Cancer pain

Key points about cancer pain

  • People who have cancer don't always have pain. 
  • However, if you have cancer and you are experiencing pain, don't accept it as a normal part of having cancer. 
  • Cancer pain can always be managed.
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The main causes of cancer pain is the tumour. As the cancer grows or spreads, it can cause pain by pressing on surrounding tissues, such as your nerves, bones, spinal cord or body organs.

  • When a tumour spreads to your spine, and presses on your spinal cord, it can causes spinal cord compression, often resulting in back or neck pain. Everyday actions like coughing or sneezing can make it worse.
  • Cancer pain can also be caused by some tests and treatments such as a biopsy, spinal tap or bone marrow test. Pain related to these tests will pass. Talk to your doctor about pain relief options.
  • Treatments for cancer such as chemotherapy, radiation therapy and surgery can also cause pain, as a result of damage to your nerves (called nerve pain) or due to the removal of a body part (called phantom pain). 

The amount or type of pain you have depends on the type of cancer you have, its stage (extent), and your pain threshold (tolerance for pain). People with advanced cancer are more likely to have pain.

The pain can be acute, which comes on quickly and lasts for a short time or chronic, which tends to be ongoing and continuous.

Another type of pain that may occur in people with cancer is called breakthrough pain, which is  a flare of pain, or an intense rise in pain. This can happen even if you are taking pain medicine regularly for chronic pain. It varies in intensity and usually cannot be predicted. It can happen several times a day, despite taking the right dose of pain-relieving medicine. It may happen as the current dose of your medicine is wearing off.

Being in pain affects your quality of life. When pain is not treated properly, you may feel tired, depressed (have low mood), angry, worried, lonely or stressed. Pain can keep you from doing everyday things like sleeping, eating and being active. 

Being in pain is not a normal part of having cancer. Cancer pain can be controlled in almost every situation. This does not mean that you have no pain, but it does mean that the pain stays at a level that you can bear. When pain is controlled, you can sleep and eat better, enjoy being with your family and friends, and continue with your work and hobbies. 

Medications used for the treatment of cancer pain are chosen on the basis that they provide the greatest pain relief possible with the fewest number of side effects.

  • For mild cancer pain, pain relievers such as paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac and naproxen, may be sufficient.
  • For mild-to-moderate pain, if it is not relieved by paracetamol or NSAIDs alone, opioid medications like codeine are often added. 
  • For moderate-to-severe pain, higher doses of opioid medications such as tramadol, oxycodone or morphine are used.

Sometimes the standard painkillers above are not effective on their own or are not suitable, and other medications are used such as antidepressants, anti-epileptics and corticosteroids. Read more about pain relief medications.

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  • Talk to your healthcare team about your pain. Describing your pain accurately can help your doctor develop the best pain control plan. See how can I describe my pain to my healthcare provider?
  • Work with your healthcare team to develop a pain control plan for you and your needs. Everyone experiences pain differently and responds to medicines differently. Even if you have the same cancer as someone else, your pain control plan may be different.  

Your pain control plan

  • Stop pain before it starts. The best way to control your pain is to stop it before it starts or to prevent it from getting worse. Take your pain medicine on schedule to keep the pain from starting or getting worse. Do not skip doses of your scheduled medicine. The more pain you have, the harder it is to control. 
  • Don’t run out of pain medicine. Prescriptions are needed for most pain medicines, and pharmacies don’t always have them in stock. It can take a few days to get some medicines, so allow time for delays.
  • Be aware of side effects. Ask your healthcare team about the side effects of your pain medication and how you can prevent them. Common side effects include constipation, nausea (feeling sick), vomiting (being sick) and drowsiness (feeling sleepy). Side effects vary with each person, so talk to your doctor about your experiences. Don't  let any side effects stop you from getting your pain controlled. 
  • Don't let the fear of addiction prevent you from taking medication to manage your pain. Many people develop tolerance to a medicine that requires them to have an increase in dosage, as their body gets used to the medication. This is normal and is not an addiction. People with cancer sometimes need strong medication to control their pain.  
  • Use non-medication techniques. Your pain control plan can include non-medication techniques. Some people may prefer to use non-medication techniques  such as massage, acupuncture or TENS (transcutaneous electrical nerve stimulation). You may find these more effective in managing your pain, or find them to be a useful complement to your medication.  Talk to your healthcare team about your options and preferences. See non-medication treatments for pain  
  • Adapt and adjust. Talk to your doctor about changing your pain control plan if it isn't working. If your pain isn't getting better or going away, or if you are having breakthrough pain despite taking your pain medication as prescribed, or if the side-effects of your medicines are bothersome, tell your doctor. Small adjustments to your medication can make a big difference. 

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