Cancer: Controlling cancer pain

Sometimes people try to live with their pain because they believe these common myths:

Myth #1: Pain is just part of cancer.

Truth: Pain can almost always be relieved if you work with your doctor to develop a treatment plan that is right for you.

Myth #2: It is best to wait as long as possible between doses of pain medicine.

Truth: Pain medicine works best when you stay on top of your pain. That means not holding off treatment until the pain becomes bad. If you let the pain get bad, you may need larger doses of medicine to relieve it.

Myth #3: Pain medicines work the same for everyone.

Truth: There are many kinds of pain medicines. They are given in different amounts to different people. And they are given in different ways (for example, as pills you swallow or as a patch taped to your skin). Your treatment is based on several factors, including your general makeup, other health problems you may have, and the type, stage, and location of your cancer. It is also based on how much pain makes you uncomfortable.

Myth #4: Doctors are so busy. I should not bother my doctor with my pain problems.

Truth: There is a reason you are having pain, and your doctor needs to know about it. Your pain may be an early warning of cancer growth, infection, or side effects of treatment. Talking to your doctor about your pain and what treatment works or does not work is an important part of your treatment plan. It is also important for your well-being.

Myth #5: If I whine about pain, it means I am weak. My doctor and family won't respect me if I am not tough.

Truth: Telling your doctor about your pain does not mean you are weak. It means you are being honest with your doctor. You are giving your doctor important information. No two people feel the same when they have cancer. Do not compare yourself to others.

Myth #6: If I take strong drugs like morphine, I will become addicted.

Truth: Some painkillers can cause your body to keep expecting the medicine if it is used for longer than a week or so. This is called a drug dependency. Dependency is not the same as addiction. Addiction is a behavioral disorder in which a person has a craving for the drug. This craving may not even be related to the level of pain. Addiction to pain medicine is rare if you have not had a problem with addiction in the past and you take your medicine as directed under your doctor's care. Your body may come to expect daily doses of medicine to control the pain, but your doctor can gradually lower the amount you are taking when and if the cause of your pain is gone.

Myth #7: If I take strong pain medicine before I really need to, it might not help me when my pain gets worse.

Truth: It is much better to treat your pain when you first notice it, before it gets bad. Although you may gradually need more medicine, this is rarely a problem.

Test Your Knowledge

1. Narcotic painkillers are strong drugs that should be used only as a last resort or when people are near death.

   1. True.

      This answer is incorrect.

      Narcotic painkillers, such as morphine, are effective for moderate to severe cancer pain. Many people use them for months or even years for pain relief.

   2. False.

      This answer is correct.

      Narcotic painkillers, such as morphine, are effective for moderate to severe cancer pain. Many people use them for months or even years for pain relief.

2. It is better to hold off as long as you can before you take your pain medicine.

   1. True.

      This answer is incorrect.

      Pain medicine works best when you take it as soon as you notice any pain. If you wait until the pain gets bad, you may need a larger amount of medicine than you would have. Plus, it may take some time to get your pain back under control.

   2. False.

      This answer is correct.

      Pain medicine works best when you take it as soon as you notice any pain. If you wait until the pain gets bad, you may need a larger amount of medicine than you would have. Plus, it may take some time to get your pain back under control.

Cancer pain can lower your quality of life if it is not treated. Untreated pain may cause you to feel:

• Depressed.
• Unable to cope.
• Tired.
• Isolated.
• Stressed.
• Unable to sleep.
• Worried.
• Angry.
• Uninterested in food.
• Lonely.

Controlling your cancer pain can help you to:

• Be active.
• Sleep.
• Cope more effectively with cancer and its treatment.
• Enjoy family and friends.
• Eat with pleasure.

Test Your Knowledge

1. Cancer and cancer treatment should not prevent you from being able to enjoy food and friends.

   1. True.

      This answer is correct.

      One of the goals of cancer treatment is to control your pain and discomfort so that you can maintain your quality of life, including enjoyment of food and friends.

   2. False.

      This answer is incorrect.

      One of the goals of cancer treatment is to control your pain and discomfort so that you can maintain your quality of life, including enjoyment of food and friends.

Keep track of your pain and your treatments

Your doctor needs all the information you can give about what your pain feels like. Your doctor needs to know how your treatment is working or not working. It may be easier to give your doctor information if you write it down. Use a daily diary to rate your pain. Write down what drugs you are taking and how well they are working. Write down any other methods you are using to control your pain.

Pay attention to the details of your pain so you can tell your doctor. Is it burning? Throbbing? Steady? How long does it last? Take your written information and any questions with you when you see your doctor.

Use a calendar or a pain control diary (What is a PDF document?) to keep track of your treatment. Write down how strong your pain is and when it comes and goes. Most doctors use a "0 to 10" scale to measure pain. On this scale, "0" means no pain and "10" means the worst possible pain.

It is easy to get confused about medicines when you are in pain and are looking for something to help you feel better. You may have prescriptions from more than one doctor. Keeping a written medication record (What is a PDF document?) can help you and your doctors work together.

