Pain Management for the Cancer Patient

James Metz, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 1, 2001

The goal of pain management for the cancer patient is the prevention or complete control of pain. There are many options available for the treatment of cancer related pain. Most patients are treated with medications initially. Other treatments for pain may include surgery, radiation therapy, or neurosurgery. Almost all patients have complete relief of pain with the appropriate management.

Cancer pain is usually caused by a tumor pressing against bones, nerves, or bodily organs. Cancer treatments can also cause pain and discomfort. Patients may have pain caused by things that have nothing to do with cancer such as muscle strains and arthritis.

The first step in the management of cancer pain is choosing the correct pain medication. There may be a period of trial and error while your physician attempts to find the right medication and dosage for you. There are a large variety of medications, which range in strength from over the counter medications such as aspirin to strong prescription medications such as morphine. Medications may be short-acting and taken on an "as needed" basis, or long-acting to suppress any pain before it occurs. Pain medications may be given as pills, liquids, suppositories, skin patches, or injections.

There are some non-drug treatments of pain that are effective for some patients. Guided imagery can be a very effective and soothing technique. Breathing and relaxation exercises can also help many patients. Transcutaneous electrical nerve stimulation (TENS) units may be prescribed in specific circumstances. Hot or cold packs may also provide symptomatic relief of discomfort.

There are some important points to remember when dealing with cancer pain that include:

Take charge and become an active participant in the health care team
Be honest with your physicians and nurses about your pain
Keep a diary of the times you are in pain
Quantify your pain on a scale of 0-10 (0= no pain, 10= excruciating pain)
Note how much medication you are taking and the time you take your pills
Always let your physician know if the pain is worsening or you develop bowel or bladder problems
Make sure you are on appropriate medications to prevent constipation if you are taking any narcotics for pain control
Take your medications as prescribed. Do not wait until the pain is unbearable. It is easier to prevent pain or relieve it when it starts then to wait until it gets really bad.
Do not worry that you will become "hooked" or "addicted" to your pain medication. Studies have shown this is very rare with cancer patients.
Contact your nurse or doctor if your pain medication is not working.