Pain
Key Points
- When pain is controlled, the quality of life improves dramatically.
- Pain can be acute or persistent.
- Cancer pain can be managed, often with relatively simple treatments.
- Many of the common fears people have about cancer pain management are often unfounded.
- In addition to opiods, many complementary therapies can also be remarkably helpful in controlling pain.
|
Pain, which can range from mild to severe, is the most common symptom leading people to seek medical attention. Both our experience and research tell us that when pain is controlled, quality of life improves dramatically. Uncontrolled pain, on the other hand, creates unnecessary suffering, "not only by causing immediate physical suffering, but also by increasing the anxiety level and the fear about the future and future problems." Pain may even shorten life.
Types of Pain
Pain can be acute or persistent:
- Acute pain is short-term and usually ends after the source of the pain is addressed and the painful area heals—for example, incision pain after surgery.
- Persistent pain is present frequently or constantly most of the day and persists beyond the period of time when the painful area is expected to heal. In persistent pain, the cause of the pain may not be able to be addressed.
Read more
Many cancer patients fear that they will have persistent pain, but many don’t usually experience such pain except perhaps with advanced cancer.
If you have pain, first understand that cancer pain can be managed, often with relatively simple treatments such as oral pain medications. Become educated about cancer pain, how to communicate your pain, where to get help, and what to do next if you’re not satisfied.
Pain may be a side effect of many medications, such as statins. Before pursuing treatments for pain, check with your doctor or pharmacist to see if any of your prescription medications may contribute to pain and whether adjustments can be made.
Reporting Pain
A critical step is reporting pain to your doctor. To learn how to talk with your doctor about pain, see NCI’s booklet: Pain Control. If your doctor is not trained in cancer pain management and is unable to help you relieve your pain satisfactorily, consider asking for a referral to a healthcare professional trained in managing cancer-related pain. These professionals often have a point of view that pain is an “emergency”, encouraging patients to report unmanaged pain promptly. In addition to medical oncologists (who are usually very knowledgeable about cancer pain management), doctors and nurses trained in palliative care are experts in helping people manage symptoms related to chronic illnesses such as cancer. These palliative care specialists often work in hospice or palliative care programs.
Our fears are masks of old hurts and not necessarily premonitions about the future.
Benjamin Shield
Myths and Truths about Pain
Fears about pain and pain treatment are common. Perhaps your fears come from experience with someone with cancer whose pain caused suffering, and you are afraid that will happen to you. Many people are also afraid that if they take opiates such as morphine, they will become addicted or will be confused, incoherent or “out of it” all the time. Many may fear that if they take an opiate now, it won’t work later if the pain gets worse.
Addiction Risk Factors
As with other diseases, risk factors are associated with higher likelihood of addiction:
Expand list
- Genetic predisposition
- Certain brain characteristics such as impairments in the brain’s reward circuitry, compensation for trauma and mental health problems
- Psychological factors: stress, personality traits like high impulsivity or sensation seeking, depression, anxiety, eating disorders, personality and other psychiatric disorders
- Environmental influences: exposure to physical, sexual or emotional abuse or trauma, substance use or addiction in the family or among peers, access to an addictive substance; exposure to popular culture references that encourage substance use
- Starting alcohol, nicotine or other drug use at an early age
|
Read more
Many of the common fears people have about cancer pain management are often unfounded. Allow space for the probability that you will not have persistent pain, and that if you do, you will have knowledge of and access to expert help for managing your pain.
Some truths:
- Unreported, uncontrolled pain will make you weak.
- Addiction is not common if you are taking your pain medication as your doctor prescribes and you don’t have have the disease of addiction or high risk for addiction (see at right).
- The risk of opiod-related death is very low in cancer patients.
- Pain dampens your thinking abilities. When opiates effectively control pain, cognitive function usually improves over time.
- Raising the dose of opiate as needed or even switching to another opiate can achieve good pain management with minimal side effects.
- Most opiate side effects can be prevented or controlled.
Finally, bear in mind that complete obliteration of physical pain is not usually a realistic objective; however, a realistic goal is to manage the pain so that it is tolerable and frees you up to achieve your own goals of living well.
A realistic goal is to manage the pain so that it is tolerable and frees you up to achieve your own goals of living well.
Managing Pain
Clinical Practice Guidelines
The 2016 American Society of Clinical Oncology clinical practice guideline for management of chronic pain in survivors of adult cancers makes these recommendations regarding complementary approaches:
Pain and Suffering
Unrelieved physical pain can cause unnecessary suffering. In addition to physical pain, people also experience emotional, mental, social and spiritual pain. These types of pain may also lead to suffering.
