Pain treatment options for cancer

Cancer isn’t always painful, but then again, everyone handles pain differently. You are the only one who truly knows when you’re in pain; it’s important to tell your doctor or nurse when it happens, so that you can manage it together. Keep in mind, though: Treatments that work well for one person might not work at all for another. It may take a while to find the best solution for your type of pain.

Sources of pain

If you have cancer pain, it may come from one of these sources:

  • Pain due to the cancer itself, such as a tumor that presses on a nerve or organ.
  • Cancer that has spread to another part of the body, such as the ribs or the spine.
  • Pain due to cancer treatments:
    • Chemotherapy side effects can include mouth sores, pain, and tingling in the fingertips. There may also be pain in your bones or joints when walking or moving.
    • Radiation side effects can include skin problems that feel like a sunburn, and irritation-like pain in certain parts of the body. For example, radiation to the head or neck may cause a sore throat and problems with swallowing.
    • Surgery to remove cancer, or to test for cancer (biopsy): Surgery can cause pain because of incisions made during the operation. This type of pain may last for a while as you heal.
  • Pain that’s not related to cancer, such as arthritis pain, sore muscles, or a headache from a stressful day.

Types of pain

Two types of pain are linked with cancer:

  • Nociceptive (no see sep tiv) pain is caused by stretching, pressure, or injury to muscles, tissues, or organs. It can also include aches or pains deep inside the body.
  • Neuropathic (nur oh path ik) pain is caused by nerves that are hurt, inflamed, or pressed. People usually say that this pain gives burning, stabbing, shooting, or electric-shock feelings. Neuropathic pain can show up without warning, happen without any clear reason, and it can come and go for weeks or months.

Types of treatment for cancer pain

There are a few different ways to handle pain that’s caused by cancer. The kind of treatment that’s chosen depends on the type of pain (nociceptive or neuropathic) and whether it’s mild, severe, or somewhere in the middle. But the most important reason for choosing one type of pain reliever over another is how badly the pain is affecting your day-to-day life.

There are three main types of pain-relieving medications:

  1. Opioids: prescription narcotics, such as morphine.
  2. Non-opioids: over-the-counter and prescription pain relievers that aren’t narcotics.
  3. Adjuvant medications: other drugs used along with the main pain-relievers listed above. Adjuvant medications include tricyclic anti-depressants like amitriptyline, and anti-convulsants like gabapentin.

Non-drug treatments can help relieve pain, too: Heat, cold, massage, relaxation/visualization, yoga, and acupuncture are some examples of non-drug treatments. These methods, either on their own or in combination with medications, can work for most types of pain. Ask your doctor for help in choosing the best option.

Treating mild cancer pain

Mild cancer pain can be helped by non-drug treatments, if they’re used along with acetaminophen or NSAIDS (non-steroidal anti-inflammatory drugs) like ibruprofen. Acetaminophen and NSAIDS have limits on the amount that can be safely taken each day, though: More is not always better – in fact, it can sometimes be harmful.

Some common, mild cancer pain problems include:

  • Skin reactions due to radiation: These problems may be treated by keeping the skin clean and dry, and by wearing non-scratchy, 100% cotton clothing next to the area. Don’t choose your own skin creams: Only use products suggested by your radiation team, because they know what will work well with your treatment.
  • Mouth sores due to some kinds of chemotherapy: These sores may look like cold sores, but they need different treatment. Ask your doctor for advice. Don’t try to treat them yourself.
  • Swelling and pain (lymphedema) of the arms or legs: This problem may happen after some types of cancer surgery. It can sometimes be treated with massage that’s done by specially-trained therapists, or by keeping the swollen area raised, or by wearing special sleeves or stockings that put pressure on the swelling. Speak with your doctor before trying these treatments, however.

Treating moderate to severe cancer pain

If these treatments don’t help your pain, your doctor may prescribe a stronger narcotic drug, like hydrocodone or oxycodone. Opioids can also be taken together with non-opioids, because they work on different types of pain. The opioid/non-opioid combination lets you take lower doses of each drug, while getting better overall pain relief. Adjuvant medications, like tricyclic antidepressants or anti-convulsants, were made to treat other health problems besides pain. Doctors found, though, that they also work for some types of neuropathic pain.

With your doctor’s help, the right dose and type of medicine can take care of most serious cancer pain; it can also help with sudden, harsh, flare-ups of “breakthrough” pain.

Important: Be sure to tell your doctor everything that you are doing or taking for your pain — including herbs, dietary supplements, and over-the-counter medicines. Some drugs may not interact well with cancer medications or treatments.

References

National Cancer Institute. (2008) Understanding cancer pain. Retrieved 6/30/08 from www.cancer.gov.