Cancer Pain

People with advanced or late-stage cancer have more severe pain.

People with cancer (about 75 percent) experience pain that can be caused by cancer itself, treatment, diagnostic procedures, or a combination of factors.

Cancer pain can be acute or chronic:

• Acute pain
  • Due to damage caused by an injury or a surgery
  • Pain tends only to last a short time
  • Painkillers help to keep it under control
• Chronic pain
  • Due to changes to the nerves or chemicals produced by a tumor
  • Pain may continue long even after the injury or treatment ends and can range from mild to severe

Cancer pain can be dull, aching, pressure, burning, or tingling.

People with advanced or late-stage cancer have more severe pain. Even after successful cancer treatment, many may get pain that continues long even after cancer treatment ends.

People can experience several types of cancer-related pain, such as:

• Postoperative pain
• Spasms, pain, stinging, and itching
• Mouth sores
• Compressive pain (due to spinal cord compression)
• Ostealgia (bone pain)
• Peripheral neuropathy (pain, numbness, tingling in hands or feet because of damage to the nerves)
• Pain in joints and muscles throughout the body
• Osteonecrosis of the jaw
• Avascular necrosis
• Pain syndromes caused by radiation therapy, including:
  • Pain from brachytherapy
  • Pain due to a long time lying in the same position during treatment
  • Dermatitis
  • Pain flares

Pain can be due to the tumor or cancer treatment or causes unrelated to cancer.

Pain can be related to any of the following reasons:

• Tumor:
  • A growing tumor may stretch the affected organ, causing pain.
  • If the tumor spreads to other organs, it may put pressure on nerves and damage them, causing pain.
• Surgery: Some people may have pain lasting for months or even years due to permanent damage to the nerves and the development of scar tissue.
• Radiation therapy: Pain may develop after radiation therapy and is often temporary.
• Chemotherapy: Can cause peripheral neuropathy, pain, and numbness in the fingers and toes.
• Other causes: People with cancer can have pain from other reasons, such as migraines, arthritis, or chronic low back pain.

Cancer pain treatment aims to relieve pain with minimal adverse effects, allowing the person a better quality of life.

Psychological intervention

• Coping strategies: Includes enlisting the help of others, persisting with tasks despite the pain, rethinking maladaptive ideas, and praying or rituals.
• Psychosocial interventions: Education and coping-skills training, such as changing thoughts, emotions, and behaviors, through training in skills (problem-solving, relaxation, distraction, and cognitive restructuring).

Medications

• If the person is not in severe pain, use nonopioid drugs, such as dipyrone, nonsteroidal anti-inflammatory drugs, or COX-2 inhibitors.
• If these drugs do not relieve pain or disease progression necessitates more aggressive treatment, use mild opioids, such as codeine, dextropropoxyphene, dihydrocodeine, or tramadol.
• If these are not sufficient, while continuing nonopioid therapy, use stronger opioids, such as morphine. Gradually increase the opioid dose until the person is pain-free or gets the maximum possible relief without side effects.

Other major symptoms of cancer are:

• Fatigue
• Weakness
• Headache
• Shortness of breath
• Nausea
• Constipation
• Sleep disturbances
• Depression
• Anxiety
• Mental confusion