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Put an End to Cancer Pain

by by Kim Thiboldeaux and Mitch Golant, PhD

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For many people, the most fright­ening part of any diagnosis is experiencing pain that is not treatable. Many people, however, un­dergo cancer treatment without ever having pain. If you do experience pain, you should talk to your healthcare team and together create a plan to manage your pain.

When pain is a result of tumors press­ing on an organ, it can often be relieved by surgery to “debulk” (i.e., reduce the size or amount of) the tumor or by us­ing radiation or chemotherapy to shrink the mass. Cancer can also cause pain when it spreads into the bones and dam­ages their structure. Frequently, treating the bone with radiation relieves this type of pain. Pain can occur when cancer presses on a nerve, causing a burning, tingling, or shooting pain sensation. Certain pain medications are especially effective for nerve pain. Sometimes a nerve block, which makes the whole nerve numb, can treat such a pain.

Unfortunately, cancer treatment itself can also cause pain and discom­fort. Certain types of chemotherapy can cause neuropathy (numbness or tingling), which usually affects the hands or feet. Radiation or chemotherapy can cause damage to the lining of the esoph­agus or stomach (stomatitis), resulting in pain and discomfort.

The first step to being empowered means knowing how to communicate about pain and how to take control of it effectively before it becomes disabling.

Taking Control
The first step to being empowered means knowing how to communicate about pain and how to take control of it effectively before it becomes disabling. Admitting that you are in pain is not a sign of weakness. Pain is a medical condition that can and should be treated. By talking about pain, you begin the process of control­ling it.

You can describe your pain in many ways. For example, you can use adjec­tives like “tingling,” “pressure,” or “cutting,” or use a number scale. Rat­ing your pain on a scale of zero (no pain) to ten (extreme pain) is a simple and effective way to explain this to your doctor. The rule of thumb is that any pain over a rating of three needs to be treated. Each person is different in how he or she experiences pain, so do not hesitate to talk to your doctor if you are experiencing pain.

Once you and your doctor have iden­tified the reason for your pain, the next step is usually to choose the correct med­ication. There have been many recent improvements in pain management. There might be a period of trial and error while your healthcare team tries to find the right medication and dosage for you. The many medications available range in strength and may be short-acting (lasting just a few hours) or long-acting (lasting 24 hours or more). Pain medi­cations can be given as pills, liquids, suppositories, skin patches, or injections.

There is a common myth about pain management that prevents many people from getting the pain control they need. The myth is that people will become addicted to pain medication. Addiction is very rare for people with cancer. In fact, less than one percent of people with cancer who are treated with pain medication become addicted. On the other hand, poorly managed pain will increase anxiety and distress, which will in turn intensify feelings of pain. That’s why it’s important to find a quali­fied professional who will provide you with a reasonable pain management program to end pain and distress.

For some people with cancer, mind-body practices such as guided imagery, relaxation and breathing exercises, bio­feedback, massage, acupuncture, light exercise, music therapy, and counseling can help as well.

Most people will have complete relief of pain with appropriate manage­ment. You have a right to have your pain managed, but you need to commu­nicate with your healthcare team about your symptoms. You can ask your on­cologist to recommend a pain specialist if your pain is severe and previously tried treatments have not helped.

What about Side Effects from Pain Medications?
Unfortunately, pain medi­cation can cause side effects, including nausea, drowsiness, and constipation. Most people develop tolerance to the drowsiness and nausea caused by opi­oids, meaning that the medication might cause these side effects at first, but they will eventually subside. Nau­sea might be treated with antinausea medication. If you are taking opioids for pain, you should talk to your doctor about starting a bowel regimen; usually, a combination of a stool softener and laxative is best. If such solutions do not work, switching to a different pain medication might be necessary.

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Kim Thiboldeaux is president and CEO of the Cancer Support Community. Dr. Mitch Golant is a health psychologist and senior vice president of Research & Training for the Cancer Support Community.

Excerpted with permission from Reclaiming Your Life After Diagnosis: The Cancer Support Community Hand­book, by Kim Thiboldeaux and Mitch Golant, PhD, copyright © 2012 by the Cancer Support Community. All rights reserved.

This article was published in Coping® with Cancer magazine, March/April 2013.