Key questions about cancer pain

Q: What is pain?

A: Pain is not just a sensation that hurts.   It is "an unpleasant sensory and emotional experience associated with actual or possible tissue damage, or described in terms of such damage".

People experience pain in individual ways:

• the  pain may occur  occasionally or often
• it may be steady or throbbing, or stabbing, aching or pinching
• pain can cause discomfort, distress or agony
• if left untreated, it can also result in anxiety or depression. However  pain is felt,  it must be  described or defined clearly  because it is a personal experience.

The way pain is felt and its effects is influenced by physical, emotional and environmental factors. These act directly or indirectly on the body's nervous system (the brain, spinal cord and nerves).

 

Q: What is cancer pain?

A: Cancer  pain is a broad term for different kinds of pain that people may experience when they have cancer.

• Not all people with cancer have pain, and those who do experience it may not be in pain all the time.
• The way people experience cancer pain depends on factors such as the type and stage of cancer that they have, their cancer treatment, and other health issues.
• Pain can have a huge impact on  a person's  life, preventing them from doing the things  they want to do or normally do. Controlling the pain may allow  people to return to many of the activities  they enjoy.

 

Q: What types of pain are there?

A: There are many types of pain.

• Acute pain - severe pain that lasts a short time only, possibly for days or weeks.
• Chronic pain - ranges from mild to severe pain and can last for many months, usually at least three.
• Breakthrough pain -  a flare-up of severe pain that can occur despite people taking pain medication.
• Nerve pain - caused by pressure on nerves or the spinal cord, or damage to nerves. People often describe it as burning or tingling, or the sensation of "˜pins and needles'.
• Bone pain - caused by the spread of cancer into the bones, which damages bone tissue in one or more areas. People often describe it as aching, dull or throbbing.
• Soft tissue pain - caused by damage to or pressure on an organ or muscle. It may be hard to describe exactly where the pain is, but it tends to be sharp, aching or throbbing.
• Referred pain - pain is felt away from the site of the problem.
• Phantom pain -  a strange sensation of pain in a body part that is no longer there, such as breast pain after the breast has been removed. This type of pain is very real to those who experience it.

 

Q: What are some causes of pain?

A: Cancer patients have pain for a variety of reasons and they may feel it in more than one area of their body. It may be caused by the cancer itself or it can result from treatment. Pain is more common in people with advanced cancer (also called metastatic or secondary cancer). Some reasons for pain occurring include:

• a tumour pressing on organs, nerves or bone
• a bone fracture if the cancer has spread
• side effects from chemotherapy, radiotherapy or surgery
• poor circulation because the cancer has blocked blood vessels
• blockage of an organ or tube in the body
• infection or swelling and redness (inflammation)
• muscle stiffness from tension or inactivity
• poor posture causing back pain.

 

Q: What affects pain?

A: As well as the cause of the pain itself, your emotions, your environment and your fatigue levels can affect how you feel and react to pain. It's important for your health care team to have an understanding of the way any physical, emotional and environmental factors are impacting on you, so they may ask you about these.

 

Fatigue - fatigue and tiredness can make it harder for you to cope with pain. Lack of sleep can increase your pain. Ask your doctor or nurse for help if you are not sleeping well.

Emotions - people often have an emotional reaction to pain:

• you may feel worried, depressed or easily discouraged when you're in pain
• some people feel hopeless or helpless
• others feel isolated, embarrassed, inadequate, irritable, angry, frightened or frantic
• ongoing pain can cause anxiety and depression, and having these emotions can make the pain even worse. This does not mean that pain is all in the mind, but it is important to look at the emotional causes and effects of pain as much as the physical ones.

Environment - things and people in your environment - at home, at work and elsewhere - can have a positive or negative impact on your pain. For example, worrying about a child who is ill or not doing well at school can increase your pain because your state of anxiety is directly related to pain.

 

Q: Who helps manage pain?

A: Different health professionals work together to help manage your pain. This is called a multidisciplinary approach.

• general practitioner - takes care of your general health and coordinates specialist treatment
• medical oncologist - prescribes and coordinates the course of chemotherapy
• radiation oncologist - prescribes and coordinates the course of radiotherapy
• surgeon - surgically removes tumours
• palliative care physician - assesses physical, emotional, social and spiritual needs and coordinates care to address these
• palliative care team - helps you and your family with any needs that you have, including support at home
• pain medicine specialist - a doctor who specialises in treating all types of pain, particularly if it is difficult to control or severe
• nurses - administer medication and provide support and help during all stages of your treatment
• pharmacist - dispenses medications and can give advice about drugs, dosage and side effects
• psychologist - assesses psychological factors that increase your pain and provides specialised psychological methods of pain control
• physiotherapist, occupational therapist - helps you with physical and practical problems.

 

If your pain is not well controlled by your health care team, ask your GP or palliative care physician to refer you to a pain medicine specialist. These specialists often work in a pain clinic.