You want to be a "good" patient who doesn't complain. Doctors want to help you feel the best you can. They can only help if you tell them about your pain.

You fear addiction to pain medication. People do NOT get addicted or "high" from pain medication.

You worry about the side effects from medications. Most side effects can be managed if you report them to your health care team.

You are afraid that medication used over a long period of time will stop working. If tolerance develops, your doctor can safely increase your dosage, prescribe a different drug, or use a combination of drugs.

You may fear that pain means your disease has worsened, which is frightening to face. Remember pain does not necessarily mean your cancer is worse. You will have more energy to fight your cancer if your pain is controlled.

You are not certain how to describe your pain. Read further for more information on this subject.

What Can You Do to Help?

Early treatment for pain is always more effective. As an active participant in your health care, you can take the following steps:

* Inform your doctor or nurse that you are experiencing pain. Don't wait to be asked! Pain should be evaluated at every visit.

* Keep a diary of your pain – where it is, when it begins, when it peaks, when you take medications, and what helps relieve the pain.

* Be precise when describing your pain. Use words like sharp, radiating, aching, pounding, prickly, tight, deep, stabbing, dull, pinching, and tingly.

* Report the severity of your pain. On a scale from 0 to10, where 0 is no pain and 10 is the worst pain you can imagine, how would you rate it?

* Take your medication exactly as prescribed. You may be taking several medications. Be sure you understand when and how to take them, and report any side effects – they can be helped.

* Know how to reach your doctor or nurse after hours, and when you should contact them. For example, severe pain should be reported right away, not at your next appointment.

* Take medication before pain builds up. Pain control is harder to achieve if it is allowed to build to a severe level.

* Use the same pharmacy. They will know what pain medicines to keep on hand and can answer questions about the medicines and side effects.

* Consider non-drug interventions that might help you, including distracting yourself, relaxation techniques, use of heat and cold, massage, and light exercise. Consult members of your health care team (nurse, social worker, and physical therapist) for help in these areas.

The Most Important Thing to Remember: Cancer Pain Can Be Relieved

There are many options for you and your doctor to choose from when trying to control your pain, such as different dosages, medication combinations, changing medications, or routes of administration. If one is not working, communicate with your doctor and find about the other choices you have. Remember that you are the expert on your pain, and you have the right to have your pain acknowledged and relieved. By following these strategies, you and your health care team can become effective partners against pain.