Some people have cancer pain that cannot be relieved by drugs or other non-drug methods. This is where additional methods can be used to reduce pain.
Ways to block pain signaling
1) Surgery
If the nerve channel that transmits pain signals to the spinal cord is blocked, pain will not be perceived. To block this channel, neurosurgery is usually done by cutting the nerves adjacent to the spinal cord. When the nerve that conducts pain is cut, other sensations such as pressure and temperature are lost. This procedure requires a special technique. The surgeon should work with other pain management specialists to see if there are other non-surgical options before performing this procedure.
2) Nerve Blocks
A nerve block is an injection of local anesthetic (sometimes combined with steroid hormones) into the perineural or spinal cord to block pain transmission to the nerve. Phenolic drugs and alcohol may be injected to achieve prolonged pain relief. The nerve block may cause muscle atrophy and loss of all sensation in the affected area.
3) Spinal pain relief
Small doses of anesthetic drugs may be injected into the spinal fluid for pain relief purposes. If effective, a thin tube connected to a drug pump can be placed to release the drug continuously and accurately to effectively control pain. Morphine is often used for this purpose.
4) Epidural anesthesia for pain relief
Some pain can be controlled by injecting anesthetic drugs into the spinal dural cavity. If effective, the drug can also be injected accurately by placing a pump tube. This may cause numbness and weakness in the treated area.
Other methods of treating cancer can also be used to treat cancer pain
Sometimes, even if the cancer cannot be cured, cancer treatment can reduce the size of the tumor, and when the pain is caused by a tumor pressing on a nerve or organ, the shrinking of the tumor may reduce the pain. Cancer treatments such as chemotherapy, radiation therapy and endocrine therapy may all play this role. When the cancer has extensive bone metastases, isotope injections are used to slow the growth of the metastases by accumulating the isotope around them. In rare cases, other treatments such as radiofrequency ablation may also be used for some cancers. This treatment involves placing radiofrequency electrodes near or within the tumor to destroy the tumor tissue and reduce pressure to relieve pain.
Non-pharmacological treatment of pain
Non-pharmacological treatment is now widely used as an adjunct to the treatment of cancer pain. Most are used in combination with other treatments, but they are also used alone for milder pain or discomfort. Some cancer patients find that when combined with these techniques they can take low doses of pain medication and achieve good pain relief. These techniques include: relaxation therapy, biofeedback therapy, visual imagery therapy, mental distraction therapy, skin stimulation therapy, hypnotherapy, transcutaneous electrical nerve stimulation, acupuncture therapy, exercise and physical therapy, spiritual support and induction therapy.
Receiving these treatments may require the help of health professionals, including social workers, physical therapists, psychotherapists, nursing specialists and other relevant personnel, to learn to use these techniques. You may also need the help of family and friends. Look for specialists and agencies that have discovered this.
1) Consult with your doctor and nurse
2) Contact a local nursing home, oncology clinic or pain clinic
3) Use the Internet to look up
Pain can be a symptom of metastases, infections and problems caused by tumor treatment. Therefore, it is important to report the pain to your doctor and nurse before you are ready to use these pain management aids.
General guidelines for the use of non-pharmacological methods of pain management include:
1) Try different methods to find out what works for you
2) Try using a non-pharmacologic pain management method along with pain medication. For example, while taking pain medication, you can use relaxation therapy (to reduce stress, anxiety, etc.)
3) Know which non-pharmacological pain relief method to use in which situation. Generally when you have good energy, you can try methods that require concentration; while when you are tired, you may need a relaxing method that does not require greater energy. For example, when you can concentrate you can use mental distraction relaxation therapy; when you are tired you can use hot or cold compresses
4) Keep an open mind to try different methods and make a note of what works for you and what doesn’t work for you.
5) If a method does not work well the first time you try it, do not give up easily, but use it several times before making a decision.
