Managing Symptoms: Pain

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The Abramson Cancer Center of the University of Pennsylvania
Last Modified: January 22, 2002

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Rena Rowan Breast CenterThis "Helpful Facts" sheet is designed to give you basic information on pain. More detailed information can be provided by your doctor or nurse. If, you have other questions or would like additional information, please talk to your doctor or nurse.

What is Pain?

  • Pain is an unpleasant sensation of hurt. Pain is whatever the person says it is and exists whenever the person says it does. It can be described as causing a vague discomfort or significant distress. It can be stabbing, aching, pinching, throbbing or shooting in nature.
  • Acute pain is temporary and lasts for a relatively short time. It is usually confined to one area and is easy to describe.
  • Chronic pain lasts for long periods of time. It is not always confined to one area and can be difficult to describe. Often patient's with chronic pain "don't look like they are in pain."
  • Pain can decrease your activity and appetite, cause difficulty sleeping, and make you feel anxious or depressed.

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.

When Should I Call the Doctor or Nurse?
If you have:

  • 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.
  • 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.

What is a pain scale?
A pain scale is a way of describing how bad the pain is so that the pain can be treated correctly. On the 0 to 10 scale, 0 means no pain and 10 means the pain is as bad as it can get.

How is Pain Treated?
Medications are usually used to treat cancerrelated pain. Do not take any medications, even over the counter medications, unless instructed by your doctor or nurse. Some commonly used medications are:

Non-prescription (Over the Counter) Medications

Acetaminophen (Tylenol)Salisytates (Aspirin)Non-Steroidal Anti-Inflammatory Drugs (NSAID'S) (Ibuprofen, Motrin, Advil, Trilisate, Toradol, Naprosyn)
Acts by:Blocks pain transmissionDecreases swelling and inflammationDecreases swelling and inflammation
Used for:Mild-moderate painMild-moderate painMild- moderate pain
Side effects:Liver damageStomach irritation, hearing changes, bleedingStomach irritation, bleeding, kidney damage

Prescription Medications

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, unless instructed by your doctor or nurse.

How often should I take my pain medications?

  • Take the medication as prescribed by your doctor. Most pain medications start to work in 3060 minutes and last 46 hours. Other medications, such as the anticonvulsants and antidepressants take a few days to start working.
  • It is also 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 require multiple doses a day of narcotic pain medication, your doctor may prescribe a "long acting" pain preparation.
  • You should keep a record of how often you take your pain medication and how much relief you feel. Share this record with your doctor and nurse.

Will I become addicted to my narcotic pain medications?

  • No. Addiction happens with use of the drug for nonmedical purposes (getting high). You are taking it for pain, which is what it is for.
  • Anyone taking narcotic pain medications on a regular basis for as little as 37 days may experience physical withdrawal symptoms if the medication is stopped quickly. Withdrawal can be avoided by gradually decreasing the amount of pain medication as directed by your nurse or doctor.

If I take pain medication now will it work later "when I really need it"?
Yes. The medication dose can be increased as necessary.

Can I drive while taking pain medications?
Initially, some pain medications can cause sleepiness. Your doctor or nurse may recommend not driving. Avoid or limit the use of alcohol and other sedating medications.

Are there any other ways to treat pain?

  • If the pain is being caused by a cancerous tumor your doctor 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.
  • Other ways to decrease pain include:
    • Heat and cold applications
    • Massage
    • Acupuncture and acupressure
    • Relaxation techniques
    • Guided imagery
    • Biofeedback
    • Hypnosis
    • Counselling
    • Diversionary activities (watching TV, listening to music)

Other Resources

  • Questions and Answers About Pain Control
  • Pain Management Guidelines for Patients
  • Feeling Better Again
  • Information sheets on: Chemotherapy, Constipation, Bowel Laxative Regimen, Nausea/Vomiting, Fatigue.



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