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.

Watch this video to learn more about living with cancer pain.

Finally, read more about managing your pain in My Guide to Cancer Symptoms.

First Line Strategies

These methods have the strongest scientific evidence for effectively treating cancer pain.

 

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.

Additional Resource:

Relief of Cancer Pain

Discusses various ways to control cancer pain with both medications and non-medication treatments. Medications include both over-the-counter (OTC) and opioids and specialized procedures such as pumps and nerve blocks. Non-medication treatments include yoga, biofeedback and acupuncture. Explains side effects of pain medications and what can be done as well as answers to frequent questions. Palliative care is discussed.

 

Physical Activity and Exercise

Physical activity and therapeutic exercise increase your pain threshold, relieve joint stress, and allow you to move with less pain. You can walk for physical activity or strengthen and stretch the muscles in a specific area.

Options include:

1. Step count monitoring and goal setting;
2. Gradual, progressive strength training with REST DVD;
3. Explore local resources if group fitness classes are preferred;
4. Explore options to resume exercises that were successful in the past.

Additional Resources:

My Road to Better Health, Move Daily

Walking: An introduction

Walking improves blood flow, reduces the risk of blood clots and stimulates digestion and other systems. Learn how taking regular walks can help with pain management.

 

Behavioral/CBT Strategies 

Distress Tolerance

Explains skills to use in difficult times to avoid making the situation worse.

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

Managing Your Thoughts

Explains ways to challenge negative thoughts rather than accepting them as facts.

• 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.

Staying Grounded

Explains techniques for bringing oneself back to the present moment to get control over overwhelming emotions and thoughts.

• 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.

 

Additional Resources:

Cognitive Coping Skills: Changing Your Thoughts About Chronic Pain and Illness

Using Relaxation Skills to Relieve Your Symptoms

What is Cognitive Behavioral Therapy (CBT)?

Anxiety and Chronic Pain or Illness

Ways to Manage Your Feelings and Thoughts

Information for Family and Friends of Those Living with Chronic Symptoms

 

Second Line Strategies

These approaches, while effective, do not have as much scientific evidence for their effectiveness in treating cancer pain.

 

Integrative therapies

Integrative therapies, such as mind-body practices, acupuncture, massage therapy, and yoga, have been proven to reduce pain. These treatments also relieve other symptoms like anxiety and insomnia. The following integrative therapies may help ease your pain.

• Acupressure/Acupuncture
• Massage
• Yoga
• Relaxation /Relaxed breathing

Focus on techniques that can be done at home with existing resources (relaxed breathing, meditation, guided imagery, progressive muscle relaxation) yoga, and acupressure. Practice at least 1-2 times a day.

Additional Resources:

Integrative Medicine Acupuncture

Explains that acupuncture is a form of traditional Chinese medicine that aims to restore a balanced energy flow in the body in order to treat pain and illness. Describes what happens during a typical acupuncture treatment session. Outlines the common risks and benefits of acupuncture.

What You Need to Know About Acupuncture

Describes acupuncture, its Chinese history and how it's done. Describes the symptoms it's often used to treat, the possible benefits, and the possible side effects and risks. Explains what usually happens during typical outpatient and inpatient sessions. Explains how to work with an acupuncturist and how to find a qualified acupuncturist.

Acupressure: An introduction
Acupressure involves applying pressure at certain points on the body to relieve discomfort. Learn how acupressure can help with pain management.

Massage: An introduction
Massage relaxes muscles, increases blood flow and stimulates the release of the body's pain-relieving chemicals. Learn how massage can help with pain management.

Mindful Movements: Gentle Yoga

Contains a QR Code to be used to watch videos about gentle yoga which provides instruction about guided yoga practice with healing music. Sessions are designed to be practiced every day and include movements to improve balance, stability, strength and flexibility. Includes introduction to gentle yoga and sessions with themes of gratitude, compassion, acceptance, higher meaning, forgiveness, reflection, celebration, and mindfulness.

Yoga: An introduction

Yoga involves gently moving through a series of positions which you briefly hold, while paying special attention to your breathing. Learn how yoga can help with pain management.

Breathing: An introduction
Breathing from the belly is a very effective way of lowering stress. Learn how practicing relaxed breathing can help with pain management.

Meditation: An introduction
Meditation is a way of focusing your attention on the present moment to manage thoughts and feelings. Learn how practicing meditation can help with pain management.

 

Procedures

Procedures used to treat pain include injections, ablations, and surgeries that interrupt pain signals or reduce
inflammation in the painful area.

• 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.

Additional Resources:

Spinal Injections: Epidural, Facet Joint, Sacroiliac Joint, and Nerve Root

Discusses spinal injections for pain and inflammation. Injections include epidural, facet joint, sacroiliac joint, and nerve root. Brief anatomical explanation of spinal cord, joints, and nerve roots. Discusses how a patient should prepare, what happens during, and what usually happens after injections. Tells common complications and when to get emergency care.

Diagnostic Nerve Block

Describes a diagnostic nerve block used to determine the source of pain. Provides prpe instructions and guidelines for care after the procedure, possible complications and when to seek emergency care.

Joint Injections

Discusses the procedure of joint injections, used as treatment for painful or inflamed joints. Explains how joints are injected with a local anesthetic and corticosteroids to reduce pain and inflammation. Discusses necessary preparations needed before, during and care following the procedure, as well as complications and when to seek emergency care.

Trigger Point Injections

Discusses the procedure of trigger point joint injections, used as treatment for areas of painful muscles. Briefly explains what a trigger point is, causes and symptoms. Describes how trigger point is injected with a local anesthetic and corticosteroids to reduce pain and inflammation. Discusses necessary preparations needed before, during and care following the procedure, as well as, complications and when to seek emergency care.

About Your IV Sedation

Explains the use of IV (intravenous) sedation to help relieve anxiety and discomfort during a procedure. It describes what to expect before, during and after sedation that includes guidelines for fasting and medications. Possible side effects are described along with activity and diet. Reasons to contact a health care provider are listed.

Lumbar Sympathetic Block

Includes information about what to expect before, during and after the procedure. Lists possible complications and care following suggestions.

Celiac Plexus Block

Explains what a celiac plexus block is and what it is used for. Describes what to expect before, during and after the procedure. Discusses common side effects and care following the procedure.

Stellate Ganglion Block

Provides information about what to expect before, during and after the procedure. Lists possible complications and care following suggestions.

Care After Your Steroid Injection

Explains care instructions to follow after a steroid injection.

 

Palliative Medicine

Specialized medical care for people living with a serious illness. Palliative care focuses on managing symptoms
and improving quality of life for patients and their families.

• Palliative care is a specialized area of medicine that focuses on preventing, managing, and relieving symptoms of cancer and any side effects caused by treatment.
• In addition to treating physical issues, such as pain, nausea, and fatigue, Palliative care also focuses on supporting your emotional, spiritual, and practical needs.
• Although you may hear “palliative care” and “hospice care” used in similar ways, they are not the same.
• Palliative care is given at every step of the treatment process no matter what stage of cancer you have.
• It provides an extra layer of support for people with any stage of cancer.

Read more here: Palliative Care.

Additional Resource:

Describes the services a Palliative Care team provides to patients and family members during treatment for a serious illness. Emphasizes the Palliative Care team's collaborations with other clinicians providing treatment. Explains the difference between hospice and palliative care.