Pain

Introduction

Sometimes cancer causes pain. Cancer treatments also can cause pain. Cancer pain may be dull, achy or sharp. It can be constant, on and off, mild, moderate, or severe. But there are ways to ease your pain.

Decide what is important to you and set clear goals for managing your pain (this document might help). Keep a diary or log of your pain (download a template here). Include when pain occurs, how long it lasts, and how intense it feels. Note where your pain is and what makes it better or worse. This information may help you recognize patterns or events that lead up to your pain. For instance, you may notice that you have a lot more pain in the middle of the night. This may be because you need pain medication that lasts longer when you sleep. Or, you may notice you have less pain after your swim. This may mean that it’s a good activity for you.

It is important to talk with a member of your health care team if you have pain. Also, tell your health care team if what you are doing for pain relief does not work.

 There are many ways to manage pain (learn about several here). When your pain is managed, you may sleep and eat better. You may enjoy activities and social occasions more. Your health care provider may prescribe pain medications. There are also non-medication pain treatments you can do on your own.

Medications

• Acetaminophen may ease mild pain. The daily dose should not be more than 3000 mg, and you should not use acetaminophen if your liver is not working well.
• Non-steroidal anti-inflammatory medications, also called NSAIDs, such as ibuprofen or naproxen sodium, may ease pain that is mild-to-moderate. Talk to you cancer care team before using NSAIDS. This is because NSAIDs can cause harm when combined with some chemotherapy and oral cancer medications.
• Prescription pain medicines, such as gabapentin, duloxetine and steroids, may ease all types of cancer pain. They calm the nerves that carry pain signals. And they are effective for nerve pain.
• Opioids, also called narcotics, may ease cancer pain that is moderate-to-severe. Because of side effects and risk of addiction, these medications are usually prescribed for a limited time.

Note: Prescription pain medications can cause side effects. These may include constipation, light-headedness, dizziness, and nausea. Laxatives and stool softeners can help with constipation. When used for a long time, opioids can lead to addiction. Use opioids only as long as needed to manage your pain. You can learn more about medication side effects here.

Rehabilitation approaches

• Electrical stimulation applied to the skin can lessen the pain signals carried by your nerves. Transcutaneous electrical nerve stimulation, also called TENS, is one example. Depending on the type of pain you have and where it is, other electrical stimulation approaches can be used.
• Desensitization gently stimulates painful areas to make them less sensitive when touched.
• Braces or orthotics can be used to stabilize painful body parts. Low back braces are a common example. These can be light weight. And they can be purchased as-is or custom made.
• Manual techniques include myofascial release and special types of massage. These approaches are used to treat muscle pain and spasms.
• Therapeutic exercises improve the strength and flexibility of painful muscles. They also can stabilize painful joints.

Procedures

• Nerve blocks can be used to prevent pain signals from reaching your brain. These can be temporary, such as when the dentist gives you Novocain™, or they can last longer. Nerve blocks work best when pain is in a limited area.
• Steroid injections can relieve pain from inflamed joints, tendons and nerves. These injections are usually given with special guidance from ultra sound or other imaging techniques.
• Trigger point injections are used to relieve spastic, painful muscles. They work best when a few painful areas can be targeted.
• Spinal approaches deliver pain medications directly to the central nervous system, as when an epidural eases pain during childbirth. Spinal approaches can be used in special situations for severe pain when oral medications don’t work or cause bad side effects.

Behavior strategies

• Cognitive behavioral therapy, also called CBT, can help you recognize negative thoughts that can make your pain worse. Learn more about CBT here.

• Relaxation, imagery and distraction can lessen stress that makes pain worse or more difficult to control. Listen to relaxing music or a favorite television program to help distract you from pain. Learn more about relaxation here.

• Rest as you need to. Let painful areas relax.
• Use pillows to keep pressure off your area of pain and to help support your body in comfortable positions.

Physical activity

Talk to your health care provider about a specific exercise program that may work for you. Common exercises for joint pain include stretching, swimming and yoga. More information about physical activity is available here.

Integrative therapies

The following integrative therapies may help ease your pain.

• Acupuncture.
• Massage.
• Guided imagery.
• Breathing, relaxation, mindfulness practices, and distraction.

Diet

Make sure you get plenty of fiber in your food and you drink water throughout the day. Doing so may help prevent constipation if you take opioids.

What friends and family can do

Family members and friends can help support you in the following ways. They can:

• Contact your health care provider for you if your pain is not tolerable.
• Give you a gentle backrub with warmed lotion.
• Watch for confusion and dizziness. This is especially important after new medicines start or when doses change.
• Encourage pleasant distractions, such as watching movies or playing games.
• Remind you to take your pain medication as prescribed in order to help you stay on schedule.
• Help you to remember to take the stool softeners and laxatives to prevent constipation.

What if I want more help?

There are health care specialists who can help you manage your pain, such as the following:

• Physical therapist. Physical therapy (PT) may help ease musculoskeletal pain. Modalities, such as electrical stimulation and massage also may help. With PT, you can learn how to stretch and strengthen certain areas that may cause you pain. PT can also help you with balance and using assisted devices.
• Occupational therapist. Occupational therapy (OT) may be able to teach you how to do everyday tasks in less pain. OT also uses special equipment to make your tasks easier so you can save your energy.
• Physical medicine and rehabilitation (PMR) physician. Physicians specialized in PMR can help you develop a program specific to your needs that combines exercise, medication, integrative therapies, and procedures to control your pain.
• Palliative care provider. Providers with expertise in the management of cancer- associated pain and other cancer- related symptoms. Visits include a detailed assessment of pain and treatment recommendations, which may include pain medications. 
• Pain medicine specialist. Physicians who practice pain medicine use injections, blocks, and other interventional procedures to control pain that is in one or a few locations.

Talk with your care team about helpful resources available in your community.

There also are self-directed materials with more information to help you manage pain. You can get these materials by:

• Going online at cancereducation.mayoclinic.org
• Asking your care team.