Living with Cancer

Cancer Pain

No. Some people with cancer have no pain.
Your doctor may be able to tell you if you're likely to have pain, for example, if a treatment may cause pain. Doctors can't always predict whether a person will have pain or whether their pain will be mild or more severe.

Remember that you can still have headaches, stomach aches and other aches and pains not related to your cancer. Tell your doctor about any pain that worries you. Make an appointment if you need to. The earlier you get help for pain, the easier it will be to treat. There will always be something doctors can do for the pain, but you must let them know so they can plan the right treatment.
Pain happens when nerves detect damage to the body. The nerves send a message to the brain, which causes the feeling of pain. Pain is often useful. It helps us avoid damage from doing something risky. For example, pain tells us to quickly get our hand out of very hot water. With cancer and other illnesses, pain can alert us to a problem. This means we seek medical help to find out what's causing the pain.

Pain in cancer can happen for different reasons:
  • Surgery and radiotherapy can cause pain when normal tissue is damaged.
  • Nerves can 'carry' pain around the body, so pain can sometimes be felt well away from the area causing it. This is called ‘referred' pain.
  • A growing tumour can press on a nerve or affect the way an organ works.
Pain hurts. Each of us knows when we feel pain. It can be hard to describe to someone else. It can be sharp or dull, mild or strong, short term or long term. Untreated pain can cause a lot of tension and fatigue. 

Pain can be acute or chronic:
  • Acute pain usually feels sharp. It often has an obvious cause, like an injury or surgery. Once the cause has gone – such as when an injury heals – the pain usually goes. Unrelieved acute pain can sometimes lead to chronic pain.
  • Chronic pain lasts for a longer time (usually six months or more) and can be harder to treat. Examples include chronic back pain, some cancer pain, bone pain and arthritis pain. Tell your nurses and doctors how your pain feels. This will help them find the right treatment for you.
Try these ideas:
  • Rate your pain on a scale of 0 to 10. If your pain is mild – similar to a minor headache that you know will go away soon – you might rate it 1 or 2. The other end of the scale, 9 or 10, is very severe pain – for example, like how you imagine torture might feel.
  • Use descriptive words: burning, shooting, cramping, throbbing, stabbing, dull, sharp, constant, aching.
  • Try timing your pain: make a note of when it starts and when it eases.
  • Where is it in your body? Draw a human figure and mark where you feel pain.
  • Describe how your pain affects you. What makes it worse? Has it changed since it began? Does it affect your sleeping, moving or eating? Does it make you feel depressed or irritable? Do you feel sick, tired, weak or dizzy with the pain? Does medication relieve all or some of the pain? Does changing your position help relieve all or some of the pain?
Always tell your doctor if your pain changes suddenly or gets worse.
There are different ways to treat cancer pain. Treatment that is aimed at relieving pain (rather than curing a disease) is called ‘palliation' or ‘palliative treatment'.

Drugs
The main treatments for pain are drugs like paracetamol and aspirin, codeine and stronger drugs known as opiates (e.g. morphine). They can be taken:
  • by mouth, as tablets and capsules (for absorption through the stomach).
  • by mouth, as lozenges (for absorption through the mouth).
  • by injection, into a vein or under the skin.
  • ‘transdermally', through a skin patch.
  • by infusion, through a catheter near the spine (for people who may have pain over a long time).
Non-steroidal anti-inflammatories, antidepressants and steroids are also sometimes used to relieve pain.

Surgery
Surgery can relieve some pain, for example by:
  • bypassing a blockage caused by a tumour.
  • making a tumour smaller.
  • draining away fluids that are causing pressure.
Radiotherapy
Radiotherapy can ease pain by reducing the size of a tumour, especially tumours that grow in the bones.

Nerve block and nerve stimulation
Nerves that are triggering pain can be blocked. This can be done with anaesthetic, chemicals, freezing or heat. Nerves may also be stimulated so the body makes its own pain relievers, called endorphins. These can help some kinds of cancer pain.

Hormones
Hormones can reduce swelling caused by some cancers.
During your illness, you may have different treatments at different times. What works for you at one stage may need to be changed at another stage. Don't be afraid to let your medical team know if your pain changes. If they know what's happening, they can usually keep pain under control.

Complementary therapies sometimes help. 
Side effects from morphine and similar drugs
These drugs can cause constipation and nausea. These side effects can be treated with other drugs and sometimes diet changes. When you start taking such drugs, your doctor will most likely start you on drugs to help prevent constipation. These are called aperients. However, if you feel you're still constipated, let your medical team know. They may need to increase the dose of the aperients or add another one. It's important to not get too constipated.

Opiates can make you sleepy in the first few days you take them. But as your body adjusts you'll feel more alert.