Relaxation therapy
Relaxation therapy can relieve pain or keep it from getting worse by relaxing muscle tension. This method helps you sleep better, maintain energy, relieve strain, reduce anxiety and make other pain relief methods more effective. For example, some people find that taking pain medication or using hot and cold packs in a relaxed state can help relieve pain.
How to use relaxation therapy
Relaxation therapy can be done sitting or lying down. Choose a quiet place if possible and keep your eyes closed. Do not cross your limbs (this can affect blood circulation and cause numbness or tingling). If lying down to stay comfortable you can place small soft pillows at the neck and knee joints or use a low stool to support the lower legs.
There are many ways to relax. Here are some ways you can try.
Visual attention and rhythmic massage
1) Open your eyes and gaze at an object; or close your eyes and imagine a quiet and peaceful scene
2) Use your palms to massage around the painful area in a circular motion. Avoid areas of redness, skin wounds and swelling. You can also ask your family and friends to do the massage for you
Inhale/tension muscles, exhale/relax muscles
1) Breathe deeply. Tense certain muscles or groups of muscles at the same time. For example, you can close your eyes, frown, clench your teeth, clench your fists, tense your upper and lower limbs, or lift your upper and lower limbs as high as possible
2) Keep inhaling, while maintaining muscle tension for 1-2 seconds
3) Then, exhale and relax your body.
Breathe slowly and rhythmically
1) Gaze at an object or close your eyes, while concentrating on your breath or a peaceful image
2) Take slow, deep breaths. Tense your muscles as you inhale, and relax them as you exhale and feel the tension go away.
3) Now keep relaxed and start breathing slowly and comfortably. Concentrate on your breathing, maintaining a rhythm of 9-12 breaths per minute. Breathing too fast or too deeply may cause dizziness or other symptoms.
4) As you breathe slowly, you can silently say to yourself: “Inhale, 1, 2; Exhale, 1, 2”. It may help to make a sound at the beginning. If you feel that your breathing is not under control, take a deep breath first and then breathe slowly. Each time you exhale, you should experience a feeling of complete relaxation and weakness. If some muscles, such as the shoulder muscles are not relaxed, inhale when they are tense, exhale when they are relaxed, so that each group of muscles for 1-2 times of training.
5) Continue breathing slowly and rhythmically for a few seconds to 10 minutes as you need.
6) Count 1, 2, 3; end the slow rhythmic breathing and open your eyes. Begin the soothing movement by saying to yourself: “I feel refreshed and relaxed”.
Other relaxation methods that can be added along with slow rhythmic breathing
1) Visual relaxation. See later section for more details
2) Enjoying slow and calm music through earbuds or headphones
3) Further relaxation of body parts. Once you enter the slow rhythm of breathing, you can relax all parts of your body. From your feet to your head. You can think of feelings of weakness, heaviness, relaxation, warmth and floating. With each exhalation, you can focus on a part of the body and feel it relax. Try to imagine the tension being released from there. For example, as you exhale, feel the feet and ankles relax; on the next exhale, feel the calves and knees relax; and so on through all parts of the body.
4) Ask your doctor and nurse for instructional materials, such as CDs, that describe body relaxation methods. These instructional materials will describe these body relaxation methods in detail.
Caution
Some patients who have used relaxation therapy to treat their pain have found some common problems:
1) When you have severe pain, relaxation therapy may not work as quickly. Patients with this condition can use quick and easy relaxation methods, such as image-focused combined massage or breath control. Alternatively, you can wait until the pain medication takes effect before starting relaxation therapy.
2) Sometimes breathing too deeply for a certain period of time may cause shortness of breath. If this happens, you can take shallow or/and slow breaths.
3) You may feel drowsy or even fall asleep. If you plan to sleep, this is a good situation. If you don’t intend to sleep, sit in a hard chair or set a timed reminder bell.
If you have any problems using these relaxation methods, consult your medical professional or ask them to refer you to someone who has experience using these methods. Do not insist on using methods that increase your pain, make you feel difficult or unpleasant experiences.
