Overcoming cancer pain


Overview

What is pain?

Pain is not just a sensation that hurts. It is an unpleasant sensory and emotional experience associated with actual or possible tissue damage.

People experience pain in different ways and even people with the same type of cancer can have different experiences. The way people feel pain is influenced by emotional, environmental, behavioural and physical factors. These factors act directly or indirectly on the body's nervous system (the brain, spinal cord and nerves). The type of cancer, its stage, the treatment you receive, other health issues, your attitudes and beliefs about pain, and the significance of the pain to you, will also affect the way you experience pain. Health professionals assess all these factors to help treat pain.

If left untreated, pain can lead to anxiety or depression, and prevent you from doing the things you want to do. Learning to control pain may allow you to return to many of the activities you enjoy and improve your quality of life.

Your experience of pain

Only you can describe your pain - it may be steady, burning, throbbing, stabbing, aching or pinching. Health professionals, family members and carers will rely on your description to work out the level of pain and its impact on your life. See Describing pain for different ways to let health professionals know how you're feeling.

Does everyone have cancer pain?

Cancer pain is a broad term for the different kinds of pain

people may experience when they have cancer. Not everyone with cancer will have pain. Those who do experience pain may not be in pain all the time - it may come and go.

During treatment, about six out of ten people (55%) say they experience pain. People with advanced cancer are slightly more likely to experience pain (66%). After treatment, about one in three people (39%) say they experience pain. 2

What causes cancer pain?

People with cancer may have pain caused by the cancer itself or by cancer treatment. They may also have pain from other causes, such as arthritis. Some reasons for pain include:

  • a tumour pressing on organs, nerves or bone
  • a fracture if the cancer has spread to the bones
  • side effects from surgery, radiation therapy, chemotherapy, targeted therapy or immunotherapy
  • poor circulation due to blocked blood vessels
  • blockage of an organ or tube in the body, such as the bowel
  • infection or swelling and redness (inflammation)
  • muscle stiffness from tension or inactivity
  • poor posture (which can lead to back pain, for example).

New pain or an increase in pain doesn't necessarily mean that the cancer has advanced or spread to another part of the body. This is a common concern when pain levels change.

What types of pain are there?

There are many types of pain. Pain can be described or categorised depending on what parts of the body are affected or how long the pain lasts.

Acute pain

Pain that starts suddenly and lasts a short time, possibly for a few days or weeks. It may be mild or severe. Acute pain usually occurs because the body is hurt or strained in some way, but it generally disappears when the body has healed.

Chronic pain

Pain that lasts for three months or more. Chronic pain may be due to an ongoing problem, but it can develop even after any tissue damage has healed.

Breakthrough pain

A flare-up of pain that can occur despite taking regular pain medicine. It may happen because the dose of medicine is not high enough or because the pain is worse at different times of the day. Other causes of breakthrough pain include anxiety or illnesses.

Nerve (neuropathic) pain

Pain caused by pressure on nerves or the spinal cord, or by nerve damage. It can come and go. People often describe nerve pain as burning or tingling, or as "pins and needles". Nerve damage to the hands and feet is called peripheral neuropathy.

Bone pain

Pain caused by cancer spreading to the bones and damaging bone tissue in one or more areas. It is often described as dull, aching or throbbing, and it may be worse at night.

Soft tissue pain

Pain caused by damage to or pressure on soft tissue, including muscle. The pain is often described as sharp, aching or throbbing.

Visceral pain

Pain caused by damage to or pressure on internal organs. This type of pain can be difficult to pinpoint. It may cause some people to feel sick in the stomach (nauseous).

Referred pain

Pain that is felt in an area of the body away from the cause of the problem (e.g. a swollen liver can cause pain in the right shoulder).

Localised pain

Pain that occurs directly where there's a problem (e.g. pain in the back due to a tumour pressing on nerves in that area).

Phantom pain

A pain sensation in a body part that is no longer there, such as breast pain after the breast has been removed. This type of pain is very real. Phantom pain can be difficult to control with medicines, and other strategies often need to be used.

"I had some numbness and pain in my hands from one of the chemotherapy drugs. Doing hand stretches and exercises, and soaking my hands in warm water, helped. The doctors stopped that drug so the numbness wouldn't become permanent." - Ann

What affects pain?

As well as the physical cause of the pain itself, your emotions, thoughts, environment and fatigue levels can affect how you feel and react to pain. It's important for your health care team to understand the way these factors affect you.

Fatigue

Extreme tiredness can make it harder for you to cope with pain. Lack of sleep can increase your pain. Ask your health care team for help if you are not sleeping well.

