What is Cancer Pain?[肿瘤咨询在线论坛]

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What is Cancer Pain?

Cancer pain takes many forms. It may be short-lived or long-lasting, mild or severe, or affect one or a few organs, bones or organ systems. Each patient’s pain is unique. Therefore, each patient must have a treatment plan that addresses his or her individual needs.

The more you know about your cancer pain, the more you can help your caregivers plan the best treatment for you.

Causes of Cancer Pain

There are many causes of cancer pain. They include:

Pain from the tumor
Most cancer pain arises when a tumor presses on bone, nerves or body organs. The pain may vary according to location. For example, a small tumor located near a nerve or the spinal cord may be very painful, while a larger tumor elsewhere may not cause discomfort. But, pain does not always indicate tumor progression or recurrence.
Pain related to cancer therapy
Cancer treatment -- including chemotherapy, radiotherapy and surgery -- also can cause pain. Also, certain painful conditions are more likely to occur in patients with a suppressed immune system, which often results from these therapies.
Post-operative or post-op pain is acute (short-term) pain suffered as a result of surgery. Post-op pain is not unique to cancer patients; more than 25 million people suffer from it each year. Relieving post-op pain helps people recuperate from surgery more quickly and heal more effectively.
Other painful conditions
You may also have pain that has nothing to do with your illness or its treatment. Like everyone else, you can experience headaches, muscle strains and other aches and pains. Other conditions -- such as arthritis, kidney stones, a herniated disc in the back, and other non-cancerous conditions -- can cause pain, too. Pain from these conditions can be treated along with cancer pain.

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How is Cancer Pain Treated?

Cancer pain is very treatable. Approximately nine out of 10 cancer pain patients will find relief using a combination of medications. Although cancer pain is usually treated with medicine, other treatments such as radiation therapy, surgery, relaxation, biofeedback, imagery and other non-drug treatments can be used with medicine to give even more pain relief.

The following page lists the general types of pain medicine and the methods by which they are taken. Ask your doctor, nurse or pharmacist for advice before you take any medicine for pain.

Types of Pain Medicine

Many medicines are used to treat cancer pain, and your doctor may give you one or more to take. The following list describes the broad groups of pain medicine and the kind of pain each works on. Information on specific pain medications and their side effects is located elsewhere on this website.

For mild to moderate pain
Nonopioids: Examples are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. You can buy many of these over-the-counter (without a prescription). Others need a prescription.

For moderate to severe pain
Opioids: Examples are morphine, hydromorphone, oxycodone, hydrocodone, codeine, fentanyl and methadone. A prescription is needed for these medicines. Nonopioids may also be used along with opioids for moderate to severe pain.

For tingling and burning pain
Antidepressants: Examples are amitriptyline, imipramine, doxepin and trazodone. A prescription is needed for these medicines. Taking an antidepressant does not mean that you are depressed or have a mental illness.
Antiepileptics: Examples are gabapentin and other medications. A prescription is needed for these medicines. Taking an antiepileptic does not mean that you are going to have seizures.

For pain caused by swelling
Steroids: Examples are prednisone and dexamethasone. A prescription is needed for these medicines.

How Pain Medicine is Taken

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 (pill) 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:

Rectal suppositories
Medicine that dissolves in the rectum and is absorbed by the body.

Transdermal patches
Patches that are filled with medicine and placed on the skin.

Injections
Many kinds of injections can give pain relief. Most injections use a tube or needle to place medicine directly into the body. Types of injection include:
Subcutaneous - medicine is placed just under the skin using a small needle.
Intravenous - medicine is placed directly into a vein through a needle that stays in the vein. This method includes a type of pain managment called patient-controlled analgesia (PCA). PCA lets patients adjust how much medicine they receive according to their level of pain.
Epidural or intrathecal - medicine is placed directly into the back using a small tube. Most of these injections give pain relief that lasts for many hours.
Subdermal and intramuscular - commonly known as "shots," these injections are placed more deeply into the skin or muscle using a needle. These injections are not recommended for long-term cancer pain treatment. Constantly having shots into the skin and muscle can be painful.

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What Can You Do to Help Control Your Pain?