Stay on top of your pain

Your pain will be harder to control if you let it get worse before you take your medicine. Make the most of your pain medicines by following these rules:

• Take them on time (by the clock).
• Do not skip a dose or wait until you think you need it.
• Be prepared for breakthrough pain. You may find that taking your medicine works most of the time, but your pain flares up during extra activity or even for no clear reason. This is called breakthrough pain. Your doctor can give you a prescription for fast-acting medicines that you can take for breakthrough pain.
• Ask one of your doctors to be your team leader. It is best to have one doctor in charge of all your medicines. If more than one doctor prescribes pain medicine, make sure they talk to each other about it.

Manage the side effects

Pain medicines may cause side effects. For example, narcotic painkillers may cause drowsiness, constipation, nausea, and vomiting. Some anti-inflammatory drugs, including aspirin, may cause stomach upset or bleeding. Before you start taking a drug, ask your doctor about the possible side effects.

There are things you can do to manage some side effects.

• Home treatment for nausea or vomiting includes eating clear soups, mild foods, and liquids if you feel nauseated. Watch for and treat early signs of dehydration. Older adults can quickly become dehydrated from vomiting.
• Home treatment for constipation includes making sure you drink enough fluids each day. Most adults should drink between 8 and 10 glasses of water, fruit juice, or other drinks that do not contain caffeine. Include fruits, vegetables, and fiber in your diet each day.

Try complementary medicine

Complementary medicine is the term for a wide variety of health care practices that may be used along with or in place of standard medical treatment. If you use one or more of these practices, you may be able to take a lower dose of pain medicines.

Most of these therapies have not been subjected to the same degree of rigorous scientific testing for safety and effectiveness that standard medical treatments must go through before they are approved in the United States. Be sure to talk with your doctor about which therapies might be best for you.

Behavioral therapies

• Biofeedback is a method of consciously controlling a body function that is normally controlled unconsciously, such as skin temperature, muscle tension, heart rate, or blood pressure.
• Cognitive-behavioral therapy is a type of counseling to teach you how to become healthier by modifying certain thought and behavior patterns.
• Relaxation exercises, music therapy, humor therapy, and prayer reduce tension, help you feel relaxed, and reduce stress.
• Guided imagery is a series of thoughts and suggestions that direct your imagination toward a relaxed, focused state. You can use an instructor, tapes, or scripts to guide you through this process.
• Hypnosis is a state of focused concentration that allows you to become less aware of your surroundings.

Physical therapies

• Heat and cold treatments relieve sore muscles and decrease pain.
• Hydrotherapy is the use of water, in any form, to treat a disease or to maintain health.
• Massage helps reduce tension and pain, improves circulation, and encourages relaxation.
• Transcutaneous electrical nerve stimulation (TENS) uses electrical current delivered through electrodes to the skin for pain relief.
• Acupuncture is a form of traditional Chinese medicine. It is done by inserting very thin needles into the skin at certain points on the body. Acupuncture combined with pain medicine may help relieve pain.²

Other therapies

• Aromatherapy is the therapeutic use of aroma-producing oils (essential oils) extracted from a plant's flowers, leaves, stalks, bark, rind, or roots. These oils are mixed with another substance, such as oil, alcohol, or lotion, and then applied to the skin, sprayed in the air, or inhaled.
• Healing touch is the conscious influence of one person on another, without physical means of intervention, to benefit the recipient's physical or emotional well-being.
• Meditation is the practice of focusing your attention to alter your state of consciousness, usually directed toward feeling calm and having a clear awareness about your life.
• Yoga is a meditation program that includes exercises to help improve flexibility and breathing, decrease stress, and maintain health.

For more information on alternative therapies, see the topic Complementary Medicine.

Test Your Knowledge

1. It's important to keep track of how the pain feels and when it's better or worse.

   1. True.

      This answer is correct.

      Pain can be a sign of infection, problems with treatment, or cancer growth. Telling your doctor exactly how, where, and when your pain occurs makes it easier to control the pain.

   2. False.

      This answer is incorrect.

      Pain can be a sign of infection, problems with treatment, or cancer growth. Telling your doctor exactly how, where, and when your pain occurs makes it easier to control the pain.

2. It is important to rely on medicines to treat pain and not to try alternative methods such as hypnosis.

   1. True.

      This answer is incorrect.

      Alternative treatments for pain, such as hypnosis, biofeedback, and acupuncture, are accepted as helpful therapies for people with cancer. Some people are able to use less pain medicine by using alternative therapies.

   2. False.

      This answer is correct.

      Alternative treatments for pain, such as hypnosis, biofeedback, and acupuncture, are accepted as helpful therapies for people with cancer. Some people are able to use less pain medicine by using alternative therapies.

Discuss your pain and your feelings about having cancer with your doctor. He or she can address your concerns and refer you, as needed, to organizations that can offer additional support and information. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who have cancer and may have similar feelings can be helpful.