Everyone with cancer does not experience cancer pain. However, most cancer patients report having pain related to cancer and/or the treatment. Pain from cancer may be short-lived or long-lasting, and it may be mild or severe. Since cancer can affect a patient’s organs and bones, pain should never be accepted as a normal part of cancer.
What is Cancer Pain?
Cancer pain is any pain associated with cancer. The type of pain a person feels depends on the type of cancer and how it affects the body. The pain can be a deep, aching pain, or a burning pain. The pain can be acute for a short period of time, or it can be chronic. The pain can be from the cancer itself, the affect the cancer has on the patient’s body, or the discomfort associated with cancer treatments. Cancer pain is any pain associated with cancer. The type of pain a person feels depends on the type of cancer and how it affects the body. The pain can be a deep, aching pain, or a burning pain. The pain can be acute for a short period of time, or it can be chronic. The pain can be from the cancer itself, the affect the cancer has on the patient’s body, or the discomfort associated with cancer treatments.
What Causes Cancer Pain?
As mentioned above, cancer pain can result from the cancer itself, the affect it has on the patient’s body, and the discomfort from cancer treatments.
Most cancers do not hurt at first, and are detected as a painless lump, through a diagnostic test, or because of other symptoms. Many patients, therefore, are surprised to learn that they have cancer, and don’t even feel sick.
Cancer pain most often comes later in the disease, as the cancer grows and spreads. Patients experience pain as the cancer metastases (spreads to other regions of the body), and as tumors press against bones, nerves, soft tissue, and organs. Some cancers also secrete proteins that can cause pain.
What Are the Symptoms of Cancer Pain?
Cancer pain varies from patient to patient. The amount of pain depends on the type of cancer, the stage (extent) of the disease, and the patient’s pain threshold and tolerance for pain. Pain can range from mild and occasional to severe and constant.
Deep, Aching Pain. A tumor that presses on the bones, or grows into the bones, causes deep, aching pain. Bone pain is the most common type of cancer pain.
Burning pain. A tumor pressing on a nerve is the most often cause of a burning pain. However, chemotherapy, radiation, and surgery can sometimes damage nerves and cause a burning pain. Nerve pain is the second most common type of cancer pain.
Acute pain. A severe pain that lasts for a relatively short time.
Chronic pain. On-going pain that comes and goes for an extended time (longer than three months). Chronic pain is often a side effect of the cancer or its treatment. Chronic pain can range from mild to severe.
Breakthrough pain. A strong pain that begins suddenly and lasts for only a short time is a breakthrough pain. Breakthrough pain can occur even while taking medication to control pain. Breakthrough pain is not controlled by regular doses of pain medicine. It varies in intensity and is usually unpredictable.
What are the Major Types of Cancer Pain?
It is crucial to determine the type and cause of the pain so that treatment can begin as soon as possible. Cancer pain patients may find that their pain changes throughout the day, and should strive to communicate these changes to their doctor.
Nerve pain is often called neuropathic pain. Nerve pain results from pressure on nerves or the spinal cord, or by damage to the nerves. People report nerve pain as a burning, tingling, or shooting pain, and may feel as if something is crawling under their skin.
Bone pain occurs when cancer spreads to the bone. It can cause pain in one or more areas. The pain is from cancer cells within the bone damaging bone tissue. Sometimes described as somatic pain, the pain is usually said to be aching, dull or throbbing.
Soft tissue pain is pain from an organ or muscle. Patients usually describe the pain as sharp, cramping, aching, or throbbing.
Phantom pain is pain in a part of the body that has been removed. Phantom pain is very real and can be unbearable. Doctors are not sure why phantom pain happens. Although the body part is gone, nerve endings at the site can send pain signals to the brain that thinks the body part is still there.
Referred pain is pain from an organ that is felt in another part of the body. For example, cancer in the liver might cause pain in the right shoulder – even though the liver is under the ribs. The reason may be from the liver pressing on nerves that end in the shoulder.
Cancer pain can be the result of some cancer-related treatments and tests. Some of the tests that diagnose cancer and determine how well treatment is working can be painful. Some types of pain related to cancer treatments and tests include:
Peripheral neuropathy (PN) is a burning, tingling, or numbness in the hands, arms, feet, or legs. It can also cause weakness, clumsiness, or trouble walking. Peripheral neuropathy can be caused by nerve damage from certain types of cancer as well as chemotherapy. It can also be from other problems not related to cancer or its treatment.
Mouth sores (stomatitis or mucositis) are sores resulting from chemotherapy in the mouth and throat. The pain can cause problems eating, drinking, and speaking.
Radiation mucositis and other radiation injuries occur from external radiation. The location depends on the part of the body receiving cancer treatment. Radiation can cause skin burns, mucositis (mouth sores), and scarring – all of which can cause pain. The throat, intestine, and bladder are also prone to radiation injury if these areas are treated.
How is Cancer Pain Treated?
Mild to moderate cancer pain treatment consists of pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter drugs do not require a prescription, but stronger versions are available with a prescription. However, it is very important that patients consult their doctor before taking these, or any, medications, especially when being treated for cancer.
Moderate to severe pain treatment consists of narcotic pain relievers such as codeine and morphine.
Tingling and burning pain treatment consists of using certain antidepressants, even if the patient isn’t depressed. Anti-seizure medications can also control burning and tingling pain (symptoms of nerve damage) in addition to treating seizures.
