Cancer Pain

Pain From Cancer

Summary

According to Cancer-Pain.org, approximately 30% to 50% of people with cancer experience pain while undergoing treatment, and 70% to 90% of people with advanced cancer experience pain. Opioid analgesics are used to treat moderate to severe pain. Opioids in particular are used to treat patients with severe pain. Unlike NSAIDs, opioids do not have a ceiling, meaning that increased pain relief can be achieved with increased dosage of drug, although this leads to higher incidence of side effects.

About one-half to two thirds of patients with chronic cancer-related pain also experience episodes of "breakthrough" cancer pain, according to Cancer-Pain.org. More than 1,000,000 patients in the U.S. suffer from breakthrough cancer pain, defined as transitory flare of pain when chronic pain is managed with opioids. Generally, breakthrough pain happens fast, and may last anywhere from seconds to minutes to hours. Severe chronic pain is common where there is direct tumor involvement. It has been reported that of cancer patients in their last year of life, over 80% have severe pain, and 60% have severe pain for over six months. The treatment of breakthrough pain is a major medical challenge.

The most desirable characteristics of treatment for this type of pain are speed of onset of action and ability to increase dose according to onset of pain. However, according to a recent article in Pharmacologic Treatment of Cancer Pain, chronic cancer pain can be successfully treated in about 95% of people with the drug and non-drug therapies that are currently available.

A new transmucosal drug for the treatment of breakthrough pain is now available. Called ACTIQ (Oral Transmucosal Fentanyl Citrate), it is the only analgesic drug to be approved by the Food and Drug Administration specifically for breakthrough pain, and the first analgesic medication that comes in the form of a lozenge on a handle. ACTIQ dissolves through the mucus membranes in the mouth and provides rapid pain relief within 5 to 10 minutes.

Your doctor and nurse will try to find out why you are hurting. To do this they will gather important information. One of the first steps they may take is to ask you questions about your pain.

For example, they may want to know where it is.

Does it stay in one place, or does it move around?

They may ask you to tell them how your pain feels.

Does it feel dull, aching or burning?

You may also be asked how strong your pain is. There are several ways to measure your pain. One way is by selecting a number on a scale from 0 to 10.This scale is called a pain rating. “0” means no pain, and “10” means you have the worst pain imaginable. Which number between 0 and 10 best describes the pain you are feeling?

It is important for you or a member of your family to keep a diary of your pain. You should share all of the important details with your doctor.

For example, in your diary, you could write down the date, time of day, a pain rating, and things you did to make the pain better.

Use a diary like this one to write down the date, time of day, a pain scale rating, and things you did to make the pain better.

Date	Time	Pain rating (0-10 scale)	Pain medication (name, dose, how often taken)	Other pain-relief methods tried	Side effects from pain medicine
June 6 (example)	8 am	6	Morphine 30 mg every 4 hrs	massage	constipation

After the doctor has asked you questions about your pain, he or she may need to gather more information about what is causing it.

You may be examined or asked to have an X-ray or a scan of the areas where you hurt.

Since pain can be caused by many things, such as tumor in the bones or tumor pressing on a nerve, it is important for the doctor to find out the reason for your pain.

Your doctor and nurse will combine the information they have gathered and plan how to make you more comfortable.

Medicines for Cancer Pain

Medicines are one of the most common ways to control your pain.

Most pain from cancer can be simply treated using medicines taken by mouth. The doses of these medicines often need to be changed to make you feel better.

Pain medicines can be divided into three groups.

1) The first group is for mild pain. You may have used some of these medicines in the past for problems such as headaches or sore muscles. Aspirin, Tylenol® and Advil® belong to this group.

2) The second group of medicines is for more severe pain.

You may have heard them called narcotics or opioids. Examples include codeine, oxycodone, morphine, and hydromorphone.

Many patients are afraid to take opioids because they think they may become "hooked" or addicted. This problem is very, very rare, occurring in about 1 in 10,000 patients. You will not become addicted if you take opioids for pain relief.

If you are worried about addiction, talk to your doctor, nurse, or pharmacist.

Patients also worry about using strong pain medicines too soon. They fear that if the pain really gets bad, there may not be a medicine to use later to control it.

In fact, it is best to treat your pain when it begins, even if strong medicines are needed.

This will make it easier for the doctors to control your pain later.

Some patients also worry about side effects of medicines.

Some side effects are very common but can be treated.

These include sleepiness, nausea, and constipation. You should tell your doctor, nurse, or pharmacist if you are having these problems.

You have learned about two groups of medicines. T

3) The third group is usually used to treat other medical problems, but is also effective for treating cancer pain.

For example, if you describe your pain as burning or tingling, you may have an injured nerve.

Medicines used to treat depression or seizures may be helpful for this kind of pain.

What are some other ways to control pain?

Treatments such as radiation therapy and chemotherapy can reduce pain by shrinking some tumors.

This relieves pressure on bones, nerves, or other parts of the body.

For some types of pain, your doctor may suggest a nerve block to help you feel better.

If this is needed, a specially trained doctor will use a needle to place medicine directly near a nerve. This blocks or deadens the nerve so you do not feel the pain.

There are other simple treatments that do not involve medicines. These include enjoyable activities such as

listening to music,

receiving a back rub,

taking a warm bath,

or even watching television.

You can ask your doctor, nurse or social worker to teach you about other methods that do not involve medicines and that you can use on your own. Your family can help you with these, too.

* page last updated 03/10/2008

Source: National Cancer Institute