Cancer Pain

	Overview
	Health Tools
	Frequently Asked Questions
	Cause
	What Does It Feel Like?
	When to Call a Doctor
	Who to See
	Treatment Overview
	Keeping a Pain Control Diary
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits

Can cancer pain be controlled?

Cancer pain can be controlled in almost every case. This does not mean that you have no pain, but that it stays at a level that you can bear.

Cancer and its treatments can be painful. A tumor that presses on bones, nerves, or organs can cause pain. Surgery for cancer can cause pain. So can chemotherapy and radiation. There are a number of ways to control each of these kinds of pain.

You are the only person who can say how much pain you have, or if a certain pain medicine is working for you. Telling your doctor exactly how you feel is one of the most important parts of controlling pain.

What does your doctor need to know?

The more specific you can be about your pain, the more your doctor will be able to treat it. It often helps to write everything down. Include:

• When your pain started, what it feels like, and how long it has lasted.
• Any changes in your pain.
• If the pain is constant or if it comes and goes.
• If you have more than one kind of pain. Use words such as dull, aching, sharp, shooting, or burning.
• What makes your pain better or worse.
• A rating of your pain on a scale of 0 to 10, with 10 being the worst pain you can imagine.

Tell your doctor exactly where you feel pain. You can use a drawing. Say if the pain is just in one place, if it is in several places at once, or if it moves from one place to another.

How is cancer pain managed?

Pain control often starts with medicine. Many drugs are used to treat pain. You and your doctor may need to adjust your medicine as your pain changes. Your doctor may suggest different drugs, combinations of drugs, or higher doses.

For a tumor that causes pain, removing or destroying all or part of the tumor, if possible, often helps. Doctors use chemotherapy, radiation, or surgery to do this.

There are many other ways to control cancer pain, including:

• Heat or cold.
• Splints or braces.
• Massage.
• Treatments that help you cope better with the pain, such as relaxation exercises, biofeedback, or guided imagery.
• Drugs you can buy without a prescription, such as ibuprofen, aspirin, or acetaminophen.
• Stronger drugs your doctor can prescribe. These include:
  • Drugs that relieve pain and swelling.
  • Mouthwashes that help with mouth sores.
  • Very strong painkillers.
  • Drugs used to treat depression. These drugs can relieve pain and help you sleep.
  • Some of the drugs used to treat seizures. These drugs help control burning and tingling pain caused by nerve damage.
  • Skin creams that help relieve pain.

Nerve blocks may help with very bad pain. Drugs are injected right into the nerve that affects the painful area. They provide short-term pain relief by preventing the nerve from sending pain signals.

Learning as much as you can about your pain may help. Emotional support from your friends and family may also help. Many people use other kinds of treatment, such as acupuncture and aromatherapy.

What is a pain control diary?

This is a record of your pain treatment and how it helped or did not help you. You can write down when you used each treatment, how it worked, and any side effects it caused. Having it written down helps you let your health care team know exactly how well your treatment is working.

Will you get addicted to pain medicine?

Some pain medicines 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.

Many people who take pain medicine worry about getting addicted. 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.

Do not let your fear about becoming addicted get in the way of pain relief. Ask for pain relief if you need it. Pain is easier to control when you treat it as soon as it starts. You may also be able to predict pain and treat it before it begins, such as before physical activity. Pain is harder to control if you wait until it is bad.

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	Actionsets are designed to help people take an active role in managing a health condition.
	Controlling cancer pain
	Controlling nausea and vomiting caused by chemotherapy

Cancer pain may be caused by the cancer or by the treatments and tests used. Cancer treatment does not always cause pain. But out of every 10 adults with cancer, between 1 and 3 of them report having pain caused by the treatment. Out of every 10 children with cancer, as many as 6 report having pain caused by treatment.¹

Pain may also be caused by an infection, such as shingles, that may develop because of the cancer or its treatment. The kind of pain may vary depending on the cause. The first step in managing your pain is understanding what is causing it.

