Other ways to control pain

Saturday 1 September, 2018

Sometimes cancer-related pain can be difficult to relieve completely with medicines, or you may need to stop taking a pain medicine because of its side effects. It is important to let your health care team know if you have pain. Uncontrolled pain may lead to depression, relationship difficulties and inability to return to work.

Your doctor may suggest you see a pain management specialist in a multidisciplinary pain clinic. The specialist can recommend a range of painrelieving therapies and help you create a pain management plan to restore your ability to function.

Medical treatments

These techniques can be temporary or longer lasting and range from simple options such as nerve blocks to more complex procedures such as implanted pumps. They are not suitable for everyone, but can be particularly useful for treating nerve pain or pain that is difficult to control. Your pain specialist will talk to you about the risks and benefits of each procedure they recommend.

Nerve block

A nerve block uses an injection of local anaesthetic to numb the nerve sending the pain signals. Sometimes an x-ray or ultrasound machine is used to help guide the needle. In most cases, the effect lasts for a few hours but it sometimes lasts for days. A nerve block is generally used to provide short-term pain relief or to help diagnose which nerve is sending the pain signals.

Radiofrequency ablation (RFA)

This procedure can be used after a nerve block to provide longer-lasting pain relief. A pulsed RFA aims to re-educate the pain nerve to lessen the pain signal. It may take up to two months to take effect. A thermal RFA uses heat to damage the nerve.

Epidural

An injection of local anaesthetic and sometimes other pain medicines near the nerves in the back. An epidural is given in hospital and the pain relief can last for up to two weeks. An epidural can also be used to see if a spinal procedure (see below) is likely to help.

Spinal catheter with port or pump

If longer-term pain control is needed, a small tube (epidural catheter) may be placed a little deeper in the back. This is connected to an opening (port), which allows pain medicine to be dripped in continuously. If pain is likely to last longer than six months, the catheter is attached to a pump implanted under the skin of the abdomen (known as an intrathecal pump). This pump is refilled about every three months with pain medicine. The pump can be adjusted to provide a suitable amount of relief for your pain.

Spinal cord stimulator

This is a long-lasting procedure to treat nerve pain problems. An electrical device is placed into the spine. It causes tingling against the nerves in the back or neck, which reduces the amount of pain felt. The procedure is done in two phases, with an initial trial phase to assess the benefit. If pain relief is above 60%, the device is permanently implanted.

"I have an intrathecal pump, which is filled by a community nurse. I also take breakthrough medication, but some days I don't need any. You can never tell. The pain is mysterious." - Kate

Allied health services

Allied health professionals, such as physiotherapists, psychologists and exercise physiologists, support the work of doctors and nurses. Practitioners are usually part of your hospital multidisciplinary team (MDT), or your GP can refer you to private practitioners. They can teach you techniques for managing your physical activity, thoughts and emotions to help improve your pain management.

Exercise techniques

A physiotherapist or exercise physiologist can develop a program to improve muscle strength and increase the ability to function, which may help relieve pain.

Specialised physiotherapy

This can help reprogram the brain (e.g. to manage phantom limb pain after an amputation).

Transcutaneous electrical nerve stimulation (TENS)

TENS delivers electrical pulses to the skin to change nerve activity and relieve pain. Many physiotherapists offer this treatment.

Talk therapies

Psychological therapies such as cognitive behaviour therapy, acceptance and commitment therapy, and mindfulness-based cognitive therapy can help people understand how their thoughts and emotions can influence how they respond to pain. This can help them build new coping skills and resume normal activity as much as possible.

Desensitisation

This psychological technique involves focusing on the pain and relaxing at the same time; it is used for neuropathic pain (e.g. numbness or tingling).

Hypnotherapy

This psychological technique helps people relax and become more aware of their inner thoughts. It has been clinically tested with good results for helping people cope with pain.

Distraction techniques

These help people temporarily focus on something other than the pain, e.g. by counting, drawing, reading.

Complementary therapies

Complementary therapies may help you cope better with pain and other side effects caused by cancer and its treatment. These therapies are used alongside conventional treatments. They may increase your sense of control, decrease anxiety, and improve your quality of life.

Let your doctor know about any complementary therapies you are using or thinking about trying. Depending on the conventional treatment and pain medicines you are having, some complementary therapies may cause reactions or unwanted side effects. You should also tell the complementary therapist about your cancer diagnosis, as some therapies, such as massage, may need to be modified to accommodate the changes in your body. See Understanding Complementary Therapies.

Alternative therapies are used instead of conventional medical treatments. They are unlikely to be scientifically tested and may prevent successful treatment of cancer-related pain. Cancer Council does not recommend the use of alternative therapies for cancer-related pain.