Read more BCCT founder Michael Lerner teaches that “suffering is the human experience of pain.” He explains that very often suffering is viewed negatively in our society. However, many of the wisdom traditions as well as our own experience teaches us that there is a dual nature to painful events—they can cause suffering as well as deliver great wisdom and growth.
Dr. Lerner says: “Suffering is in large part the story we tell ourselves about our pain. And that story can sometimes profoundly shift the experience of that pain.” Indeed, many people find that in simply telling about their pain, their pain level begins to ease. Research verifies that people’s immune systems and healing abilities improve when they write or talk about the story of their pain, whether that pain be physical, mental, emotional, social or spiritual.
Roshi Joan Halifax, PhD, has written Meditations on Transforming the Suffering of Pain, which includes meditative practices that assist with being with pain and transforming the suffering of pain.
Share the facts of your pain with your doctor; share the story of your pain with those who will receive it with love: the first may ease your pain, the second may transform your pain and ease your suffering. |
Conventional Approaches
Opiates are currently the mainstay of treating moderate to severe cancer pain. We can often further manage pain with other kinds of medication, such as anti-inflammatories, anticonvulsants and antidepressants. Sometimes, chemotherapy, surgery or radiation therapy may also be part of your pain-treatment plan.
Complementary Approaches
Many non-drug techniques—complementary therapies—can also be remarkably helpful in controlling your pain. Persistent pain often is best managed with an integrative approach, combining conventional medications and treatments with complementary approaches. The Society for Integrative Oncology clinical practice guidelines list integrative therapies with evidence for addressing pain:
Read more
- Massage therapy from a therapist trained in oncology massage
- Mind-body approaches including these:
- Cognitive-behavioral stress management
- Cognitive-behavioral therapy (CBT)
- Hypnosis
- Music therapy
- Relaxation training
- Support groups
- Supportive/expressive therapy
- Acupuncture
- Therapies based on a philosophy of bioenergy fields such as these:
- Medical cannabis or cannabinoids can be highly effective with fewer concerns than opiods.
- Bioelectromagnetically based therapies:
- Pulsed electromagnetic fields (PEMF): Several studies and reviews show reduced pain, opioid use and inflammation after surgery.
- Transcutaneous electrical nerve stimulation (TENS): A review and meta-analysis showed reduced blood levels of proinflammatory cytokines, and a clinical trial found reduced pain intensity, lower opioid use and fewer requests for chest radiographs after coronary artery bypass surgery. A review found improved postoperative pain in urology patients.
- Electroacupuncture: Randomized trials showed evidence of reduced pain after thoracic surgery.
- Transcutaneous electrical acupoint stimulation (TEAS): A randomized study found that TEAS use with general anesthesia led to stable blood pressure during surgery, reduced analgesic use and better pain relief compared to general anesthesia alone..
Some of these methods may relieve pain directly, while others may improve your ability to cope with the mental, emotional and spiritual discomforts that often accompany and aggravate physical pain.
Integrative Programs, Protocols and Medical Systems
- Programs and protocols
- Traditional systems
Written by Laura Pole, RN, MSN, OCNS, and reviewed by Nancy Hepp, MS; most recent update on April 19, 2018.
- Strang P. Existential consequences of unrelieved cancer pain. Palliative Medicine. 1997 Jul;11(4):299-305.
- The National Center on Addiction and Substance Abuse. Who develops addiction? April 14, 2017. Viewed April 3, 2018; The National Center on Addiction and Substance Abuse at Columbia University. Addiction Medicine: Closing the Gap between Science and Practice. June 2012. Viewed April 3, 2018; Mayo Clinic Staff. Drug addiction (substance use disorder). Mayo Clinic. October 26, 2017. Viewed April 5, 2018.
- Paice JA, Portenoy R et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology. 2016 Sep 20;34(27):3325-45.
- Lerner M. Choices In Healing: Integrating The Best of Conventional and Complementary Approaches to Cancer. MIT Press. 1994.
- Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120; Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S; Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232.
- Abrams DI. The therapeutic effects of cannabis and cannabinoids: an update from the National Academies of Sciences, Engineering and Medicine report. European Journal of Internal Medicine. 2018 Mar;49:7-11.