Pain from the cancer itself can happen when:

• A cancer growth, or tumor, presses on bones, nerves, or organs.
• Cancer cells spread to the bone and destroy it.
• A tumor presses on the spinal cord, causing pain in the back, legs, or neck.
• A tumor causes organs to swell or be blocked. For example, a bowel obstruction can be caused by a tumor.

Because some cancer spreads far and fast, treatments have to be strong. As a result, they often cause pain and other side effects that require more treatment. Pressure on or damage to a nerve may cause tingling or burning. Treatments such as surgery, radiation, and chemotherapy may also cause pain.

The type of cancer pain you feel depends on the type of cancer you have and how it affects your body. For example:

• Deep, aching pain. A tumor that presses on your bones or grows into your bones can cause deep, aching pain. Bone pain is the most common type of cancer pain.
• Burning pain. A tumor that presses on a nerve can cause a burning feeling. Sometimes chemotherapy, radiation, or surgery damages nerves and causes burning pain. Nerve pain is the second most common type of cancer pain.
• Phantom pain. Pain that is felt in the area where an arm or a breast has been removed is phantom pain. Although the body part is gone, nerve endings at the site still send pain signals to the brain. The brain thinks the body part is still there.

Acute pain is bad pain that lasts a short time. Chronic pain is pain that comes and goes for a long time. It is a side effect of the cancer or treatment. Chronic pain can range from mild to severe.

Not everyone feels pain in the same way. Only you can describe how much pain you have. The key to getting your pain under control is being able to tell your doctor what it feels like and what does and doesn't work for you.

If you have cancer, call your doctor if any of the following occur:

• You have new pain.
• Your drugs or other treatments are no longer working.
• Your pain medicine is not working long enough after each dose.
• You have new symptoms, such as having a hard time walking, eating, or urinating.
• You have side effects, such as nausea or vomiting, constipation, or diarrhea.
• Your pain makes it hard for you to do your daily activities, such as eating or sleeping.

The following health professionals can help treat cancer pain:

• Internist
• Family medicine physician
• Surgeon
• Medical oncologist
• Radiation oncologist
• Anesthesiologist
• Nurse practitioner
• Physician assistant
• Neurologist

Your pain may be managed by a team that may include doctors (including pain or palliative care specialists), nurses, psychologists, social workers, and pharmacists. Be sure that all the members of your health care team know about any changes in your pain control diary. You may wish to use one person, such as your medical oncologist, as a team leader who will make sure that all team members share information.

You are the only one who knows how your cancer pain feels. You may need different combinations of treatments. Don't be surprised if your pain control plan needs to be changed often. Don't let that discourage you. Be honest and specific about what does and does not work for you. Staying on top of your pain and in control of your pain will improve your quality of life during every stage of your disease.

Nonprescription drugs

Drugs that you can buy without a doctor's prescription may be enough to relieve your pain at times. Acetaminophen, such as Tylenol or Panadol, relieves pain, while other drugs such as ibuprofen and aspirin relieve pain and also decrease swelling.

Prescription drugs

Drugs that need a doctor's prescription may be stronger or work differently than nonprescription drugs. Follow your doctor's orders about taking them. Prescription drugs include:

• Anti-inflammatory drugs and corticosteroids.
• Bisphosphonates, to slow bone changes related to cancer.
• Narcotic painkillers.
• Drugs for depression, to treat burning pain. Plus, they can help you sleep.
• Certain drugs for seizures, to help control nerve pain, like burning and tingling.

Other treatment options

Other types of treatments that may work for you are:

• Physical treatments, such as healing touch, massage, heat or cold, and braces or splints.
• Stretching, yoga, and exercises to help keep up your strength, flexibility, and mobility.
• Behavioral treatments, such as cognitive-behavioral therapy (CBT), relaxation, biofeedback, meditation, or guided imagery.
• Education and emotional support. Your doctor can refer you to the social services department of your local cancer treatment center or hospital.
• Complementary therapies, such as acupuncture, aromatherapy, prayer, and humor therapy.