Complementary therapies used to manage pain
acupuncture Uses fine, sterile needles placed under the skin into energy channels (called meridians) to stimulate energy flow.
aromatherapy Uses aromatic essential oils extracted from plants for healing relaxation. Mainly used during massage, but can also be used in baths, inhalations or vaporisers (oil burners).
creative therapies (art therapy, music therapy, journal writing) Help you express your feelings in creative ways. The techniques also provide some distraction from the pain. You can be creative at home, or attend a program at some hospitals and support groups.
heat and cold Uses heat to relieve sore muscles, and cold to numb the pain.
massage Releases both muscular and emotional tension, and may increase your sense of wellbeing. It helps relieve muscle spasms and contractions, and joint stiffness. Avoid massaging the area with cancer.
mindfulness meditation Focuses on breathing techniques and quietening the mind. It encourages people to be more aware of their body, thoughts and surroundings. It can help you change the way you think about experiences.
relaxation Helps release muscle tension, and reduce anxiety and depression. It can help you sleep, give you more energy, reduce your anxiety, and make other pain relief  methods – such as medicine or a cold pack – work more effectively.

Ways to manage ongoing pain after treatment

Improvements in diagnosing and treating cancer have led to an increase in the number of people surviving cancer. After treatment for cancer, some people will have ongoing pain. This is known as chronic pain and it can be treated in a variety of ways:

  • Discuss your pain with your doctor so you can develop a pain management control plan.
  • A multidisciplinary pain clinic can help minimise pain, restore function and return you to your normal activities.
  • Mild painkillers may be used. Opioids such as codeine and morphine have been shown not to work very well to control chronic pain.
  • Being actively involved in managing your pain has been shown to help reduce pain. Learning how pain works can help you think about the pain differently and increase your confidence to do daily activities.
  • Psychological therapies can change how you respond to pain.
  • Some complementary therapies may help, especially those that require your active participation.
  • If pain is interfering with daily activities, set yourself some achievable goals. Gradually increase your activity - e.g. if it hurts to walk, start with walking to the front gate, then to the corner, and then to the bus stop up the road.
  • Movement is very important: daily stretching and walking can help you deal with the pain. It is important to pace activities throughout the day, including rest and stretch breaks.
  • Mindful movement combines relaxation, mindfulness and movement. It provides a way to change pathways in the body and brain that have become overactive due to pain.
  • Relaxation techniques may improve the effectiveness of other pain relief methods and help you sleep. Call 13 11 20 for a free copy of our relaxation and meditation recordings.

Key points about pain relief

How pain is relieved

  • Surgery, radiation therapy and drug therapies are used to relieve pain, usually by removing or shrinking the tumour, or stopping its growth.
  • Pain medicines are commonly used. Pain relief can be mild, such as paracetamol, or strong, such as opioids.
  • Other medicines, such as antidepressants or steroids, may also be given to help treat pain.

Using pain medicines

  • Pain medicines can be given in a variety of ways, e.g. tablets, liquids, skin patches.
  • You may have side effects from pain medicines, but these can often be managed.
  • Keep track of your medicines to ensure you use them safely.

Using opioids

  • Opioids need to be prescribed by a doctor. They are commonly used to treat strong pain.
  • It can take a few days to adjust to taking opioids and you may have some side effects. Your doctor may give you medicines to help prevent these side effects.

Other ways to control pain

  • Medicine may be delivered directly into the spine or a nerve to improve pain control.
  • Allied health professionals can teach you techniques for managing your physical activity, thoughts and emotions to help improve your pain management.
  • Complementary therapies can help you cope better with pain and other side effects.

Reviewed by: Dr Tim Hucker, Clinical Lead, Pain Service, Peter MacCallum Cancer Centre, and Lecturer, Monash University, VIC; Carole Arbuckle, 13 11 20 Consultant, Cancer Council Victoria; Anne Burke, CoDirector, Psychology, Central Adelaide Local Health Network, SA, and President Elect, The Australian Pain Society; Kathryn Collins, Co-Director, Psychology, Central Adelaide Local Health Network, SA; A/Prof Roger Goucke, Head, Department of Pain Management, Sir Charles Gairdner Hospital, Director, WA Statewide Pain Service, and Clinical A/Prof, The University of Western Australia, WA; Chris Hayward, Consumer; Prof Melanie Lovell, Senior Staff Specialist, Palliative Care, HammondCare Centre for Learning and Research, Clinical A/Prof, Sydney Medical School, and Adjunct Professor, Faculty of Health, University of Technology Sydney, NSW; Linda Magann, Clinical Nurse Consultant, Palliative Care and Peritonectomy Palliative Care, St George Hospital, NSW; Tara Redemski, Senior Physiotherapist, Gold Coast University Hospital, Southport, QLD.

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