If you are being treated for cancer pain, you may have concerns about your medicine or other treatments. Here are some common concerns people have and the facts about them.
Concern: I can only take medicine or other treatments when I have pain.
Fact: You should not wait until the pain becomes severe to take your medicine. Pain is easier to control when it is mild than when it is severe. You should take your pain medicine regularly and as your doctor or nurse tells you. This may mean taking it on a regular schedule and around-the-clock. You can also use the other treatments, such as relaxation and breathing exercises, hot and cold packs (see pages 8 and 17), as often as you want to.
Concern: I will become "hooked" or "addicted" to pain medicine.
Fact: Studies show that getting "hooked" or "addicted" to pain medicine is very rare. Remember, it is important to take pain medicine regularly to keep the pain under control.
Concern: If I take too much medicine, it will stop working.
Fact: The medicine will not stop working. But sometimes your body will get used to the medicine. This is called tolerance. Tolerance is not usually a problem with cancer pain treatment because the amount of medicine can be changed or other medicines can be added. Cancer pain can be relieved, so don't deny yourself pain relief now.
Concern: If I complain too much, I am not being a good patient.
Fact: Controlling your pain is an important part of your care. Tell your doctors and nurses if you have pain, if your pain is getting worse, or if you are taking pain medicine and it is not working. They can help you to get relief from your pain.
You may have concerns about your treatment that were not discussed here. Talk to your doctor or nurse about your concerns.
This booklet is about cancer pain and how it can be controlled. Not everyone with cancer has pain. But those who do can feel better with proper pain treatment.
Reading this booklet should help you to:
Pain can affect you in many ways. It can keep you from being active, from sleeping well, from enjoying family and friends, and from eating. Pain can also make you feel afraid or depressed.
When you are in pain or uncomfortable, your family and friends may worry about you.
With treatment, most cancer pain can be controlled. When there is less pain, you will probably feel more active and interested in doing things you enjoy.
If you have cancer and you are feeling pain, you need to tell your doctor or nurse right away. Getting help for your pain early on can make pain treatment more effective.
There are many causes of cancer pain. Most of the pain of cancer comes when a tumor presses on bone, nerves, or body organs. Cancer treatment can cause pain, too.
You may also have pain that has nothing to do with your illness or its treatment. Like everyone else, you can get headaches, muscle strains, and other aches and pains. Because you may be taking medicine for cancer treatment or pain, check with your doctor or nurse on what to take for these everyday aches and pains.
Other conditions, such as arthritis, can cause pain, too. Pain from these other conditions can be treated along with cancer pain. Again, talk to your doctors and nurses about your medical history. They will be able to tell you how each condition can be treated and what is best for you.
Cancer pain is usually treated with medicine. But surgery, radiation therapy, and other treatments can be used along with medicine to give even more pain relief (these treatments are listed on page 8). Ask your doctor or nurse how the other treatments can help you.
Pain treatments work differently for different people. Even when a doctor or nurse uses the right medicines and treatments in the right way, you may not get the pain relief you need. While you are being treated for your pain, tell your doctors and nurses how you feel and if the treatments help. The information you give them will help them to help you get the best pain relief.
Your doctors and nurses will work to find the right pain medicine and treatments for you. You can help by talking with them about:
Many medicines are used to treat cancer pain, and your doctor may give you one or more of them to take. The list below describes the different types of medicine that you may be taking and the kind of pain they work on. Ask your doctor or nurse to tell you more about the medicine you are taking.
Do not start to take a new medicine without checking with your doctor or nurse first. Even aspirin can be a problem in some people who are taking other medicines or having cancer treatment.
(For more information on pain medicines, see pages 14-15.)
All medicines can have some side effects, but not all people get them. Some people have different side effects than others. Most side effects happen in the first few hours of treatment and gradually go away. Some of the most common side effects of pain medicines are:
More serious side effects of pain medicines are rare. As with the more common side effects, they usually happen in the first few hours of treatment. They include trouble breathing, dizziness, and rashes. If you have any of these side effects, you should call your doctor or nurse right away.
Most pain medicine is taken by mouth (orally). Oral medicines are easy to take and usually cost less than other kinds of medicine. Most oral medicines are in tablet form, but sometimes they are liquids that you drink. If it is hard for you to swallow and you cannot take a tablet or liquid for some other reason, there are other ways to get these medicines. These include:
To help your pain medicine work best:
Treating pain is important, and there are many medicines and treatments that can be used. If one medicine or treatment does not work, there is another one that can be tried. Also, if a schedule or way that you are taking the medicine does not work for you, changes can be made. Talk to your doctors and nurses because they can work with you to find the pain medicine that will help you the most.
It may be helpful for you to keep a record of how the medicine is working. Keeping a record like the one on pages 18-19 and sharing it with your doctor or nurse will help to make your treatment more effective.
Your doctor or nurse may recommend that you try other treatments along with your medicine to give you even more pain relief. Relaxation exercises (see page 17) help reduce pain. Many people find that cold packs, heating pads, massage, and rest help to relieve pain. Music or television may distract you from the pain. Your family members may want to help you to use these treatments. These treatments will help to make your medicines work better and relieve other symptoms, but they should not be used instead of your medicine.
Here are a few examples of treatments that can help to relieve your pain. You may use these treatments along with your regular medicine:
Talk to your doctors and nurses about these treatments. They will be able to give you more information. Also, the counseling and support groups listed on page 16 may be able to tell you more.