For more information about what you can do, see:

Controlling cancer pain

What to think about

One of the most important things you can do is to keep track of your pain and how your treatment is working. A pain control diary(What is a PDF document?) can help you do this. It can also help you tell your doctor exactly what your pain is and how it should be treated as it changes.

Many people worry about becoming addicted to narcotic painkillers. If narcotic painkillers are used for longer than a week or so, they can cause your body to keep expecting the medicine. 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. But narcotic drugs rarely cause addiction when they are used under a doctor's care. Talk to your doctor if you are worried.

Your pain may be harder to treat if you are depressed or anxious. Talk to your doctor about how to relieve stress and anxiety.

End-of-life issues

The goal of managing your cancer pain is to be as free from pain as possible and to continue your normal activities, such as work, hobbies, and recreation. But a time may come when treatment of your condition is no longer effective. Your doctor will be able to help you answer questions or address concerns about maintaining your comfort. Hospice workers can care for you in your own home. For more information, see the topic Hospice Care.

You may find it helpful and comforting to state your health care choices in writing, with an advance directive or living will, while you are still able to make and talk about these decisions. Think about your pain control options and which kind of treatment will be best for you. You may wish to choose a health care agent, someone to make and carry out decisions about your care if you become unable to speak for yourself. For more information, see the topic Care at the End of Life.

The best way to control cancer pain is to tell your doctor exactly how your pain feels, where it is, and what works or does not work to control it. A written pain control diary will help you do this.

Your family and health care team can help you create a pain control diary(What is a PDF document?). This diary will help you keep track of when you use each treatment, how it works, and any side effects that you may have. This written record will track your progress, and will help your health care team know what you need. It will be easier for your doctor to see how well your pain treatment is working.

You can also use your pain control diary to write down questions for your doctor, the answers to your questions, and any changes that you and your doctor have made to your treatment. Be sure to include information such as clear instructions about who and when to call if you have problems or questions.

How will I know if I need to change my pain control treatment?

As your disease continues, your pain treatment may need to change. The list below provides information that may help you decide whether your needs have changed. Call your doctor if:

• New pain develops.
• Your pain treatment no longer works.
• Your pain treatment wears off too soon between each dose.
• You have new symptoms, such as problems walking, eating, or urinating.
• You have more problems with side effects, such as nausea or vomiting, constipation, or diarrhea.
• Your pain starts to get in the way of daily activities such as eating or sleeping.

For more information about what you can do, see:

Controlling cancer pain

There are many things you can do at home to reduce your cancer pain, manage side effects, and feel better in your mind and body. Follow your doctor's advice. Talk to your doctor about any home treatment you want to try.

You may find that drugs you can buy without a prescription are enough to ease your pain at times. Acetaminophen, such as Tylenol or Panadol, relieves pain. Anti-inflammatory drugs, such as ibuprofen and aspirin, relieve pain and also decrease swelling.

If you have had kidney or liver disease, gastrointestinal bleeding, or a stomach ulcer, talk to your doctor before you take any of these drugs. Be sure you know how to safely use these drugs.

Other home treatments for pain include:

• Heat or cold therapy to relieve painful areas of the body.
• Stretching, yoga, and exercises to help maintain strength, flexibility, and mobility.
• Behavioral treatments, such as relaxation, biofeedback, meditation, or guided imagery.
• Healing touch and massage.
• Education and emotional support. Your doctor can refer you to the social services department of your local cancer treatment center or hospital.
• Complementary therapies, such as acupuncture, aromatherapy, prayer, and humor therapy.

Pain medicine can cause many side effects. To help manage these side effects at home, try the following:

• Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration, such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. Your doctor also may prescribe medicines for nausea and vomiting. For more information on how to deal with these side effects, see:

  Controlling nausea and vomiting caused by chemotherapy.

• Home treatment for diarrhea includes resting your stomach and watching for signs of dehydration. Talk to your doctor before using any medicine for diarrhea.
• Home treatment for constipation includes gentle exercise along with drinking enough liquids and eating lots of fruits, vegetables, and fiber. Many pain drugs can cause constipation or make it worse. Check with your doctor before using a laxative.
• Home treatment for fatigue includes making sure you get extra rest. Let your symptoms be your guide. You may be able to stick to your usual routine and just get some extra sleep.

