Understanding and Managing Pain

This article goes over basic information about pain. If you have other questions or would like more information, please talk to your care team.

What is pain?

Pain is whatever you say it is and exists whenever you say it does. It is an unpleasant feeling that can be described as causing a vague discomfort or a lot of distress. It can be stabbing, aching, pinching, throbbing, or shooting in nature. Pain can decrease your activity and appetite, cause you to have a hard time sleeping, and can make you feel anxious or depressed.

Pain can be described as acute or chronic. Acute pain is temporary and lasts for a short time. It is often felt in one area and is easy to describe. Chronic pain lasts for long periods of time. It is not always in one area and can be hard to describe. Often patients with chronic pain "don't look like they are in pain."

What causes pain?

Pain is caused by damage to the body's tissues. Some common causes are:

• Cancer or a tumor putting pressure on or damaging organs, nerves, or bones.
• Some cancer treatments like surgery, radiation, chemotherapy, and growth factors.
• Other diseases (like arthritis).
• Infections.
• Blocked blood vessels.
• An acute injury. 

When should I call my provider?

You should call your provider if you have:

• Any new pain, especially if it is constant or severe.
• An increase in the amount or frequency of pain that you have.
• Pain that does not get better after taking pain medication or returns before the next scheduled dose.
• A hard time with side effects from pain medications (e.g. sleepiness, nausea, constipation).
• Pain that comes with numbness, tingling or weakness of arm or leg, trouble walking, urinating, or having a bowel movement.

What is a pain scale?

A pain scale is a way of describing how bad the pain is. Pain scales are used to help treat the pain correctly. There are a few scales, but the numeric scale from 0-10 is most often used. On the 0 to 10 scale, 0 means no pain, and 10 means the pain is as bad as it can get. Another scale commonly used for children and for those who have trouble using the numeric scale is the "faces" pain scale. Different faces are shown to the patient and the patient picks the face that best represents how they are feeling about their pain.

How is pain treated?

Medications are usually used to treat cancer-related pain. Do not take any medications, even over-the-counter medications, before talking to your provider. Some can have side effects that are a concern for oncology patients. Some commonly used medications are:

Non-prescription (Over the Counter) Medications

Prescription Medications

Remember: Do not take any medications, even over-the-counter medications, without first checking with your provider. Take medications only as prescribed.

How often should I take my pain medications?

• Take the medication as prescribed by your provider. Most pain medications start to work in 30 to 60 minutes. Other medications, like anticonvulsants and antidepressants that are used to treat some types of pain take a few days to start working.
• It is important to take the medication as soon as you start to feel the pain. If you wait until the pain is bad, it will take more medication and a longer period of time to control the pain.
• If you need multiple doses a day of narcotic pain medication, your provider may prescribe a "long-acting" pain medication.
• You should keep a record of how often you take your pain medication and how much relief you feel. Share this record with your care team so that they can know how well your pain is managed.

Will I become addicted to my narcotic pain medications?

• No. Addiction happens with the use and abuse of the drug for nonmedical purposes (getting high). You are taking it for pain, which is what it is for, and taking it as prescribed by your provider.
• Anyone taking narcotic pain medications on a regular basis may have physical withdrawal symptoms if the medication is stopped suddenly. Withdrawal can be avoided by gradually decreasing (slowly over time) the amount of pain medication as directed by your provider.

Can I drive while taking pain medications?

Some pain medications can cause drowsiness. Your provider may not recommend driving while you are taking pain medications. Please be sure to check with them before you drive. Avoid or limit the use of alcohol and other sedating medications as these can increase sleepiness, especially when combined with pain medications.

Are there any other ways to treat pain?

Yes, there are many ways to treat pain that are not medications:

• If the pain is being caused by a cancerous tumor, your provider may recommend treatments such as surgery, chemotherapy, or radiation therapy to remove the tumor or decrease its size.
• A nerve block is a method of injecting medication into or around a nerve that is causing pain.
• Other ways to decrease pain are:
  • Heat and cold packs.
  • Massage.
  • Acupuncture and acupressure.
  • Relaxation techniques.
  • Guided imagery.
  • Biofeedback.
  • Hypnosis.
  • Counseling.
  • Activities to distract you (watching TV, listening to music.)

Breakthrough Pain

Breakthrough pain (BTP) is a sudden flare of pain that "breaks through" the long-acting medication prescribed to treat chronic pain. These flares may be caused by disease, treatment, or other unrelated factors, like overdoing it with chores or activities. People may also have breakthrough pain flares as they reach the end of their dose of long-acting pain medication, meaning that this long-acting dose may not be enough. Talk with your care team if you find this is the case.

How is breakthrough pain treated?

With proper monitoring and treatment, breakthrough pain - like most pain - can be successfully managed. It is different from persistent pain and needs different treatment. Breakthrough pain medication is taken on an as-needed basis, as soon as symptoms start. It is prescribed in addition to long-acting pain medication.

What if breakthrough pain is not treated effectively?

Untreated breakthrough pain can affect your daily life. Without treatment, breakthrough pain flares can harm a person's sense of well-being, interfere with daily activities, and may even interrupt your treatment schedules.

As discussed above, you must call your provider if you have:

• Any new pain, especially if it is persistent or severe.
• An increase in the amount or frequency of pain that you have.
• Pain that does not improve after taking pain medication or if it returns before the next scheduled dose of breakthrough medication.
• A hard time with side effects from pain medications (e.g. sleepiness, nausea, constipation.)
• Pain that comes with numbness, tingling, or weakness of arm or leg; having a hard time walking, urinating, or having a bowel movement.

Pain from cancer and its treatments can be hard to live with, but it can be treated effectively in many cases. Do not hesitate to talk with your care team regarding any pain management issues you are having.