Cancer pain: Relief is possible
Learn what causes cancer pain and how you can work with your doctor to ensure your cancer pain is controlled.By Mayo Clinic Staff
Timothy Moynihan, M.D.
Not everyone with cancer has cancer pain, but some do. If you have cancer that's spread or recurred, your chance of having pain is higher.
Cancer pain takes many forms. It can be dull, achy, sharp or burning. It can be constant, intermittent, mild, moderate or severe. How much pain you feel depends on a number of factors, including the type of cancer you have, how advanced it is, where it's situated and your pain tolerance.
Keep in mind that most cancer pain is manageable and that controlling your pain is essential to your treatment.
Timothy J. Moynihan, M.D., a cancer specialist at Mayo Clinic in Rochester, Minnesota, offers some insight into cancer pain, why people might not get the pain treatment they need and what they can do about it.
What causes cancer pain?
If the pain is from the cancer itself, it can be from the cancer growing into or destroying nearby tissue. As a tumor grows, it can press on nerves, bones or organs. The tumor can also release chemicals that can cause pain. Or your body's reaction to the chemicals can cause pain.
Treatment of the cancer can help the pain in these situations. However, cancer treatments, including surgery, radiation and chemotherapy, also can cause pain.
How do you treat cancer pain?
There are a variety of ways. One is to remove the source of the pain through surgery, chemotherapy, radiation or other treatment.
If that can't be done, pain medications can usually control the pain. These medications include:
- Over-the-counter and prescription pain relievers, such as aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others)
- Weak opioid (derived from opium) medications, such as codeine
- Strong opioid medications, such as morphine (Kadian, Ms Contin, others), oxycodone (Oxycontin, Roxicodone, others), hydromorphone (Dilaudid, Exalgo), fentanyl (Actiq, Fentora, others), methadone (Dolophine, Methadose) or oxymorphone (Opana)
Some medications come in tablets or liquids you swallow; others dissolve quickly in your mouth. You can receive some medications by shots, either under the skin or in a vein; through rectal suppositories; or by wearing a skin patch.
Other medications used to treat cancer pain are antidepressants, anti-seizure drugs and steroids.
Also, there are specialized treatments, such as a nerve block, which is a local anesthetic that's injected around or into a nerve. The block prevents pain messages along that nerve pathway from reaching the brain.
Other therapies, such as acupuncture, acupressure, massage, physical therapy, relaxation, meditation and hypnosis, might help.
What are some reasons for not receiving adequate treatment for cancer pain?
Unfortunately cancer pain is often undertreated. Many factors can contribute to that, some of which include:
Oct. 10, 2017
Reluctance of doctors to ask about pain or offer treatments. Health care professionals should ask people with cancer about pain at every visit. Some doctors don't know enough about pain treatment. In that case, request a referral to a pain specialist.
Given current concerns about opioid use and abuse, many doctors might be reluctant to prescribe these medications. Maintaining a close working relationship with your cancer specialists is essential to proper use of these medications.
- Reluctance of people to mention their pain. Some people don't want to "bother" their doctors, or they fear that the pain means the cancer is worsening. Others are worried their doctors will think of them as complainers or that they can't afford pain medications.
Fear of addiction. If you take medications when you're not in pain or to get high, then the chance of developing addiction is high. But the risk of addiction for people who take pain medications as directed for cancer pain is low.
You might develop a tolerance for your pain medication, which means you might need a higher dose to control your pain. Tolerance isn't addiction. If your medication isn't working as well as it once did, talk to your doctor about a higher dose or a different drug. Don't increase the dose on your own.
- Fear of side effects. Some people fear being sleepy, unable to communicate, acting strangely, or being seen as dependent on medications. You might have these side effects when you start taking strong pain medications, but they often resolve once your doctors find the correct level of pain medications for you and once you achieve a steady level of pain medications in your body.
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- Daily pain diary. American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/pain.html. Accessed July 28, 2017.
- Pain control: Support for people with cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/coping/paincontrol. Accessed July 28, 2017.