Understanding and Managing Pain

What is pain?

Pain is an unpleasant feeling. It can be described in many ways from a vague discomfort to causing a lot of distress. It can feel like stabbing, aching, pinching, throbbing, or shooting. Pain is a signal in your body and each person’s feeling of pain is different. Pain can decrease your activity and appetite, cause you to have a hard time sleeping, and can make you feel anxious or depressed.

Pain can be acute or chronic. Acute pain comes on quickly and lasts for a short time. It is often felt in one area and is easy to describe. Chronic pain lasts for a long 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 are:

• Cancer or a tumor pressing on or hurting organs, nerves, or bones.
• Some cancer treatments like surgery, radiation, chemotherapy, and growth factors.
• Other diseases (like arthritis).
• Infections.
• Blocked blood vessels.
• An injury.

When should I call my provider?

You should call your provider if you have:

• Any new pain, especially if it is constant or severe.
• An increase in the amount of pain or how often you have it.
• Pain that does not get better after taking pain medication or returns before the next scheduled dose.
• A hard time with side effects from pain medications (sleepiness, nausea, constipation).
• Pain that comes with numbness, tingling, or weakness of your arms or legs, trouble walking, urinating, or having a bowel movement.

What is a pain scale?

A pain scale is a way to describe how bad the pain is. Pain scales are used to help treat the pain correctly. There are a few scales, but the numeric scale from 0-10 is most often used for adults. 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 shown to the patient and the patient picks the face that best shows how they are feeling about 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

Prescription Medications

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. Some medications, like anticonvulsants and antidepressants, take a few days to start working.
• It is important to take your medication as prescribed (as your doctor has told you to take it). If you wait until the pain is bad, it will take more medication and a longer amount of time to control your pain.
• If you need multiple doses a day of narcotic pain medication, your provider 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 can see how well your pain is managed.

Will I become addicted to my narcotic pain medications?

• No. Addiction happens with the use and abuse of medication 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 regularly may have physical withdrawal symptoms if the medication is stopped suddenly. Withdrawal can be avoided by gradually decreasing (slowly over time) the amount of pain medication as directed by your provider.

Can I drive while taking pain medications?

Some pain medications can cause drowsiness (sleepiness). Your provider may recommend that you not drive while taking pain medications. Please be sure to check with your care team before you drive. Avoid or limit the use of alcohol and other sedating medications (make you feel more calm/relaxed) as these can increase sleepiness, especially when used 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 caused by a tumor, your provider may recommend surgery, chemotherapy, or radiation therapy to remove the tumor or decrease its size.
• A nerve block is a method of injecting medication into or around a nerve that is causing pain.
• Other ways to decrease pain are:
  • Heat and cold packs. Do not use these if you have any numbness in the area. They could cause burns if you can’t feel how hot or cold they are.
  • Massage.
  • Acupuncture and acupressure.
  • Relaxation techniques.
  • Guided imagery.
  • Biofeedback.
  • Hypnosis.
  • Activities to distract you (watching TV, listening to music.)
  • Physical and occupational therapy.
  • Emotional or psychological support from a counselor or social worker.

Breakthrough Pain

Breakthrough pain (BTP) is sudden pain that "breaks through" (happens) when taking long-acting medication prescribed to treat chronic pain. These may be caused by disease, treatment, or other unrelated things, like overdoing it with chores or activities. People may also have breakthrough pain as they reach the end of their dose of long-acting pain medication. If this happens, the long-acting dose may not be enough to control your pain. Talk with your care team if this is happening.

How is breakthrough pain treated?

With proper monitoring and treatment, breakthrough pain can be managed. It is different from persistent pain and needs different treatment. Breakthrough pain medication is taken as needed, as soon as symptoms start. It is prescribed in addition to long-acting pain medication.

What if breakthrough pain is not treated effectively?

Untreated breakthrough pain can affect your daily life. Without treatment, breakthrough pain can harm a person's sense of well-being, interfere with daily activities, and may even interrupt your treatment schedules. You should call your provider if you think you are having breakthrough pain.

Pain from cancer and its treatments can be hard to live with, but it can be treated in many cases. Talk with your care team about any pain management issues or questions you have.