Managing Pain
Causes of Pain
Pain is one of the most common and feared symptoms
of cancer. However, modern medications can help
control pain. If you experience pain, talk with
your doctor about the type of medication that is
best for your condition.
You and your doctor also may discuss other methods of controlling pain, including
exercises, acupuncture, massage, and more.
Pain may be a side effect of cancer or cancer treatment. If not adequately
managed, pain may have a tremendous effect on quality of life.
Always notify your doctor if you have pain
or if your existing pain increases. Your
doctor can help you find the medication or combination
of medications and dose to control your pain.
Always take your medication as prescribed.
Treating Pain With Drugs
The type of pain medication your doctor recommends
depends on how severe your pain is. Doctors rate
pain on a scale of 1 to 10, with 1 being no pain
and 10 being the worst pain. Based on this scale,
the World Health Organization (WHO) has outlined
guidelines that your doctor may follow:
Mild-to-Moderate Pain (1-3)
For pain at the low end of the 1 to 10 scale,
your doctor may recommend over-the-counter (OTC)
medications, such as acetaminophen (Tylenol®)
or a nonsteroidal anti-inflammatory drug (NSAID)
such as ibuprofen (Advil®, Motrin®,
etc).
Moderate-to-Severe Pain (4-6)
If over-the-counter medication does not relieve
your pain, or you have moderate-to-severe pain,
your doctor may prescribe an opioid. Also
known as narcotics, opioids are similar to natural
substances produced by the body to control pain,
called endorphins. These are the strongest pain
relievers available. Opioids prescribed for moderate-to-severe
pain may include:
- Dihydrocodeine
- Propoxyphene
- Tramadol
Tylenol® or an NSAID may be added to one of the following opioids:
- Codeine
- Oxycodone
- Hydrocodone
Severe Pain (7-10)
For severe pain or pain not relieved with medications recommended for pain on the scale from 1 to 6, your doctor may prescribe a stronger opioid:
- Morphine
- Oxycodone
- Hydromorphone
- Methadone
- Levorphanol
- Fentanyl
Your doctor also may recommend adding a nonopioid analgesic or a supporting drug as needed.
How Pain Medication Is Given
Pain medication may be given in many different ways:
- Pill or liquid (oral)
- Ointment or patch (topical)
- Suppository (rectal)
- Injection into your vein (IV, or intravenous)
"As Needed"
If your doctor gives you pain medication with instructions to "take as needed," take it before the pain becomes severe. Medication takes time to work. If you wait too long to take it, you may experience unnecessary discomfort.
Long-Lasting
If your pain relief does not last long enough, ask your doctor about extended-release medicines, which can control pain for a longer period of time. Morphine and oxycodone are made in extended-release forms. Also, a skin patch that releases the opioid fentanyl can be used.
Immediate Relief
If your pain is controlled most of the time, but occasionally gets bad enough that your medication does not appear to work, your physician may prescribe a rapid-acting medicine, such as immediate-release morphine or oxycodone, to give you more pain relief when it is needed.
Dose Adjustments
Your doctor may adjust your dose as you get used to a medication. You may build a tolerance to medication, which means that you stop getting the same relief from your medication. If this happens, your doctor may increase the dose, prescribe a new medication, or add an additional medication.
Concerns About Addiction to Pain Medication
Pain medications are prescribed for controlling the type of pain that cancer patients frequently encounter. Usually, pain medication is only necessary for a short period of time, such as while you are healing from treatment. In some circumstances, you may be taking pain medication daily for a longer period of time.
Pain Medication Side Effects
Pain medication may make you feel sleepy, cause you to become constipated, or cause nausea and vomiting. Below are tips on dealing with these common side effects.
Sleepiness Due to Pain Medication
Try planning a rest time just after you take your pain medication. Your doctor also may recommend that you take a caffeine drink with your pain medication.
Constipation Due to Pain Medication
Increase fluid and fiber intake to prevent constipation. Your doctor may prescribe a laxative.
