Treating Cancer Pain Your Meaning will try to find out what is causing your pain as it relates to the treatment of the pain. Treatment of the cancer itself, the use of pain medication, physical therapy and even surgery may be the way to treat your pain. If you have severe pain, your doctor will try to find the way to treat your pain with the least amount of side effects and in the most effective way. Patients need to communicate closely with their doctors so that they have a detailed understanding of your daily treatments and how they are working. The goal is to develop a pain management treatment program that works for you. Cancer pain is usually treated with medications known as analgesics. You can buy some very good, over-the-counter pain medications (e.g. aspirin, paracetamol, ibuprofen, etc.) yourself. These medications are called over-the-counter or OTC analgesics.OTC analgesics can be used alone for moderate pain or in combination with other medications for more severe pain. In contrast, prescription analgesics are medications that require the recommended approval of doctors, nurses, and pharmacists before use, as they may react with cancer treatment medications or other more serious problems. Drugs are generally safe when used appropriately, otherwise they can be very harmful. In some cases, both medications and non-medications are less effective. There are also specific pain treatments that are often used for these particular pains. For example, your doctor may use: 1) radiation therapy to shrink a tumor 2) surgical treatment to remove all or part of the tumor 3) nerve blocks that are injected into the nerves, around the nerves, or into the spinal column to block the pain 4) neurosurgery, which is the surgical cutting of nerves to relieve pain There are also a number of other pain treatments, which are described in the section called “Other ways to relieve pain”. There are other ways to treat pain, which we describe in more detail in the section “Other ways to relieve pain”. You may also use non-pharmacological methods, such as relaxation therapy, biofeedback, mindfulness, etc., or a combination of these methods and medications. See the later section on “Non-pharmacologic Treatment of Pain” for more information. The first step in developing a pain management plan is to talk to your doctor, nurse or pharmacist about your pain. You also need to describe your pain in detail to your family or friends so that they can help or report your pain to your doctor, especially if you are particularly tired and in severe pain. Using a pain score is helpful in describing what level of pain you are feeling. Use a scale from 0 to 10 to categorize your pain in terms of data. If you don’t feel pain, use a score of 0 to indicate that. As the number increases it means that the pain you feel increases and a score of 10 means that this is the worst pain you feel. For example, you might describe, “Right now my pain is a 7 on a scale of 0 to 10” You can use the rating scale to describe: 1) what your pain is like when it is at its worst 2) what your pain is like most of the time 3) what your pain is like when it is at its lightest 4) how your pain changes with treatment Tell your doctor, nurse, pharmacist, and your family and friends the following: 1) Where you feel the pain 2) How your pain is manifesting itself, e.g., stabbing, dull, throbbing, flickering pain, persistent, unspeakable discomfort. 3)what level the pain is (use a scale of 0-10 to describe it) 4)how long the pain lasts 5)what happens when the pain is relieved 6)what happens when the pain gets worse 7)how the pain interferes with your daily life 8)what medicines you are taking to relieve the pain and how well they are working to treat it Your doctors, nurses, and pharmacists may need to know about the following vitamins, minerals, herbs, and other over-the-counter medications 2)what pain medications you have taken in the past, both those that worked and those that didn’t work 3) Any allergies you have to medications, foods, dyes, or additives It is a good idea to take the package inserts for the medications you are taking with you when you go to the doctor. Show them to your doctor and explain what you are taking. You may want to ask your doctor the following about pain medications: 1) What dose should I take and how often and for how long 2) If the current dose of pain reliever is not effective in controlling pain, can I increase the dose? 3)If I can increase the dose, how should I do it? 4)Do I need my doctor’s approval before increasing my dose? 5)If I forget to take my painkillers on time, can I take any remedial measures? 6)Should I take my painkillers with food? 7)How much water should I use when taking painkillers? 8)How long does it take for painkillers to work? 9)Is it safe to drink alcohol, drive a motor vehicle, or operate machinery after taking pain relievers? 10)Can I take other medications while taking pain relievers? 11)What other medications should I stop or avoid while taking pain medications? 