What is pain?
You feel pain when nerve fibres in your body sense something unpleasant, such as a pin prick or extreme pressure, and send a message to the brain, which reads it as pain. Although pain is unpleasant, it’s actually a really useful warning sign from our bodies that something is wrong.
People are often most concerned and scared about the pain associated with cancer. You may think that if you have cancer you are bound to have pain and that nothing can be done to relieve it. But this isn’t true.
Cancer does not have to be painful. With the help of your medical team, cancer pain can be prevented or reduced so that you can do the activities that are important to you. Never think that you are being "weak" to ask for help with pain. Nobody will think you are just complaining. The sooner you speak up about your pain, the easier it is to treat!
What kind of pain might I feel with cancer?
Cancer pain can come from many sources.
- Pain from the tumour: You may feel pain from the tumour pressing on bone, nerves or body organs. This pain usually gets milder or disappears completely as treatment removes the cancer cells from your body.
- Pain from procedures: Cancer treatment means many procedures involving needles, so this may be the most feared part of having cancer.
- Pain from side effects of the cancer treatment: Side effects of cancer treatment include stomach aches and pain from surgical incisions (cuts).
- Mucositis (say: mu-cus-eye-tis): Some chemotherapies cause painful
sores in your mouth and throughout your digestive tract (your gut, stomach and intestines).
- Neuropathic (say: NOO-roe-path-ik) pain: Sometimes cancer treatment can cause nerve damage. You might experience this as pain, burning, tingling, numbness, weakness, clumsiness, trouble walking, or unusual sensations in the hands, arms, legs or feet. Be sure to tell your doctor right away if you notice any of these symptoms.
Remember that not all pain is from cancer. There’s no need to fear that every new pain you feel means the cancer is getting worse or has come back. Like others your own age, you can get headaches, muscle strains, and other aches and pains. However, if you are taking prescription pain medicines, check with your health-care team before taking any over-the-counter pain relief medicines.
How will my medical team know about any pain I may have?
Each person feels pain differently. Your health-care team will only know about your pain from what you tell them. The team will usually ask how much pain you are having, for example by using a number scale from 0 to 10. You might be asked, "If 0 is no pain and 10 is the worst pain you can think of, how much pain are you having now?"
Your medical team may also ask you these questions.
- Where is your pain? Does it spread to another area?
- When did the pain start?
- Is the pain there more in the daytime or nighttime? Does it wake you up at night? Does moving around make it worse? What makes the pain go away?
- How long does the pain last?
It’s important to think about these questions. Your answers will help your health-care team figure out how to manage your pain as well as possible.
What can be done to reduce pain?
Your health-care team will know all about the 3 Ps of pain reduction – pharmacological (medications), physical, and psychological! Between them, the different health-care team members will work with you to help reduce your pain in every way they can.
Pharmacological pain reduction
Pharmacological strategies are medications used to treat your pain. They should almost always be used as supports to physical and psychological strategies.
- Analgesics (pain relievers) decrease the sensation of pain without causing you to lose consciousness. Simple analgesics, such as acetaminophen can be used to relieve mild pain. If you have moderate pain, your health-care team may use a mix of simple analgesics and a mild opioid medicine (see below). Your health-care team will likely tell you to avoid ASA (acetylsalicylic acid or aspirin) and ibuprofen because they can increase your risk of bleeding.
- Anaesthetic creams may be used to numb part of your body if you are having a procedure that involves only the top surface of the skin, such as putting in an IV needle.
- Sedation may be used to reduce your pain and any fear you have before scans or tests that involve needles deeper than the surface of the skin. Sedation uses different combinations of drugs that are given for a short time. This is done in the hospital and you will be closely monitored.
- Opioids (say: ope-ee-oyds), are used for stronger pain. These drugs, which include morphine and hydromorphone, work on the brain by changing how it perceives pain signals. Like most medicines, opioids have side effects. These include slower breathing, sleepiness, nausea, vomiting, constipation and itchiness. It is important to discuss the benefits and side effects of any drug with your health-care team.
- You might worry that you will get addicted to the opioids prescribed to you. Talk to your health-care team to make sure you are safely taking your medicine. They will monitor you closely while you are on opioids.
- Special anti-seizure medication such as gabapentin may be required if you have neuropathic pain.
- In small doses, certain anti-depressants, such as amitriptyline, can also ease neuropathic pain. Unlike other pain medications, these do not work immediately but instead can take up to five days to take effect.
- A mouth wash with analgesics can numb tissues in your mouth to give you relief from mouth sores before eating or drinking. A bicarbonate mouth wash can help the sores heal and stop them from getting worse.
Physical pain reduction
A physiotherapist may be asked to help with any pain that comes from your muscles and nerves. They can show you exercises and stretches to help reduce this pain.
Other ways of reducing pain include using heat, cold, or massage. For instance, the cold sensation from popsicles and ice chips can help relieve pain from mouth sores.
Psychological pain reduction
Your mind is a really powerful tool! You can use it to help change how you understand and feel pain. One way to deal with pain, for example, is through guided imagery and distraction during painful procedures or other times when you’re in pain.
Don’t forget, though, to use your brain to understand a procedure and what to expect. If you’re not sure of anything, make sure you ask. There is never a silly question, so keep asking until you are sure you know what will happen.
Your pain management plan
Your health-care team will help you reduce your pain, but you should also be involved in decisions about how pain is managed. Most of all, you need to understand your pain management plan.
Whenever you are not in the hospital, keep track of the times and amounts of each pain medicine you take. You can do this much as you would keep a diary, including notes about how much the pain has eased (using a pain rating score) and for how long. Bring this diary to the clinic to help staff make further decisions about your pain management plan.
When you understand more about pain and how to treat it, you will be better able to tell your health-care team about what you feel and how well your treatment is working.
For more information on managing your pain, check out the page on the Pain Squad™ app, an app designed to help eight to 18 year olds track pain related to cancer.