Your pain is unique. Only you know where your pain is located, how it feels, how much it hurts, how long it hurts and what makes it better. The key to getting the best pain relief is talking with your doctor and nurse about your pain. They will want to know how much pain you feel, where it is, and what it feels like.

The First Step: Talk About Your Pain

Telling your care team in detail about your pain is the best thing that you can do to assist in your cancer treatment. Sometimes patients don’t receive the best pain treatment because they don’t let their care team know about their pain. Patients may not want to complain, they may fear becoming addicted to pain medications, they may fear the side effects of pain more than the pain itself, or they may want to save their pain treatment options until they "really" need them. Each of these beliefs will hinder pain treatment and also hinder cancer therapy.

Why Pain Should Be Treated

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 make you feel afraid or depressed. Pain may also prevent your full participation in general rehabilitation programs and may slow your recovery from treatment.

Most cancer pain can be controlled with treatment. When there is less pain, you will probably feel more active and interested in doing things you enjoy. Tell your doctor or nurse right away if you are feeling pain. Getting help for your pain early can make pain treatment more effective.

Describing Your Pain

Answering the questions below will help you communicate with your health care provider about your pain. After discussing your pain, your doctor or nurse may want to examine you or order x-rays or other tests. These tests will help the doctor or nurse find the pain’s cause.

To communicate how you feel, ask yourself the following questions:

Where is the pain? You may have pain in more than one place. Be sure to list all of the painful areas.

What does the pain feel like? Does it ache, throb, burn or tingle? You may wish to use other words to describe your pain.

How bad is the pain? You can use a number scale to rate your pain (pdf) from 0 to 10, where 0 means no pain and 10 means the worst pain you can imagine. Or, you can describe your pain with words such as "none", "mild", "moderate", "severe" or "worst possible pain". A special pain rating scale that uses faces (pdf) to indicate levels of pain has also been developed to help children communicate how they feel. You may find these scales useful for keeping track of how your pain changes in response to treatment, activities or the time of day.

What makes the pain better or worse? You may have already found ways to make your pain feel better (for example, using heat or cold, or taking certain medicines). You may have also found that sitting or lying in certain positions or doing some activities affects the pain.

If you are being treated for pain now, how well is the treatment working? You may want to describe how well the treatment is working by saying how much of the pain is relieved, such as all, almost all, none, etc.

Has the pain changed? You may notice that your pain changes over time. It may get better or worse or it can feel different. For example, the pain may have been a dull ache at first and has changed to a tingle. It is important to report changes in your pain. Changes in pain do not always mean that the cancer has come back or grown. Describe how the pain was before and how it is now.

Next: Have a Plan

Work with your doctor or nurse to write a pain control plan that meets your needs. In a pain control plan, you and your doctor or nurse plan your pain control activities, including when you 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 medicines and other treatments that will help with side effects or other aches and pains, such as headaches.

Many medicines and treatments can be used to treat pain. If a schedule, medicine or way that you are taking the medicine doesn’t work for you, your doctor and nurse can help you find the medicine or approach that will help the most.

It may be helpful to keep a record of how the medicine is working. Sharing that record with your doctor or nurse will help them make your treatment more effective.

When To Take Your Pain Medicine

Take your medicine on a regular schedule (by the clock) and as your doctor tells you. This will help to keep pain under control. Do not skip a dose of medicine or wait for the pain to get worse before taking your medicine. The goal is to prevent the pain. Once you feel the pain, it is harder to get it under control.

Your doctor will usually give you additional medicine for "breakthrough pain" (a brief and often severe pain that occurs even though the patient is taking pain medicine regularly). If some activities make your pain worse (for example, riding in a car), you may need to take extra doses of pain medicine before these activities. Ask your doctor or nurse how and when to take extra medicine.

Call your doctor or nurse immediately if your pain increases or if you have new pain. Also call your doctor early to receive a refill of pain medicines. Do not let your medicines get below three or four days' supply.

Related Topics:

What is Cancer Pain?

How is Cancer Pain Treated?

Pain Medications and Side Effects

Non-Drug Treatments for Pain

Pain Definitions

Common Concerns about Pain Treatment

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Pain Medication

Medication is one of the most common methods of treating cancer pain. Doctors may use various combinations and doses of medicine. Ask your health care provider to tell you more about the medicine you are taking, and don’t take any new medicine without first checking with your doctor or nurse. Even aspirin can be a problem for some people who are taking other medicines or having cancer treatment.