Rarely, morphine causes hallucinations. This means thinking that you see (or sometimes hear) something that isn't real. This can be strange and frightening. Tell your doctor if this happens. They will be able to prescribe other methods of pain control.

Side effects from palliative radiotherapy
The main side effect is tiredness, but some people may experience nausea or poor appetite. Speak to your doctor if you have any side effects, and discuss the best ways to manage them.
Your doctor or a specialist cancer pain nurse will carefully assess your pain. Tell them as much as you can about your pain and other symptoms. This will help them to work out the best way to treat it.

A referral to a palliative care team is very helpful as they specialise in pain control. Continuous pain needs continuous pain relief. Your doctors and nurses will monitor your pain. It's important that you take your drugs as prescribed.
Cancer pain can be treated. Pain can be completely relieved or controlled to a point that's acceptable to the person who has pain. The World Health Organization estimates that the right drug in the right dose given at the right time can relieve 80 per cent to 90 per cent of cancer pain.
No. The same type of pain-relieving drug – for example, morphine – can be used for people with early-stage cancer and later-stage cancer. The doctors work out which is the best drug, and in which dose, for each person.
If you have pain, you deserve and need pain relief. Your doctor will give you the pain relief that will work on your pain. Be honest with yourself and the medical staff at all times: if it hurts, it can be helped.

There's no need to be ‘stoic' or brave in the face of pain; your medical team and your friends and family would prefer that your pain be controlled. It's not a weakness to ask for pain relief. If your pain is controlled, you'll feel better able to cope with everything else.

You may worry that when pain gets worse it means the cancer is getting worse. This may not be the case. If your pain is getting worse, try talking about your fears with friends, family or your doctor or nurses. Don't keep it to yourself. Trying to bear increasing pain without mentioning it to others will cause you a lot of unnecessary distress.
Fear, anxiety, depression and tiredness can all make your pain worse. Most people with cancer at times feel hopeless, sad or scared. You can help these feelings. Talk with a counsellor, friend or someone you trust. Call NCSM’s Resource & Wellness Centre at 03-2698 7300 if you need to talk to someone. 

Fatigue, trouble sleeping (insomnia) and shortness of breath can make your pain feel worse. Shortness of breath can make you feel fearful. It's important to discuss this with your doctor and nurses. See Australia’s Cancer Council Victoria’s fact sheet Coping with Breathlessness.

Emotional and physical changes, such as changes in your sex life and relationships, can make pain feel worse. Problems such as changes in your finances can also make pain seem or feel worse. 
Complementary therapies can be used with medical treatments. They may reduce the medical pain relief you need. Some may help you feel calmer.
  • Acupuncture may help with some cancer pain, but more research is needed.
  • Hypnotherapy may help with some but not all cancer pain. 
  • Relaxation techniques – meditation, visualisation, massage and music therapy – can help to relieve anxiety, which can reduce your cancer pain. To find out what programmes are available, call the Resource & Wellness Centre at 03-2698 7300
  • Physiotherapists and occupational therapists can help. For example, they can suggest sleeping positions and equipment that may help relieve the pain.
  • For mild or moderate pain, try warm baths or hot water bottles and ice packs (try both to see which works best). If a part of your body is especially painful, try different positions to find one that causes the least pain.
  • Try to keep your mind off your pain: talk with friends, watch TV or listen to music or the radio. If you have a special interest, pursue it when you can.
Alternative therapies are different from complementary therapies, discussed above. Alternative therapies are unproven cancer treatments. They are used instead of medical treatment. They include herbs and other substances and unusual diets.

Some have been tested scientifically and found to be not effective or even harmful. They can be harmful, especially if:
  • you use them instead of medical treatment.
  • you use herbs or other remedies that make your medical treatment less effective.
  • you spend a lot of time and money on things that simply don't work.
Don't be afraid to take opiates like morphine for cancer pain, if that is what your doctor recommends. For a lot of people with cancer pain, opiates are the simplest and best solution.

Like most drugs, they have side effects, but these can be managed. It's normal to have symptoms of withdrawal when you stop taking opiates after a long period of use.

Opiates can cause symptoms of withdrawal if they're stopped suddenly. Your doctor will gradually reduce the dose so your body can adjust. This means withdrawal symptoms are minimised. You'll be having these drugs in a controlled way, at a dose that's right for your pain.
Explain to your family that you're doing what you believe is in your best interests. Your doctor or nurses may need to talk to your family about why they've recommended this treatment for you.

Keeping your pain under control will help you feel better and more comfortable. It's important your close friends and family try to understand this.
Reviewed: 
Annie Angle, cancer nurse (Dip. Oncology Nursing, Royal Marsden, London)