- Strauch B, Herman C, Dabb R, Ignarro LJ, Pilla AA. Evidence-based use of pulsed electromagnetic field therapy in clinical plastic surgery. Aesthetic Surgery Journal. 2009 Mar-Apr;29(2):135-43; Rohde CH, Taylor EM et al. Pulsed electromagnetic fields reduce postoperative interleukin-1β, pain, and inflammation: a double-blind, placebo-controlled study in TRAM flap breast reconstruction patients. Plastic and Reconstructive Surgery. 2015 May;135(5):808e-817e; Hedén P, Pilla AA. Effects of pulsed electromagnetic fields on postoperative pain: a double-blind randomized pilot study in breast augmentation patients. Aesthetic Plastic Surgery. 2008 Jul;32(4):660-6; Rawe IM, Lowenstein A, Barcelo CR, Genecov DG. Control of postoperative pain with a wearable continuously operating pulsed radiofrequency energy device: a preliminary study. Aesthetic Plastic Surgery. 2012 Apr;36(2):458-63; Rohde C, Chiang A, Adipoju O, Casper D, Pilla AA. Effects of pulsed electromagnetic fields on interleukin-1 beta and postoperative pain: a double-blind, placebo-controlled, pilot study in breast reduction patients. Plastic and Reconstructive Surgery. 2010 Jun;125(6):1620-9; Taylor EM, Hardy KL, Alonso A, Pilla AA, Rohde CH. Pulsed electromagnetic fields dosing impacts postoperative pain in breast reduction patients. Journal of Surgical Research. 2015 Jan;193(1):504-10; Sværdborg M, Momsen OH, Damsgaard TE. Pulsed electromagnetic fields for postoperative pain treatment after breast augmentation: a double-blind, placebo-controlled study. Aesthetic Surgery Journal. 2016 Jun;36(6):NP199-201; Khooshideh M, Latifi Rostami SS et al. Pulsed electromagnetic fields for postsurgical pain management in women undergoing Cesarean section: a randomized, double-blind, placebo-controlled trial. Clinical Journal of Pain. 2017 Feb;33(2):142-147.
- do Carmo Almeida TC, Dos Santos Figueiredo FW et al. Effects of transcutaneous electrical nerve stimulation on proinflammatory cytokines: systematic review and meta-analysis. Mediators of Inflammation. 2018 Apr 2;2018:1094352.
- Jahangirifard A, Razavi M, Ahmadi ZH, Forozeshfard M. Effect of TENS on postoperative pain and pulmonary function in patients undergoing coronary artery bypass surgery. Pain Management Nursing. 2018 Aug;19(4):408-414.
- Zhou M, Li Y et al. [Clinical research of electroacupuncture on the analgesic effect of thoracic perioperative stage]. [Article in Chinese] Zhongguo Zhen Jiu. 2017 Jul 12;37(7):705-709; Gan TJ, Jiao KR, Zenn M, Georgiade G. A randomized controlled comparison of electro-acupoint stimulation or ondansetron versus placebo for the prevention of postoperative nausea and vomiting. Anesthesia and Analgesia. 2004 Oct;99(4):1070-5, table of contents.
- Yu JM, Qu PS et al. [Observation on the analgesic effect of transcutaneous electrical acupoint stimulation for breast radical carcinoma operation]. [Article in Chinese] Zhen Ci Yan Jiu. 2010 Feb;35(1):43-6.
- Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.
- McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.
View All References
More Information
- Cancer.net: Pain
- American Society of Clinical Oncology: Managing Cancer-Related Pain: A Guide for Patients, Families, and Caregivers
- SIO clinical practice guidelines:
- Jonathan Simon: Acupuncture in Cancer Care
- Michele Schuman: The Benefits of Medical Massage
- Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer
- Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- Raymond Chang, MD: Beyond the Magic Bullet: The Anti-Cancer Cocktail
- American Society of Clinical Oncology: Cancer.Net
- University of Arizona: Arizona Center for Integrative Medicine Online Courses
- United Patients Group: Informative Videos on Medical Cannabis & Marijuana
- Wayne Jonas, MD: Your Healing Journey: A Patient’s Guide to Integrative Breast Cancer Care
- September 2018 Issue of the Journal of Alternative and Complementary Medicine
- National Cancer Institute: Cancer Pain Control: Support for People with Cancer
- Mala Cunningham, PhD: Before and After Surgery
- Belleruth Naparstek: Guided Meditations to Promote Successful Surgery
- Martin L. Rossman, MD: Fighting Cancer from Within
- Integrative Cancer Review
This work is licensed under a