For more information about what you can do at home, see:

Controlling cancer pain

Many different drugs are used to treat cancer pain. If you are already taking pain medicine for another problem, tell your doctor how often you are taking it and how well it works.

The key to controlling cancer pain is to take your medicine on a regular schedule. Do not wait until your pain gets bad. Pain is easier to control when you treat it just after it starts. Painkilling drugs work to control cancer pain in most people.²

Nonprescription drugs

Drugs you can buy without a prescription may be enough to relieve your pain at times. Acetaminophen, such as Tylenol or Panadol, relieves pain. Anti-inflammatory drugs, such as ibuprofen and aspirin, relieve pain and also decrease swelling.

Know how to be careful with these drugs. If you have had kidney or liver disease, gastrointestinal bleeding, or a stomach ulcer, talk to your doctor before you take any of these drugs.

Prescription drugs

People with cancer pain often need stronger drugs that their doctors prescribe. Be sure to follow your doctor's orders when you take these stronger drugs. If you still have pain, call your doctor.

Prescription drugs may be used alone or with other drugs. Depending on your pain, some of these drugs work better than others. Prescription drugs include:

• Anti-inflammatory drugs and corticosteroids (for example, prednisone or dexamethasone). Corticosteroids used to treat cancer and cancer pain are not the same as steroids used by body builders.
• Narcotic painkillers, such as hydrocodone (for example, Vicodin), oxycodone (for example, Percocet), morphine, methadone, and fentanyl.
• Bisphosphonates, such as pamidronate and zoledronic acid. These are used to treat bone pain. Cancer cells that have spread to the bone upset the normal activity of your bone cells. These drugs slow the bone changes related to cancer. This relieves pain and helps keep your bones from breaking.
• Calcitonin may help with certain types of pain, such as phantom pain.² Phantom pain is a feeling of pain or other uncomfortable sensations in body parts that are no longer there, such as after an amputation. Although the limb is gone, the nerve endings at the site of the amputation continue to send pain signals to the brain that make the brain think the limb is still there. Women who have had a breast removed because of breast cancer may also feel phantom pain.
• Mouthwashes to relieve pain from mouth sores (mucositis).
• Antidepressants, to relieve pain and help you sleep.
• Anticonvulsants, to help control nerve pain like burning and tingling.
• Skin creams, such as capsaicin cream or lidocaine, to help relieve pain in the skin and surrounding tissues.
• Chemotherapy, to shrink the cancer that is causing pain. The type of chemotherapy that you receive depends on your cancer diagnosis, the area of your body affected, and your previous use of chemotherapy drugs.

For more information, see:

Controlling cancer pain

What to think about

Drugs that are used to treat cancer pain rarely cause addiction. Many people worry that they will become addicted to painkillers or that they will become immune to them. Their fears stop them from taking their medicine. As a result, their cancer pain goes needlessly untreated.

If narcotic painkillers are used for longer than a week or so, they can cause your body to keep expecting the medicine. 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. If you are worried about addiction or anything else, talk to your doctor.

Pain medicine works best when it is used at the time it is needed in the dose prescribed. If you know that your pain will be worse at a certain time, such as with activity, you can take your pain medicine in advance.

Some people may be able to use a patient-controlled analgesia (PCA) pump to control their pain medicines. A PCA pump is a computerized machine that contains your medicine. You press a button whenever you feel pain or are uncomfortable, and the machine gives you more medicine.

Drugs that are used to treat cancer pain can be very expensive. Talk to your doctor if financial concerns prevent you from taking your medicine as often as you need it. Schedule an appointment with someone in patient and financial support services at your cancer treatment center. Many organizations provide resources to help you with the cost of your medicine. Often a less expensive drug will work as well as a more expensive one. For more information, contact your local chapter of the American Cancer Society or call 1-800-227-2345 (1-800-ACS-2345).