Biofeedback Therapy
To learn biofeedback techniques you need the help of a qualified professional. Using special techniques that give your body immediate biofeedback, you can learn to control certain body functions, such as heart rate, blood pressure and muscle activity. Biofeedback techniques are sometimes used to learn to relax the body. You can use biofeedback techniques to help you relax your body or deal with pain. This technique is also often used in conjunction with other pain relief methods.
Imagery Therapy
Imagery is the use of imagination and thoughts to create an imaginary picture or situation. The principles of imagery therapy for pain relief are not known, and may be a combination of simple relaxation and distraction methods. Imagery therapy can also be thought of as using all of your senses, including sight, touch, hearing, smell and taste, to produce an artificial dream state. Some people consider it to be a form of self-hypnosis.
Some imagery therapies can relieve your pain for a few hours during or after. If you have to stay in bed or can’t leave the house, you can produce the effects of imagery therapy by imagining or remembering your favorite places or sights from your memory. Imagery therapy can also help you relax, reduce worry and anxiety, and help you sleep better.
How to use imagery therapy
Imagery therapy is most effective when you close your eyes. Before using imagery therapy, you may want to use one of the other relaxation therapies. This method is like having a switch that controls the movement of your body’s energy or painting a picture in your mind. For example, you can imagine that you are cutting a wire that conducts pain to your brain. Or imagine a pleasant, safe, relaxing place or activity that makes you feel happy. Arriving at these places or participating in these activities in your imagination can make you feel quiet.
Here are some exercises that use this method:
1) Close your eyes and breathe slowly to make yourself feel relaxed
2) Concentrate your attention on your breathing. Breathe slowly and naturally from the abdomen. When you breathe in, slowly and silently say “Inhale, 1, 2”; when you breathe out, slowly and silently say “Exhale, 1, 2”. Practice this slow rhythm of breathing for a few minutes.
3) Imagine that a healing energy ball is formed in the proposed lungs or chest cavity. It can be like a white light. It can also be blurred and not clear and distinct.
4) When you are ready, imagine that the inhaled air blows this healing ball of energy to the proposed painful area. Once there, it will have a healing effect and relax you.
5) When you exhale, you imagine that the gas is blowing the ball of energy out of your body. The pain is then brought out.
6) Repeat this at least twice.
7) You can imagine that as the healing ball gets bigger, it brings more and more discomfort out of your body.
8) End your imagination by slowly counting to three, taking a deep breath, opening your eyes, and saying to yourself “I feel better and I feel more comfortable. Then move slowly.
Imagery therapy can create problems similar to those created by relaxation therapy.
Distraction Therapy
Distraction therapy is the process of shifting your attention from the pain to something else. People often use this method unconsciously, for example, by listening to music and watching TV to take their attention away from their worries and pain.
Distraction therapy can be used alone to control mild pain or in combination with medication to control an emergency episode of severe pain, such as pain associated with an event. This approach can work while you wait for the medication to take effect. If the pain is mild, this method can work for a few hours. Even in the most severe pain, distraction therapy can be an effective adjunct therapy.
How do I use distraction therapy?
Any activity that you can focus your attention on can be used for distraction therapy. You can do this internally, by counting, singing to yourself, praying, or repeating the silent statement: “I can overcome, I can overcome!” Or you can distract yourself from the pain through external means, such as embroidery, model building, drawing, and reading a good book. Watching TV and listening to music are also good distractions. Slow, rhythmic breathing is also a distraction and a way to relax. Visiting with friends or family is also a useful distraction.
You may find it effective to put on headphones or earbuds and listen to fast-paced music. Tapping out to the beat of the music is also a useful way to keep your attention on the music. These methods do not require much physical effort, so they are very useful when you are tired.
After using distraction methods, some people feel fatigued, irritable, and have increased pain. If this happens, you should carefully analyze the distraction methods you use and the time you use them.
