Pain Control in Advanced Cancer

Having cancer does not mean that you will have pain. But if you do, pain can usually be controlled with pain medicine and non-drug approaches. Pain may be caused by the cancer or by cancer treatment.

Controlling pain is an important part of your cancer treatment plan. Trying to just "deal with" pain can make it harder to control in the future. Effectively treating pain can make a big difference in everyday life, improve your mood, help you sleep better, and give you energy.

There are a few common types of pain in people with cancer:

• Acute pain may feel sharp and come on quickly. It often lasts only a short time.
• Breakthrough pain may come on suddenly while you are taking medicine for chronic pain. It usually lasts a short time and may be intense, even when you are taking the correct amount of medicine.
• Chronic pain, also called persistent pain, usually lasts more than three months. It may be mild or severe and may come and go or be constant.

Sometimes the cancer causes the pain, such as when a tumor presses on nerves. Some treatments or tests cause pain, like surgery. Pain can also be a side effect of treatment, such as mouth sores or peripheral neuropathy.

Your doctor will develop a pain control plan that is unique to you, based on your symptoms and what is causing the pain. To help, describe your pain as clearly as you can. Your team may ask:

• Where do you feel pain?
• What does it feel like: sharp, burning, shooting, or throbbing?
• Does it come and go, or is it constant?
• How bad is it, on a scale of 1 to 10?
• What makes it better or worse?
• Does it interfere with eating, sleeping, or daily activities?

Some people track their pain and the medicine they took in a notebook, a chart, or a phone app. Once you have a plan, your team will check whether your pain is going down and adjust the plan as needed.

Different types of pain medicine are used, including over-the-counter medicines, prescription medicines such as antidepressants or steroids, and opioids for moderate to severe pain. Your doctor will explain what to take, when, and how much.

A few important points:

• Take the medicine on schedule. Do not wait until pain gets bad, because it may take longer to go away or you may need more medicine.
• Tell your doctor if the medicine is not working. The type or amount may need to change.
• Never stop suddenly. Stopping abruptly could cause withdrawal, with symptoms like anxiety, sweating, or nausea. Talk to your doctor first.

Ask about side effects so you know what to expect. Common ones include constipation, drowsiness, nausea, or vomiting, and some may ease as your body adjusts.

People with cancer often need strong pain medicine, and it is common to worry about addiction. These three terms are different:

• Drug tolerance happens when the body gets used to a medicine and it no longer works as well; the dose or medicine may be changed.
• Physical dependence means the body has unpleasant symptoms if the drug is suddenly stopped or greatly reduced. It can happen even when medicine is taken as instructed.
• Addiction involves compulsive drug seeking and being unable to stop despite harmful effects.

Needing a higher dose, or having symptoms when the dose is decreased, is not the same as addiction. Your doctor carefully prescribes and monitors your medicine so your pain is safely treated. Most people with cancer who take strong pain medicine use it safely and effectively.

In addition to medicine, your team may suggest other practices, often called complementary or integrative medicine. Some examples include acupuncture, biofeedback, distraction (such as music or a movie), guided imagery, hypnosis, and meditation.

These practices are available in many communities and hospitals, and there are online programs too. Ask your health care team which options may be best for you. And remember: contact your doctor if you feel new pain, if pain is not going away with medicine, or if you have side effects. Pain is not something you have to put up with.