Side Effects of Pain Medication

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. Each one is an anticipated side effect, and most can be treated so that the pain can be effectively managed. If the side effects cannot be alleviated, doctors may switch a patient’s pain medication to make sure a patient gets the maximum pain control with minimum side effects. The benefits and risks of various categories of pain medicine are outlined in the next section.

Cancer pain is most commonly treated with opioid medication. Some of the most common side effects of opioid medication are:

Constipation: (not being able to have a bowel movement): The best way to prevent constipation is to drink lots of water, juice and other liquids, and to eat more fruits and vegetables. Exercise also helps to prevent constipation. Your doctor or nurse may also give you a stool softener or a laxative. (More on preventing constipation...)

Nausea and vomiting: When this happens, it usually only lasts for the first day or two after starting a medicine. Tell your doctors and nurses about any nausea or vomiting. They can give you medicine to stop these side effects. (More on managing nausea and vomiting...)
Sleepiness: When first starting to take opioids, some patients feel drowsy or sleepy. For most patients, this side effect usually disappears within one to three days. Talk to your doctor or nurse if this is a problem for you.
Slowed breathing: This sometimes happens when the amount of medicine you are taking is increased. Your doctor or nurse can tell you what to watch for and when to report slowed breathing.

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. More serious side effects include trouble breathing, dizziness and rashes. If you have any of these side effects, you should call your doctor or nurse right away.

Benefits and Risks of Treatment

The list below describes the benefits and risks of the different types of medicines used to relieve cancer pain.

Nonopioids - Examples: Acetaminophen, aspirin, ibuprofen
Benefits: These drugs control mild to moderate pain. Some can be bought over-the-counter (without a prescription).
Risks: Some of these medicines can cause stomach upset. They also can cause bleeding in the stomach, slow blood clotting and kidney problems. Acetaminophen does not cause these side effects, but high doses of it can hurt the liver. Drugs that include salicylates, ibuprofen and acetaminophen may affect blood platelets. Cancer patients should check with their physician before using these over-the-counter medicines.
Opioids - Examples: Morphine, hydromorphone, hydrocodone, oxycodone, codeine, fentanyl, methadone
Benefits: Control moderate to severe pain and do not cause bleeding.
Risks: May cause constipation, sleepiness, nausea and vomiting. Opioids sometime 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. (More on opioid side effects...)
Antidepressants - Examples: Amitriptyline, imipramine, doxepin, trazodone
Benefits: Help control tingling or burning pain from damaged nerves. They also improve sleep.
Risks: May cause dry mouth, sleepiness and constipation. Some cause dizziness and lightheadedness when a person stands up suddenly.
Antiepileptics - Example: Gabapentin
Benefits: Antiepileptics help control tingling or burning from nerve injury.
Risks: They 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.
Steroids - Examples: Prednisone, dexamethasone
Benefits: Steroids (also known as corticosteroids) help relieve bone pain, pain caused by spinal cord and brain tumors, and pain caused by inflammation. Steroids also increase appetite.
Risks: They may cause fluid to build up in the body. May also cause bleeding, irritation to the stomach, increased blood sugar, muscle weakness and thrush. Confusion is a problem for some patients when they take steroids.

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Non-Drug Treatments for Pain

Your doctor or nurse may recommend that you try certain nondrug treatments to supplement your pain medication. These treatments will help to make your medicines work better and relieve other symptoms, but they should not be used instead of your medicine.

Non-drug pain treatments include:

Biofeedback: A technique that makes the patient aware of bodily processes that are normally thought to be involuntary (such as blood pressure, skin temperature and heart rate). The technique enables the patient to gain some conscious voluntary control of these processes, which can influence a patient's level of pain.
Breathing and relaxation exercises: Methods used to focus the patient’s attention on performing a specific task. The patient concentrates on the task instead of their pain.
Distraction: A method used to divert the patient’s attention to a more pleasant event, object or situation.
Heating pads and hot or cold packs: Using temperature to facilitate pain control.
Hypnosis: A focussed state of consciousness that allows the patient to better process information.
Imagery: A method used to teach the patient to make mental images of something soothing. Focusing on these positive images allows the patient to relax.
Massage, pressure and vibration: Methods that physically stimulate muscles or nerves. These methods facilitate relaxation and relieve muscle spasms or contractions.
Transcutaneous electrical nerve stimulation (TENS): A technique using a mild electric current applied to the skin at the site of the pain.
Rest: A basic tool that allows the body’s immune system to help in the recovery process.