Hypnosis
Hypnosis is a state of heightened sleep-like state that is awake but very calm and stable. In this relaxed state, people become receptive to the suggestions of others. Hypnosis can be used to block the awareness of pain, to replace the sensation of pain with another sensation, and to change the sensation to one of no pain. You can be hypnotized by an experienced hypnotist, or you can learn to hypnotize yourself through training.
In the hypnotic state, many people feel very much like we do when we first wake up in the morning. Although we can’t open our eyes, we are very aware. We can hear sounds from inside and outside the room. Our eyes are closed, and we feel that we neither can nor want to wake up and open them.
A trained hypnotherapist can put you into a hypnotic state, give you some positive advice, and take you out of the hypnotic state when needed.
Skin Stimulation Therapy
Techniques to reduce or block pain by stimulating the skin with pressure, cold, heat, etc. Massage, compression, vibration, heat, cold compresses and mint products can also be used to stimulate the skin. These techniques can also alter the blood flow to the irritated area. Sometimes this skin stimulation can reduce or eliminate the pain at the time of stimulation and for several hours afterwards.
Skin stimulation can be performed on or around the area of pain. You can also reduce pain on one side of the body by stimulating the skin on the opposite side, for example, stimulating the skin on the left thigh to reduce pain on the right thigh. Stimulating the skin away from the painful area can be used to relax tension and reduce pain.
What you should know about skin stimulation therapy
If you are undergoing radiation therapy, consult your physician before using skin stimulation treatments. You should not use ointments, shocks or pain relievers on the treated area, and you should not use heat or excessive cold compresses. If you are receiving chemotherapy, consult your physician before applying hot or cold compresses.
Massage: Use slow, steady, circular movements to massage the painful area and its surroundings. You can use your bare hands to massage directly. You can also use talcum powder, essential oils, skin creams, and other supplies to massage the area. Depending on the area of pain, you can massage it yourself or ask your family, friends or massage therapist to massage it. Some people feel more comfortable with gentle rubbing and clicking than with deep massage. You can choose the method of massage that works best for you.
Caution:
If you are undergoing radiation therapy, avoid massaging the treatment area, as well as any redness, swelling, broken skin and delicate, sensitive areas. Consult your physician regarding the above.
Compression: Using your entire hand, palm, fingertips, knuckles, fist to compress the painful area and its surroundings, holding the painful upper arm or lower extremity with one hand or two hands in a circular grip can relieve the pain. You can observe if it helps by pressing for 10 seconds. You can also find out if there is a “trigger point” around the painful area, which is a small area of skin that is very sensitive or causes significant pain. Sometimes giving steady pressure at this trigger point will significantly reduce the pain. Pressure is usually most effective when it is as large as possible but does not cause pain. You can apply pressure for as large as one minute. This can often relieve pain for a few minutes or a few hours.
Vibratory therapy: Vibrations in and around the painful area can bring short term pain relief. A handheld vibrator touching the scalp can often relieve headaches. For chronic back pain, a long, thin electric vibrator placed on the back is helpful for pain relief. There are various vibration therapy devices that can be used.
Caution: If you are undergoing radiation therapy, avoid using vibration therapy in the treatment area. Vibratory therapy should also not be used on the stomach or on areas of red, broken, swollen and sensitive skin.
Hot and cold packs: As with any technique we describe, you should use the method that works best for you. Hot packs are often used to relieve muscle pain. Cold compresses can relieve pain by dulling the sensation in the treated area. You can also alternate between hot and cold packs to treat a particular area.
Cold compresses:
For cold packs, you can try using a gel capsule that is sealed with gel, which remains soft even when frozen. This can be bought in pharmacies or other stores. It can be stored in a freezer and used again and again. You can use it more comfortably by wrapping it in a towel. You can also use ice packs, ice cups, etc. to apply cold compresses to the treatment.
Caution:
1) If you get chills when using cold packs, stop the cold packs immediately. Do not apply cold compresses so strongly or for so long that the cold compress itself causes pain.