Non-Drug Treatment Options
Your doctor may recommend non-drug treatments for managing cancer pain in addition to pain medications. These treatments can help medications work better and relieve other symptoms.
Acupuncture involves placement of very thin needles into the body at certain points and at various depths and angles. Each point is thought to control the feeling of pain in a different part of the body. It’s especially important to check with your doctor before starting acupuncture if you are under a doctor’s care for cancer.
Biofeedback helps bring awareness to bodily processes normally thought to be involuntary (like blood pressure and heart rate).
Breathing and relaxation exercises help focus attention on performing certain tasks, instead of concentrating on pain.
Distraction shifts attention to a more pleasant event, object, or situation, instead of the pain.
Heat and cold temperature can facilitate pain control using ice packs or heating pads. Cold can help lessen pain by partially numbing the painful area.
Hypnosis. A focused state of consciousness obtained through hypnosis can allow a pain sufferer to better process information. Hypnosis can be useful to help substitute another feeling for the pain or to change to a less painful sensation
Imagery. By using the imagination to create mental pictures or situations that are soothing and positive, pain sufferers can relax and be distracted from their pain.
Massage, pressure, and vibration. Physical stimulation of muscles or nerves can help pain sufferers relax, and thereby relieve painful muscle spasms or contractions. This treatment is only beneficial if treatment does not damage the skin.
Rhythmic breathing. Long, slow breaths while alternately tensing and relaxing the muscles may help relax the body.
Transcutaneous electrical nerve stimulation (TENS). The application of a mild electric current to the skin at the site of the pain.
Other therapies such as meditation and humor may also help.
How Is Cancer Pain Medication Administered?
Often, cancer pain patients believe if their pain becomes severe, they’ll need an injection or “shot” of pain medicine. In reality, pain “shots” are rarely needed to relieve cancer pain. At Novus Spine and Pain Center, we have several ways to administer pain medicine.
Oral. Medication taken by mouth. Oral medication can be swallowed or absorbed in the mouth. The medicine comes in liquid, pill, capsule, or transmucosal form (the drug is in a lozenge, “sucker,” or spray, and absorbed directly through the tissues of the mouth).
Skin patch. A patch that sticks to the skin, slowly and consistently releasing medicine through the skin for 2 to 3 days.
Rectal suppositories. Medicine that dissolves from a small capsule placed in the rectum and is absorbed by the body.
Injections. If an injection is necessary to deliver medication, there are several ways to inject medicines into the body.
Subcutaneous injection (SC). The method most people are familiar with; the medicine is put just under the skin using a short, small needle.
Subdermal and intramuscular injections. Targeted injections that are placed deeper into the skin or muscle. Not usually recommended for long-term cancer pain treatment.
Intravenous injection (IV). The medicine goes into a vein through a needle, port, or catheter.
Intrathecal and epidural injections. A doctor injects the medicine into the fluid around the spinal cord (intrathecal) or into the space around the spinal cord (epidural).
Pump, or patient-controlled analgesia (PCA). A pump is connected to a small tube going into your body. The medicine goes into a vein, just under the skin, or into the area around the spine. This method allows the patient control over the amount of pain medicine taken by pressing a button that delivers a preset dose of pain medication through a computerized pump. (The pump carefully controls how much medicine the patient receives at any one time, to prevent an overdose.)
Nerve Block. Specific nerve blocks and certain neurodestructive procedures can help relieve cancer pain. Nerve block treatment consists of the injection of a local anesthetic into the spine, into, or around an affected nerve to interrupt pain signals sent to the brain.
Pain Pump. An implanted pump, filled with pain medication, sends the medication through a catheter directly to the spinal area at the location of specific nerves in an area of the spinal cord called the intrathecal space.
Reasons People Do Not Receive Adequate Cancer Pain Treatment
Unfortunately, cancer pain is undertreated for several reasons; the most often of which is because patients are reluctant to talk about their pain.
Some want to avoid “bothering” their doctors with the information.
Some may fear that the pain means the cancer is getting worse.
Others may be reluctant to report pain to avoid complaining.
Some cancer patients think they’re supposed to have cancer pain and should be able to deal with it, which simply isn’t true.
Another factor that might keep patients from asking for help to control cancer pain is the fear of becoming addicted to pain medications. Some cancer doctors may be concerned about prescribing pain medications because the drugs can be abused or become habit forming. However, people in pain are unlikely to abuse their pain medications.
Others fear the side effects of pain medications. Many are afraid of being constantly sleepy and unable to communicate with others. Some think a person on pain medication will act strangely or can become dependent on the pain medicine. People may also think that taking morphine can shorten their life. There is no evidence of any of these things happening if the medication is properly dosed and supervised by a pain specialist.
Developing a Pain Control Plan
Only you know how much pain you are experiencing. Pain may be an early warning of side effects of the cancer treatment, or it may be another problem. It is important to tell your cancer care team when you’re in pain because pain is easier to treat when it first begins. As a patient, you have the right to be treated for cancer pain, and you should insist on it.
The American Cancer Society has a free Pain Diary to help you track your pain. Download this PDF of the Pain Diary, and use it to talk with your doctor about your cancer pain.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating Cancer Pain. By using a comprehensive approach and cutting edge therapies, we help patients get relief from the pain they suffer because of cancer and cancer treatments while minimizing the need for opiates.