Emotions

You may worry or feel easily discouraged when in pain. Some people feel hopeless, helpless, embarrassed, angry, inadequate, irritable, anxious, frightened or frantic. You may notice your behaviour changes. Some people become more withdrawn and isolated.

Environment

Things and people in your environment - at home, at work and elsewhere - can have a positive or negative impact on your experience of pain.

Thoughts

How you think about pain can influence how you experience the pain, e.g. whether you see it as overwhelming or manageable.

How is cancer pain treated?

Treatment depends on the cause of the pain, but relief is still available even if the cause is unknown. There are many ways of managing both acute and chronic cancer pain, including:

Many people need a combination of treatments to achieve good pain control. It might take time to find the right pain relief for you, and you may need to continue taking pain medicines while waiting for some treatments to take effect.

Different things might work at different times, so it is important to try a variety of pain relief methods and persist in finding the best options for you. The World Health Organization estimates that the right medicine, in the right dose, given at the right time, can relieve 80-90% of cancer pain. 3

Sometimes pain cannot be completely controlled. You may still feel some discomfort. However, your health professionals can help make you as comfortable as possible. If your pain persists, you can seek a second opinion or ask for a referral to a specialist pain management clinic.

When can I use pain medicines?

You can use different types of pain medicines whenever you feel any level of pain. If you have pain, it's better to get relief as soon as possible. This results in better pain control and less pain overall.

If pain lasts longer than a few days without much relief, see your doctor for advice. It's important not to let the pain get out of control before doing something about it.

Your doctor will talk to you about how much medicine to take (the dose) and how often (the frequency). The aim is for pain to be continuously controlled.

Many people believe that they should delay using pain medicines for as long as possible, and that they should only get help when pain becomes unbearable. If you do this, it can mean you are in pain when you don't need to be.

There is no need to save pain medicines until your pain is severe. Severe pain can cause anxiety and difficulty sleeping. These things can make the pain harder to control. See Using pain medicines for more information.

If the pain doesn't improve the first time you use a new pain relief method, try it a few more times before you give up. If you're taking medicine that doesn't seem to work or has stopped working, talk to your doctor - don't change the dose yourself.

Is palliative care the same as pain management?

To "palliate" means to relieve. Palliative care aims to relieve symptoms of cancer without trying to cure the disease. Pain management is only one aspect of palliative care. The palliative care team may include doctors, nurses, physiotherapists, social workers, occupational therapists, psychologists and spiritual care practitioners. They work together to:

  • maintain your quality of life by relieving physical symptoms
  • support your practical, emotional, spiritual and social needs
  • provide support to families and carers
  • help you feel in control of your situation and make decisions about your treatment and ongoing care.

Your cancer specialist or nurse can put you in touch with a palliative care team for treatment in hospital or at home. This type of care can improve quality of life from the time of diagnosis, and can be given alongside other cancer treatments. See our Understanding Palliative Care.

Who helps manage my pain?

Different health professionals work together to help manage your pain. Some of these professionals are listed below. They will often discuss treatment options at a multidisciplinary team (MDT) meeting. If your pain is not well controlled, you may want to ask your GP or palliative care specialist for a referral to a pain medicine specialist who is experienced in cancer pain and part of a multidisciplinary pain clinic.

Health professionals you may see
Role
general practitioner (GP) assists with treatment decisions; provides ongoing care in partnership with specialists
surgeon* surgically removes tumours from the body
radiation oncologist* treats cancer by prescribing and overseeing a course of radiation therapy
medical oncologist* treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy (systemic treatment)
palliative care specialist* treats pain and other symptoms to maximise wellbeing and improve quality of life
pain medicine specialist* treats all types of pain, particularly acute pain during active treatment, ongoing pain after treatment, or pain that is difficult to control
nurse administers drugs and provides care, information and support
nurse practitioner works in an advanced nursing role; may prescribe some medicines and tests
pharmacist dispenses medicines and gives advice about dosage and side effects
physiotherapist helps with restoring movement and mobility, and preventing further injury
 psychologist helps you identify the thoughts, emotions and behaviours that affect your pain; provides psychological methods of pain management
counsellor, social worker help you with emotional, practical or financial issues

*Specialist doctor

Expert content reviewers:

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.

References:

2. MH van den Beuken-van Everdingen et al., “Update on prevalence of pain in patients with cancer: systematic review and meta-analysis”, Journal of Pain and Symptom Management, vol. 51, no. 6, 2016, pp. 1070–90.

3. World Health Organization, Cancer Pain Ladder for Adults. Available from: who.int/cancer/palliative/painladder/en [accessed 2 May 2018].

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