2) Avoid using cold packs on the radiation treatment area or on the treatment area within six months of radiation treatment.
3) If you are undergoing chemotherapy, consult your physician before applying cold compresses.
4) Do not use cold packs on areas where you feel poor circulation and sensation.
5) Do not use cold compresses for more than 10 minutes at a time.
Hot compresses:
To use hot packs for pain relief, a hot water bag with controlled steam is more convenient. You can also try a regular hot water bag, a hot water cup wrapped in a towel, a towel soaked in hot water, a hot bath, etc. You can also buy a heat-releasing patch from a pharmacy, and for painful joints, you can use a lightweight plastic wrap over the joint to keep the body itself warm and hydrated.
Cautions:
1) Do not use hot water packs on bare skin. Do not use hot packs while sleeping. If you are taking sleeping pills and in areas that do not feel sensitive use hot packs with caution.
2) Do not apply heat to the newly injured area, as this may cause bleeding. Do not consider applying heat until at least 24 hours have elapsed.
3) Do not apply heat to insensitive areas and areas with poor circulation.
4) Do not apply heat for more than 5-10 minutes at a time.
Peppermint preparations:
Many menthol preparations are available. For example, peppermint cream, peppermint cream, peppermint gum, etc. are effective in relieving pain. When they are applied to the skin and soaked into the body, they can improve blood circulation to the area, produce heat (sometimes with a cooling effect), and the pain relief can last for several hours.
When using peppermint preparations, you can first apply a small amount of peppermint to the painful area and observe if there are any uncomfortable sensations or skin irritations. If there are no such problems, you can apply more of the mint preparation to the desired area. The effects from the peppermint will gradually increase and remain for several hours. If you are concerned about the mint smell affecting other people, you can use it at night or when you are alone.
Precautions.
1) Do not apply peppermint preparations in the eyes, on damaged skin surfaces, where there is a rash, and on mucous membranes, such as in the nose, in the mouth, and around the genitals and anus.
2) Make sure the menthol does not get into the eyes. Wash your hands with soap and hot water after applying the menthol preparation.
3) Do not use mint preparations in radiotherapy areas.
4) If you have been told not to use aspirin in the past or are allergic to aspirin, consult your doctor before using mint preparations. Many menthol preparations contain small amounts of aspirin-like ingredients. Small amounts of this aspirin-like material can enter the body through the skin.
Transcutaneous electrical nerve stimulation (TENS): This is a technique in which a microcurrent is applied to an area of the skin. The sensation during treatment is often described as a buzzing, tingling or tapping sensation. These small electrical pulses interfere with the sensation of pain. The size and frequency of the current can be adjusted to make the sensation more comfortable and provide better pain relief. This pain relief can last for some time after the treatment. This device is available on the market.
Acupuncture:
Acupuncture techniques have been used for a long time to relieve pain. Some specific acupuncture points are associated with certain areas of pain, and an experienced acupuncturist will be able to improve the ideal service for you.
Caution: If you are undergoing chemotherapy or radiation, you need to consult with your doctor before having acupuncture.
Emotional support and counseling:
If you feel anxious or depressed, your pain will feel worse. Pain can also cause you to feel anxious and depressed and to feel hopeless and helpless. Some people may have bad feelings such as anger, emotional outbursts, and loneliness. All of these feelings are normal. It is important to understand the causes of these emotions and take the necessary steps to regulate them through counseling to relieve pain.
Find support:
You can try to talk about your feelings with someone you think is reliable or easy to talk to, such as doctors, nurses, social workers, family members and friends, and other cancer patients. You may also want to talk to counselors and psychologists about your problems.
You may also want to try to get support from cancer professional organizations and patient organizations to share their feelings and experiences in dealing with pain. This support can be face-to-face, or through online and telephone conversations over the Internet. Information is available in many traditional and modern media, as well as from your doctor, nurse and social worker.