Talk to your doctor and nurse about these treatments. Your family members may want to help you use them. Alternative treatment professionals at M. D. Anderson’s Place...of wellness may also be able to give you more information.

When Medicine Is Not Enough

Some patients have pain that is not relieved by medicine. In these cases the following treatments can be used to reduce pain:

Radiation therapy: This treatment reduces pain by shrinking a tumor. A single dose of radiation may be effective for some people.

Nerve blocks/Implanted Pump: Certain nerve blocks, temporary or permanent, may help relieve some painful conditions. Implanted pain pumps are also available which can be of great benefit in some instances.

Neurosurgery: In this treatment, pain nerves (usually in the spinal cord) are cut to relieve the pain.

Surgery: When a tumor is pressing on nerves or other body parts, operations to remove all or part of the tumor can relieve pain.

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Definitions

Acute pain: severe pain that has a sudden onset, but lasts a short time
Addiction: a psychological or physical dependence on a medicine
Analgesic: medicine used to relieve pain
Adjuvant medicine: medicine that has another primary purpose but may in some cases relieve pain
Breakthrough pain: pain that occurs although the patient is being medicated
Chronic pain: pain that is constant and lasts a long time
Deep brain stimulation: a pain control method using electrodes implanted in the brain and controlled by the patient
Epidural medication: medicine that is injected into the spinal column
Immediate-release medication: medication that takes effect in a short period of time
Infusion: a method of administering medication into a vein
Intramuscular (IM) injection: injection of medication into a muscle
Intrathecal (IT) injection: injection of medication into the sheath around the spinal cord
Intravenous (IV) injection: injection of medication into a vein
Long-acting or sustained released medicines: medicines that act for long periods of time and are taken on a regular basis
Narcotic: medicine that produces pain relief by depressing the central nervous system (see opioid)
Neuropathic pain: pain, usually arising from nerve damage, that is burning, shooting or numbing
Patient-controlled analgesis (PCA): a method of pain control in which the patient controls the amount and timing of the release of the medication by pressing a button on a computerized pump that releases a preset amount of the medication into the patient’s body
Phantom pain: pain felt in a part of the body that is no longer there
Nerve block: injection of medicine directly into the nerve or spine for pain control
Non-opioids: medicine that does not contain an opioid. Examples include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. Many of these medicines are available over-the-counter and do not require a prescription.
Opioids: medicine that requires a prescription and provides strong pain relief. Examples include morphine, hydromorphone, oxycodone and codeine.
Radiofrequency lesioning: a catheter is inserted through an incision and uses radiowaves to destroy affected nerves
Rescue medicines: medicine used to control breakthrough pain
Somatic pain: pain, usually arising from the body wall or voluntary muscles in the legs or arms, that feels achy, throbbing and well localized in one spot
Subcutaneous injection (SQ): injection of medicine just under the skin
Titrate: to adjust the dose of medicine needed to control pain
Tolerance: adjustment of the body to medication so that more medication or another type of medication is needed to control pain
Vertebroplasty: cement is injected into the vertebrae to ease pain
Visceral pain: pain, usually arising from the internal organs, that feels like squeezing, cramping or pressure

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Common Concerns About Pain Treament

Cancer patients have many concerns about pain, pain medication and other treatments. Here are some of the most common.

Concern: I can only take medicine or other treatments when I actually 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 has instructed you. This usually means taking it on a regular schedule and around-the-clock, even when you are not feeling the pain. You can also use other treatments, such as relaxation and breathing exercises, and hot and cold packs, as often as you want to.

Concern: I will become "hooked on" or "addicted to" pain medicine.

Fact: Studies show that getting "hooked on" or "addicted to" pain medicine for cancer pain 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 adjusted 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.

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