What is cancer pain?

Common types of cancer pain are bone pain, nerve pain, and visceral pain. Bone pain may cause a deep, aching pain. Nerve pain can cause a burning feeling. Visceral pain may be hard to describe. Cancer pain may last a short time (acute) or come and go over a long time (chronic).

Medical treatments to manage cancer pain include:

• Prescription and over-the-counter medicines. Many types of medicines are used. Your doctor may suggest different combinations of medicines.
• Surgery, chemotherapy, radiation, and hormone therapy. These may be used to remove or destroy a tumor that is causing pain.
• Nerve treatments. These are used to help with nerve pain. They include:
  • A nerve block that uses medicine injected near the nerve.
  • A nerve surgery that cuts the nerve to stop the pain.
  • Other treatments, such as injecting a chemical or using heat or cold, to destroy the nerve and stop the pain.

Nonmedical treatments include:

• Physical therapy, gentle massage, acupuncture, and heat or cold to ease pain.
• Stretching, yoga, and exercises to help you keep your strength, flexibility, and mobility.
• Relaxation, biofeedback, and meditation to relieve stress and anxiety.
• Counseling. This may help you manage your cancer pain or the pain from treatments.
• Education and emotional support. Learning as much as you can about your pain may help. So can sharing your feelings with others. A support group can be a safe and comfortable place to talk about your illness.

Radiation can be used to control pain by destroying a growing tumor that is invading or interfering with normal tissue, such as when a tumor presses on bones, nerves, or other organs. This may be done with radiation to part of the body or, in rare cases, with radiation to the whole body. Or you may be given a shot with a radioactive medicine.

Radiation therapy is the use of X-rays to destroy cancer cells and shrink tumors. Radiation damages the cells in the area being treated, stopping or slowing the growth of the cancer cells.

Many different medicines are used to treat cancer pain. Over-the-counter medicines may relieve your pain at times. But you may need stronger medicines that your doctor prescribes. These may be used alone or with other medicines.

Over-the-counter pain relievers.

These include:

• Acetaminophen, such as Tylenol.
• Anti-inflammatory medicines, such as ibuprofen.

Talk with your doctor before you take these medicines. Don't take more than the label says unless your doctor tells you to.

Prescription medicines.

These include:

• Anti-inflammatory medicines and steroid medicines.
• Medicines to treat bone pain.
• Opioid pain relievers.
• Antidepressants. They can relieve pain and help you sleep.
• Certain seizure medicines. They help control nerve pain.

These medicines may be stronger or work differently than over-the-counter medicines. Be sure to follow your doctor's instructions when you take these medicines.

Some may work better than others. It depends on the type of pain you have.

The following health professionals can help treat cancer pain:

• Internist
• Family medicine physician
• Surgeon
• Medical oncologist
• Radiation oncologist
• Anesthesiologist
• Nurse practitioner
• Physician assistant
• Neurologist

Your pain may be managed by a team that may include doctors (including pain specialists or palliative care specialists), nurses, psychologists, social workers, and pharmacists. Be sure that all the members of your health care team know about any changes in your pain control diary. You may wish to use one person, such as your medical oncologist, as a team leader who will make sure that all team members share information.

Your doctor needs all the information you can give about what your pain feels like. It often helps to write things down in a pain diary.

• Write down when your pain starts, what it feels like, and how long it lasts. Use words like dull, aching, sharp, shooting, throbbing, or burning.
• Note changes in your pain. Is it constant, or does it come and go? Do you have more than one kind of pain? How long does it last?
• Rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine.
• Write exactly where you feel pain. You can use a drawing. Say whether the pain is just in that one place or several places at once. Or tell your doctor if it travels from one place to another.
• Write down what makes your pain better or worse. Note when you used a treatment, how well it worked, and any side effects.

If you and your doctor are not able to control your pain, ask about seeing a pain specialist. A pain specialist is a health professional who focuses on treating resistant pain.

Talk to your doctor if you are having problems with depression. Treating depression can make it easier to manage your cancer pain.

Counseling, including cognitive behavioral therapy, may help you manage cancer pain or the pain from cancer treatments. Integrative practices, such as acupuncture, massage, and relaxation exercises, are helpful for some people with cancer pain. Ask your doctor if you think you might want to try one of these.

Cancer and its treatments can be painful. A tumor that presses on bones, nerves, or organs can cause pain. Surgery, chemotherapy, and radiation can also cause pain.

• You are the only person who can say how much pain you have. If you tell your doctor when you have pain or when pain changes, your doctor can help you.
• Cancer pain can almost always be relieved if you work with your doctor to create a treatment plan that is right for you.
• Pain is often easier to control right after it starts instead of waiting until it becomes bad.
• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• You may find that taking your medicine works most of the time, but your pain flares up during extra activity or for no clear reason. This is called breakthrough pain. Ask your doctor what you can do if this happens. Your doctor can give you a prescription for fast-acting medicines that you can take for breakthrough pain.
• People who take opioid pain medicines for cancer pain rarely develop opioid use disorder. Moderate to severe opioid use disorder is sometimes called addiction. Your body may come to expect daily doses of medicine to control the pain. But your doctor can gradually lower the amount you are taking when and if the cause of your pain is gone.

Your doctor needs to understand your pain to treat it effectively. The more specific you can be about your pain, the better. It often helps to write everything down. Some people use a pain diary for this.

You can help by telling your doctor:

• Exactly where you feel pain. Is the pain just in one place? Is it in several places at the same time? Or is it moving from one place to another?
• What your pain feels like. Use words such as dull, aching, sharp, shooting, or burning.
• When your pain started and how long it has lasted.
• How bad it is on a scale of 0 to 10, with 10 being the worst pain you can imagine.
• If the pain is constant or if it comes and goes.
• What makes your pain better or worse.
• About any changes in your pain.