Surgery is sometimes used to relieve cancer pain. Removing a tumor that is pressing on nerves, bones, or your spinal cord can help your pain. Surgery can also remove tumors that block the intestine and cause pain. The type of surgery that you may have depends on the type of cancer you have, which parts of your body are affected, and what treatments you have had before.

For more information, see:

Controlling cancer pain

What to think about

Although surgery to control pain does not cure cancer, it can help you feel more comfortable. Talk to your doctor about the benefits and risks of surgery.

When drugs are not enough to relieve cancer pain or when they cause troublesome side effects, treatments such as radiation and nerve blocks may help.

• Radiation is the use of X-rays to destroy cancer cells and shrink tumors. It is used to destroy cancer growths that press on your nerves, bones, or spinal cord. The type of radiation that you receive depends on your cancer diagnosis, the area of your body that is affected, and your previous history of radiation therapy. Destroying growths relieves pressure on organs and nerves and reduces pain.
• A pump that is placed under your skin may be used to deliver pain medicine directly to your spine. Because the drug goes right to your spinal column, not as much of it is needed. That usually means that side effects are not as severe.
• Nerve blocks usually are used only after other treatments have not worked. A nerve block is a drug that is injected into or around a nerve to temporarily prevent the nerve from telling your brain about the pain. In some cases, deadening the nerve may not only reduce the pain but also lower the amount of medicine you need.

For more information, see:

Controlling cancer pain

What to think about

Radiation treatments may cause side effects, such as diarrhea and fatigue. The type of side effects that may develop depend on your cancer diagnosis, the area of your body that is affected, and the type of radiation that you have. You can use home treatment measures for diarrhea and fatigue to help you manage these side effects.

Nerve blocks can cause loss of feeling or, in rare cases, paralysis in the affected area or in the tissue surrounding the area.

Organizations

• Bladder Cancer
• Breast Cancer, Metastatic or Recurrent
• Care at the End of Life
• Cervical Cancer
• Colorectal Cancer
• Endometrial (Uterine) Cancer
• Hospice Care
• Leukemia
• Lung Cancer
• Non-Hodgkin's Lymphoma
• Ovarian Cancer
• Prostate Cancer, Advanced or Metastatic

Citations

1. Foley KM (2000). Controlling cancer pain. Hospital Practice (Office Edition), 35(4): 101–112.

2. Foley KM (2005). Management of cancer pain. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 2615–2649. Philadelphia: Lippincott Williams and Wilkins.

Other Works Consulted

• Agency for Healthcare Research and Quality (2001). Management of Cancer Pain: Summary. Evidence Report/Technology Assessment No. 35 (AHRQ Publication No. 01-E033). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.ahrq.gov/clinic/epcsums/canpainsum.htm.

• Agency for Healthcare Research and Quality (2002). Management of Cancer Symptoms: Pain, Depression, and Fatigue. Evidence Report/Technology Assessment No. 61 (AHRQ Publication No. 02-E032). Rockville, MD: Agency for Healthcare Research and Quality.

• American Cancer Society (2007). Coping With Physical and Emotional Changes. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/MBC/MBC_0.asp.

• Cox KA, Fausett HJ (2002). Patient-controlled analgesia. In CA Warfield, HJ Fausett, eds., Manual of Pain Management, 2nd ed., pp. 270–272. Philadelphia: Lippincott Williams and Wilkins.

• Lindsey E, et al. (2000). Fact Sheet 8: HIV palliative and terminal care. Fact Sheets on HIV/AIDS for Nurses and Midwives. Geneva, Switzerland: World Health Organization (WHO). Available online: http://www3.who.int/whosis/factsheets_hiv_nurses/fact-sheet-8/.

• National Cancer Institute (2000). Pain Control: A Guide for People With Cancer and Their Families. Washington, DC: U.S. Department of Health and Human Services. Also available online: http://www.cancer.gov/cancerinfo/paincontrol.

• National Cancer Institute (2000). Understanding Cancer Pain. Washington, DC: U.S. Department of Health and Human Services. Also available online: http://www.cancer.gov/cancerinfo/understanding-cancer-pain.