12)What are the possible side effects of taking pain medications and how should I prevent them? What should I do if these side effects occur? You may find it useful to keep a detailed pain record and a diary of what treatments are effective in reducing pain. You can go ahead and share this record with your doctor and nurse to discover the most effective ways to control your cancer pain. A record of pain includes the following: 1) language describing the pain 2) behaviors that increase or decrease the pain 3) behaviors that you are unable to perform because of the pain 4) the names and doses of pain medications you take, as well as the times they are taken 5) times you use other methods of pain relief (e.g., rest, relaxation methods, recreation, skin stimulation, or intentional guidance) 6) times you have used measures to control your pain (including medications and other non-pharmacological methods), your rating scale for pain 7) pain scores 1-2 hours after using pain control measures 8) the amount of time it takes for pain medications to take effect and the amount of time it takes to maintain their effectiveness 9) pain scores throughout the day (to get an assessment of overall physical comfort) 10) how pain affects your daily activities, such as resting, eating, having sex, and working 11) all side effects that may be associated with pain medications The type of pain affects the treatment you will need in the future Pain is generally divided into acute and chronic pain. Acute pain is generally more intense and shorter in duration, and usually occurs when the body is being injured in some way; this pain usually goes away as the injury heals. Chronic or persistent pain generally lasts longer and the pain may be mild, moderate or severe. You’ll notice that most of the pain we’re talking about here is chronic pain, because this type of pain can affect your life if it’s not treated effectively. Certain patients with chronic pain that is controlled with medications may have a sudden pain bleed. This sudden pain is usually moderate to severe and lasts for a short period of time. It is common to have sudden pain for chronic pain that is being treated, and this will be discussed in more detail in the following sections. Understanding Sudden Pain in Patients with Chronic Pain Patients with cancer pain will notice that their pain changes throughout the day. Many patients who have chronic cancerous pain (pain that lasts more than 3 months) have two types of pain – persistent pain and sudden onset pain. Persistent pain can be controlled by regular use of pain medications. Sudden pain, on the other hand, cannot be controlled by regular use of pain medications. Sudden pain is sudden pain that occurs in spite of regular use of pain medication for chronic pain. Sudden pain also varies from person to person and its occurrence is often unpredictable. Usually this pain comes on quickly, lasts for about an hour, and most of its pain is comparable to or worse than chronic pain. It may occur several times a day, even though you are taking the correct medication for chronic pain. The intensity of this pain can vary somewhat and is also unpredictable. The cause of sudden onset pain is generally the same as chronic pain. It may be caused by the cancer itself or due to cancer treatment. For some people their sudden pain occurs during certain activities, such as walking or dressing. For others there may not be any clear trigger. Different approaches to treating chronic and sudden pain Treatment of chronic pain: Medicines used to treat chronic pain take a long time to work. They are called long-acting or extended-release medications. These medications need to be taken on a regular basis, even when you don’t have pain, when you need them. By taking these medications on a regular basis, a fairly constant level of pain relief can be maintained throughout the day. These medications can be tablets taken by mouth every 8 or 12 hours, capsules, or patches that are stuck to the surface of the skin for a few days. These medications are released slowly to provide continuous pain relief. Treatment of Sudden Pain: Sudden pain is effectively treated by fast-acting pain medications that last for an intermittent period of time. They are usually used on an as-needed basis, which means you use them as soon as you feel sudden pain. These short-acting medications (sometimes called rescue medications) work faster than medications used for persistent pain. They also remain in the body for a short time and rarely cause side effects. You should take this short-acting pain medication as soon as you notice sudden pain developing so that it can work immediately. Do not allow the pain to develop and worsen as this will make it harder to control. These medications are usually used as prescribed by your doctor. Tell your doctor or nurse promptly if the usual dose does not relieve the sudden pain, or if you think the sudden pain episodes are more frequent. They may be able to adjust the dose or number of pain medications you usually use as needed. If you find that sudden pain comes on after or during certain activities, you may also want to take this short-acting painkiller before it strikes.