Nausea and Vomiting Due to Pain Medication
For nausea and vomiting, a variety of drugs can help relieve your symptoms. Taking your medication with food may also help.
Not everyone experiences these side effects, and not every pain medication causes them to the same degree. Talk to your doctor if you experience side effects with your pain medication.
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Nondrug Treatments for Pain
There are many additional techniques for controlling pain that you may wish to try or discuss with your doctor. These are described below.
Acupuncture
In acupuncture, a licensed specialist inserts thin needles into the body at certain points and at various depths and angles. Each point controls the pain sensation of a different part of the body.
- When the needle is inserted, a slight ache, dull pain, tingling, or electrical sensation is felt for a few seconds.
- Once the needles are in place, no further discomfort should be experienced.
- The needles are usually left in place between 15 and 30 minutes, depending on the condition treated.
Acupuncture is now a widely practiced method of pain relief. Ask your doctor for more details and the name of a licensed acupuncturist.
Biofeedback
Learning this technique requires the help of a licensed biofeedback technician. With the help of special machines, people can learn to control certain body functions, such as:
- Heart rate
- Blood pressure
- Muscle tension
You may use biofeedback techniques to help you relax and, in concert with other pain relief methods, to help you cope with pain.
Emotional Support and Counseling
Anxiety or depression may make your pain seem worse. Also, pain can cause you to feel worried, depressed, or easily discouraged. These are normal feelings that can be relieved.
Try to talk about your feelings with someone you feel comfortable with—doctors, nurses, social workers, family or friends, a member of the clergy, or other people with cancer.
You may also wish to talk with a counselor or a mental health professional. Your doctor, nurse, or the social services department at your local hospital can help you find a counselor who is specially trained to help people with chronic illnesses.
Imagery
Imagery involves using your imagination to create mental pictures of situations. The way imagery relieves pain is not completely understood.
Imagery can be thought of as a deliberate daydream that uses all of your senses—sight, touch, hearing, smell, and taste. Some people believe that imagery is a form of self-hypnosis.
Massage
Many forms of massage may help reduce pain. Some massage therapists specialize in chronic pain. You can also ask friends or family members to help. You also may be able to do massage on yourself. Try using a slow, steady, circular motion. Massage over or near the area of pain with just your bare hand or with hand lotion or warm oil. Check with your doctor before getting a massage to make sure that it is acceptable for your condition.
Meditation
Meditation is the practice of quieting the mind and focusing it on breathing or a mantra (a repeated sound or phrase). Meditation may help you focus your mind on something other than the pain and give you the strength to better cope with pain.
Menthol
Many menthol preparations are available for pain relief. There are creams, lotions, liniments, and gels that contain menthol. When rubbed into the skin, they increase blood circulation to the affected area and produce a warm (sometimes cool) soothing feeling that lasts for several hours.
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Other Actions to Manage Pain
It's hard to be motivated to exercise when you are in pain. In fact, it's probably the very last thing you want to do! However, regular exercise can help you combat pain in a variety of ways:
- Exercise prompts your body to release chemicals called endorphins that block pain signals from reaching your brain.
- Endorphins also help alleviate anxiety and depression, conditions that can make pain more difficult to control.
- Regular exercise can also improve your sleep and give you more energy to cope with pain.
- Talk with your doctor to determine whether exercise is appropriate for you.
Medications to Manage Pain
Narcotic Analgesics
Help relieve pain:
Learn more about how you can best manage other types of chemotherapy side effects.
UNDERSTANDING CANCER
TREATING CANCER WITH CHEMOTHERAPY
CHEMOTHERAPY SIDE EFFECTS
TREATING CANCER IN OTHER WAYS
TRACKING YOUR TEST RESULTS
UNDERSTANDING INSURANCE AND TAX ISSUES: INSURANCE TIPS
WEB RESOURCES AND ORGANIZATIONS
TOOLS FOR ORGANIZING YOUR CANCER INFORMATION
FOR CAREGIVERS
GLOSSARY OF CANCER TERMS
REGISTER FOR PROGRAMS
FOR HEALTHCARE PROFESSIONALS
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