Some patients have pain that is not relieved by medicine. In these cases other treatments can be used to reduce pain:
Talk to your doctor about other pain treatments that will work for you.
The key to getting the best pain relief is talking with your doctors and nurses about your pain. They will want to know how much pain you feel, where it is, and what it feels like. Answering the questions below may help you describe your pain. You may wish to write your answers in the space after each question.
Where is the pain?You may have pain in more than one place. Be sure to list all of the painful areas.
These tests will help the doctor or nurse find the cause of your pain.
You can work with your doctor or nurse to write a pain control plan to meet your needs. In a pain control plan, you and your doctor or nurse plan your pain control activities. This will include when to take your medicine, how and when to take extra medicine, and other things you can do to ease and prevent your pain. Your doctor or nurse may also list the medicines and other treatments you can use to help you with any side effects or other aches and pains, such as headaches. A sample pain control plan that you can use is on pages 20-21.
Some people find that the first pain control plan does not work for them. You and your doctor or nurse can change your pain control plan at any time. Here are some questions to ask yourself about the pain plan:
Is the pain plan hard to follow?
This booklet talks about many different treatments for cancer pain. It also talks about side effects of medicines. Information about benefits and risks (side effects) of medicines may also be important to you. The list below describes the benefits and risks of the different types of medicines described on pages 4-5.
Benefits: Control mild to moderate pain. Some can be bought without a prescription.
Risks: Some of these medicines can cause stomach upset. They can also cause bleeding in the stomach, slow blood clotting, and cause kidney problems. Acetaminophen does not cause these side effects, but high doses of it can hurt the liver.
Benefits:These medicines control moderate to severe pain and do not cause bleeding.
Risks:May cause constipation, sleepiness, nausea and vomiting. Opioids sometimes cause problems with urination or itching. They may also slow breathing, especially when they are first given, but this is unusual in people who take opioids on a regular basis for pain.
Benefits:Antidepressants help to control tingling or burning pain from damaged nerves. They also improve sleep.
Risks:These medicines may cause dry mouth,sleepiness,and constipation. Some cause dizziness and lightheadedness when standing up suddenly.
Benefits:Help to control tingling or burning from nerve injury.
Risks:May hurt the liver and lower the number of red and white cells in the blood. It is important to have regular blood tests to check for these effects.
Benefits:Help relieve bone pain, pain caused by spinal cord and brain tumors, and pain caused by inflammation. Steroids also increase appetite.
Risks:May cause fluid to build up in the body. May also cause bleeding and irritation to the stomach. Confusion is a problem for some patients when taking steroids.
Pain can make you feel many emotions. You may feel sad, helpless, vulnerable, angry, depressed, lonely, isolated, or other emotions. Lots of people feel these things when they are in pain. Often, when the pain is successfully treated, these feelings lift. Many people who have had cancer feel that counseling, religious, and other support groups have helped them to get back a sense of control and well being.
To find out more about support groups and to receive books and pamphlets about cancer pain, call or write to:
Ask for the booklet Questions and Answers About Pain Control.
The booklet Questions and Answers About Pain Control is also available from this group.
For adults, ask for Cancer Pain Can Be Relieved.
For children with cancer pain, ask for Children's Cancer Pain Can Be Relieved.For adolescents with cancer pain, ask for Jeff Asks About Cancer Pain.
Deep breathing exercises can help relax you. These exercises may work along with your medicine to lessen or relieve your pain.
You can use a chart like this to rate your pain and to keep a record of how well the medicine is working. Write the information in the chart. Use the pain intensity scale to rate your pain before and after you take the medicine.
Pain control plan for ______________________________________________ At home, I will take the following medicines for pain control: Medicine How to take How many How often Comments _________ ___________ ________ _________ _______________ _________ ___________ ________ _________ _______________ _________ ___________ ________ _________ _______________ Medicines that you may take to help treat side effects: Medicine How to take How many How often Comments _________ ___________ ________ _________ _______________ _________ ___________ ________ _________ _______________ _________ ___________ ________ _________ _______________ Constipation is a very common problem when taking opioid medications. When this happens, do the following: - Increase fluid intake (8 to 10 glasses of fluid per day). - Exercise regularly. - Increase fiber in the diet (bran, fresh fruits, vegetables). ==================================================== Use a mild laxative, such as milk of magnesia, if no bowel movement in 3 days. ==================================================== Take ____________________every day at______________(time) with a full glass of water. Use a glycerin suppository every morning (this may help make a bowel movement less painful). Nondrug pain control methods: ______________________________________________ ______________________________________________ ______________________________________________ Additional instructions: ______________________________________________ ______________________________________________ ______________________________________________ Important phone numbers: Your doctor_________________________________ Your nurse _________________________________ Your pharmacy_______________________________ Emergencies_________________________________ Call your doctor or nurse immediately if your pain increases or if you have new pain. Also call your doctor early for a refill of pain medicines. Do not let your medicines get below 3 or 4 days' supply.
The information in this booklet was taken from the Clinical Practice Guideline on Management of Cancer Pain. The guideline was written by a panel of private-sector experts sponsored by the Agency for Health Care Policy and Research. Other guidelines on common health problems are being developed.
To order a single copy of this booklet call the National Cancer Institute, Cancer Information Service at: 800-4-CANCER
or write to: