This answers some common questions about cancer pain. Many people find that knowing about their illness can help them manage it and help themselves. It is not a substitute for talking to your doctors or nurses. Please use it as a guide to questions you want to ask.
No. Some people with cancer have no pain at all.
Around fifty per cent of people (one in two) who are treated for cancer have pain after their treatment. People who have advanced cancer (cancer which spreads through the body from its original site) are likely to experience pain from their cancer. About ninety per cent of people (nine in ten) with advanced cancer have pain.
Your doctor may be able to tell you if you are likely to experience pain, for example if you might have pain after a treatment. However, doctors can't always predict whether a person will have pain from their cancer, or whether their pain will be mild or more severe.
Remember that you can still have headaches, stomach aches and other aches and pains that are not related to your cancer. Tell your doctor about any pain that worries you.
Pain happens when nerves detect damage to the body and send a message to the brain, causing the sensation of pain to occur. Pain is useful when it helps you avoid doing something risky, like putting your hand in very hot water. With cancer and other illnesses, it can alert us to the fact that there is a problem, like a tumour growing.
Pain in cancer can happen for a number of reasons. A tumour can press on a nerve or affect the way an organ works. Surgery and radiotherapy can cause pain when normal tissue is damaged. Nerves can ‘carry' pain around the body, so pain can sometimes be felt in a place well away from the factor that is causing it. This is called ‘referred' pain.
‘Pain hurts.' Each of us knows when we feel pain, although it can be hard to describe to someone else. It can be sharp or dull, mild or strong, short-term or long-term. When it is not relieved, pain can cause tension and fatigue.
Pain can be acute or chronic. Acute pain is usually sharp and often has an obvious cause, like an injury to the body. If the injury can be fixed, so usually can the pain. Chronic pain lasts for a longer-than-expected time and can be more challenging to treat.
If you're having difficulty describing your pain, try these ideas:
Always tell your doctor if your pain changes suddenly or becomes more severe.
There are different ways to treat cancer pain. Treatment which is aimed at relieving pain (rather than curing a disease) is called ‘palliation' or ‘palliative treatment'.
The main treatments for pain are painkillers like paracetamol and aspirin, and codeine, morphine and other opiates. They can be taken:
Your doctors and nurses will try different approaches until they find the right one for your pain. During your illness, you may try several different approaches: what works for you at one stage may need to be changed at another stage.
Morphine and similar drugs can cause constipation and nausea; these can be treated with other medications. Opiates can also make you sleepy in the first few days you take them.
The main side effects of palliative radiotherapy are tiredness, nausea and poor appetite over the course of the radiotherapy. The area of skin where you have your radiotherapy can become irritated and feel like it is sunburnt.
Let your doctor know if you have any side effects.
Your doctor will assess your pain and work out the best way to treat it. Give as much information about your pain as you can, to help the doctor work out the best treatment.
Continuous pain needs continuous pain relief. This means your pain needs to be monitored by your medical team. It is important that you take your medications as prescribed and keep your doctor informed about pain and other symptoms.
All cancer pain can be treated. Pain can either be completely relieved, or controlled to a point which is acceptable to the person who has pain. The World Health Organization estimates that the right drug in the right dose given at the right time can relieve 80% to 90% of cancer pain.
No. The same type of painkiller - for example, morphine - can be used for people with early-stage cancer and later-stage cancer. The doctors work out which is the best painkiller, and in which dose, for each person needing pain relief.
If you have pain, you need pain relief. Your doctor will give you the pain relief that will work on your pain. Be honest with yourself and the medical staff at all times: if it hurts, it can be helped.
There is no advantage to being ‘stoic' or brave in the face of pain; your medical team and your friends and family would prefer that your pain be controlled, so that you can get on with life.
You might be concerned that increasing pain means your cancer is getting worse. This may not be the case. If your cancer is getting worse, try talking about your fears: with friends, family members or your doctor or nurses. Trying to bear increasing pain without mentioning it to others will cause you a lot of unnecessary distress.
Fear, anxiety, depression and tiredness can all make your pain worse. Most people with cancer go through times when they feel hopeless, sad or scared. There are different things you can do to help these feelings. Talking about them with a counsellor, friend or someone else who you trust can be useful. Contact the Cancer Council Helpline on 13 11 20 for free and confidential information, if you need to.
Non-medical therapies can be used with medical treatments. They could reduce the amount of medical pain relief you need. Some may help you feel calmer.
Don't be afraid to take opiates for cancer pain, if that is what your doctor recommends. For a lot of people with cancer pain, opiates are the simplest and best solution. Like most medications, they have side effects, but these are easily managed.
It is normal to develop symptoms of tolerance and withdrawal when you need to take opiates for a longer period. This means the amount you take may have to be increased every so often, for as long as you need to take opiates. Opiates can cause symptoms of withdrawal if they are stopped suddenly. You should not experience these symptoms: when you don't need to take opiates any more, your doctor will gradually reduce the dose, so your body can adjust.
Because you will be having these medications in a controlled way, at a dose that is right for your pain, you will not experience the cravings and sicknesses that affect addicts.
Sometimes, families have different opinions from the medical staff and the person with cancer about that person's treatment. If this happens, explain to your family that you are doing what you believe is in your best interests. Your doctor or the nursing staff may need to also talk to your family about why they have recommended a particular treatment for you.
For more information, contact the Cancer Council Helpline on 13 11 20.
Information sheet material adapted from The Cancer Council South Australia's Understanding and controlling cancer pain; BACUP's www.cancerbacup.org.uk/info/pain; Palliative Care Victoria's brochure Pain and pain management; and the www.cancer-pain.org (an ACOR site).
Updated August 2007
