Understanding and Managing Pain

Author: OncoLink Team
Last Reviewed: February 26, 2020

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

What is pain?

Pain is whatever the person says it is and exists whenever the person says it does. It is an unpleasant sensation that can be described as causing a vague discomfort or significant distress. It can be stabbing, aching, pinching, throbbing or shooting in nature. Pain can decrease your activity and appetite, cause difficulty sleeping, and 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 usually 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 include:

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

When should I call my 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.
  • Difficulty with side effects from pain medications (e.g. sleepiness, nausea, constipation).
  • Pain that is accompanied by 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 variety of 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 presented to the patient and the patient picks the face that best represents how they are feeling and best describes 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

Description 

Acetaminophen (Tylenol)

Salisytates (Aspirin)

Non-Steroidal Anti-Inflammatory Drugs (NSAID'S) (Ibuprofen, Motrin, Advil, Trilisate, Toradol, Naprosyn)

Acts by:

Blocks pain transmission

Decreases swelling and inflammation

Decreases swelling and inflammation

Used for:

Mild-moderate pain

Mild-moderate pain

Mild- moderate pain

Side effects:

Liver damage

Stomach irritation, hearing changes, bleeding

Stomach irritation, bleeding, kidney damage

Prescription Medications

Description 

Narcotics (Morphine, Dilaudid, Oxycodone, Methadone, Fentanyl)

Anti-convulsants (Dilantin, Tegretol, Neurontin, Topamax)

Anti-depressants (Elavil, Pamelor, Trazedone, Desyrel)

Steroids (Decadron, Prednisone)

Acts by:

Blocks pain transmission

Action in pain relief is unclear

Action in pain relief is unclear.

Decreases swelling and inflammation

Used for:

Moderate-severe pain

"Nerve pain" (tingling, burning or shooting pain)

"Nerve pain" (tingling, burning or shooting pain)

Pain caused by pressure and swelling

Side effects:

Constipation, nausea and drowsiness for the first few days, dry mouth

Drowsiness

Constipation, drowsiness, dry mouth

Fluid retention, stomach irritation, facial flushing, excitation, increased blood sugar, muscle weakness

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, such as the 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 severe, 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 doctor 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 may evaluate the effectiveness of your pain management.

Will I become addicted to my narcotic pain medications?

  • No. Addiction happens with 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 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 do 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 a medication into or around a nerve that is causing pain.
  • Additional ways to decrease pain include:
    • Heat and cold applications.
    • Massage.
    • Acupuncture and acupressure.
    • Relaxation techniques.
    • Guided imagery.
    • Biofeedback.
    • Hypnosis.
    • Counseling.
    • Diversionary activities (watching TV, listening to music.)

Breakthrough Pain

Breakthrough pain (BTP) refers to 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, such as over exerting yourself. People may also have breakthrough pain flares as they reach the end of their dose of long-acting pain medication, signaling that this long-acting dose may not be truly adequate and should be reevaluated by your healthcare team.

How is breakthrough pain treated?

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

What if breakthrough pain is not treated effectively?

Untreated breakthrough pain can have significant consequences for individuals. 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 experience:

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

Pain can be a challenging side effect of cancer and cancer treatments 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. 

References

Glare PA et al. Pain In Cancer Survivors. Journal of Clinical Oncology. 32, no. 16 (June 01, 2014) 1739-1747.

National Cancer Institute. Cancer Pain (PDQ®)-Patient Version. 2020. 

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