Cancer Pain Management

There is no test that can measure pain levels, so it’s important to communicate effectively and accurately with your care team to address and mitigate the pain you’re experiencing. Specific details about your level of discomfort, its source and characterizations of how it feels can help your doctor locate the cause of the pain and develop a plan to provide you with as much relief as possible. Being able to answer the following questions can greatly aid in this process:

• Can you describe the pain and what it feels like? What do you think could be the cause? Descriptors can be helpful:
  
  • Throbbing: Surges, beats or pounds.
  • Steady: Pain that does not change in its intensity.
  • Sharp: Knife-like pain that causes intense mental or physical distress.
  • Acute: Severe, short-lasting pain.
  • Chronic: Mild to severe long-lasting pain.
  • Dull: A slow or weak pain.
  • Breakthrough Pain: Pain that appears between doses of medication.

• How strong is the pain on a scale from 0 to 10?
• When did the pain start and how long does it last?
• Is the pain worse during certain times of the day or night?
• Can you show exactly where on your body you are experiencing pain?
• Does the pain move or travel? If yes, can you show how and where?
• Have you taken any medications to relieve the pain, or tried any other approaches to reduce the pain? Have you experienced any relief?
• Have you noticed particular activities or positions that make the pain better or worse?

It can help to make notes so that when your doctor asks specific questions about your pain, you will be able to provide accurate answers. Write down the details of any discomfort you might have been having so you will not forget to report them. A diary of your pain can be especially helpful. Consider including:

• Date
• Time
• Pain scale rating
• Medication type, dose and time
• Pain response to medication
• Other pain relief methods attempted

Your doctor will develop a specific pain management treatment plan tailored to you, based on your age, overall health, medical history, the extent of the disease you’re suffering from and your tolerance for specific medications, procedures or therapies. Of course, your personal opinions and preferences will also be taken into consideration. Cancer pain can be a result of the cancer, cancer treatment, or both. Treatments that reduce pain by fighting the cancer itself include:

• Chemotherapy: Chemotherapy uses special medications that attack cancer cells or keep them from reproducing. This can help relieve pain that the cancer is causing.
• Radiation: Radiation therapy is a minimally invasive procedure that works by shrinking and destroying cancer cells with beams of ionizing radiation. This can reduce cancer pain by reducing the size and spread of tumors and cancer cells.
• Surgery: A surgical procedure may even be recommended specifically to reduce pain.

Pharmacological pain management is the use of medications to mitigate or manage cancer pain. There are many types of medications and several methods used for administration, from very temporary (10 minute) mild sedation, to full general anesthesia (where you are in a deep sleep) in the operating room. Examples of pharmacological pain relief include the following:

• Analgesics: For mild to severe pain relief.
• Sedation: Usually given for relief of pain during a procedure.
• Anesthesia: Usually given for relief of pain during a procedure.
• Topical Anesthetics: Cream, gel or liquid applied to the skin to numb the area.

Pain medication may be given in one or more of the following methods:

• Oral: Medications taken by mouth orally in pill, liquid or lozenge form.
• Subcutaneous Injection: An injection under the skin.
• Intravenous (IV): An injection through a needle in a vein.
• Epidural: Administered via a special catheter in a space around the spinal column.
• Nerve Block: Blocks a specific nerve that is causing pain.
• Transdermal: Medication administered through a patch on the skin.
• Implanted Methods: Such as a pump that is implanted in the body.
• Rectal Suppositories: Medication inserted anally.

Non-pharmacological pain management is the management of pain without medications. This method utilizes ways to alter thoughts and focus concentration to better manage and reduce pain. Methods of non-pharmacological pain include:

• Education and Psychological Conditioning: Not knowing what to expect with cancer treatment is very stressful. However, if you are prepared and can anticipate what will happen, your stress level will be much lower. Consider asking for explanations of each step of cancer treatment, meeting with the doctor who will perform the treatment and touring the room where the procedure will take place.
• Hypnosis: A psychologist or trained clinician guides you into an altered state of consciousness to help focus or narrow your attention and reduce discomfort.
• Imagery: Using mental images of sights, sounds, tastes, smells and feelings can help shift attention away from the pain.
• Distraction: Using colorful, moving objects or singing songs, telling stories or looking at books or videos can distract preschoolers. Older children and adults may find watching TV or listening to music helpful.
• Relaxation: Deep breathing and stretching and can often reduce discomfort.
• Comfort Therapy: Comfort therapy may include companionship, meditation, massage therapy, pastoral counseling or other comforting approaches.
• Physical and Occupational Therapy: Physical and occupational therapy address physical and practical challenges you face and may include aquatherapy, tone and strengthening and desensitization.
• Psychosocial Therapy or Counseling: This can take place in an individual, family or group setting.
• Neurostimulation: Includes acupuncture, acupressure and transcutaneous electrical nerve stimulation.