Many people with advanced cancer worry they will be in pain, but not everyone will have pain. Those who do have pain may not be in pain all the time – it may come and go. The pain may be caused by the cancer itself or by cancer treatment. For example, the tumour may be blocking an organ or pressing on organs, nerves or bone.
If you do experience pain, it can usually be controlled. Pain management is a specialised field, and palliative care doctors and nurses are specifically trained in pain management.
There are many ways to relieve pain, including:
- pain medicines
- pain-relieving procedures for nerve pain
- complementary therapies such as massage, meditation, relaxation, acupuncture or hypnotherapy
- chemotherapy, radiation therapy or surgery.
Everyone experiences pain differently, so it may take time to find the most effective pain relief or combination of treatments for you. Using tools, such as a pain scale or pain diary, can help you describe your pain and how it is affecting you. This will help your pain specialists work out the best way to control the pain.
How and where the pain is felt and how it affects your life can change. Regular reviews by pain management experts can help keep the pain under control. It’s better to take medicine regularly, rather than waiting for the pain to build up. This is called staying on top of the pain. Controlling the pain may allow you to continue with activities you enjoy for some time and offer a better quality of life.
Medicines that relieve pain are called analgesics (also known as pain relievers, painkillers and pain medicines). Depending on the type of pain and how intense it is, you may be offered:
- mild pain medicines, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs)
- moderate pain medicine, such as codeine
- strong pain medicine, such as the opioids morphine, hydromorphone, oxycodone and fentanyl.
Some people worry about becoming addicted to pain medicine, but this is unlikely when medicines are taken palliatively. Your health care team will monitor you to avoid potential side effects. Any side effects, such as constipation or drowsiness, can usually be managed.
Other pain relief methods
You may also be given other types of medicine to take with the main pain medicine. These could include antidepressants and anticonvulsants for nerve pain; anti-anxiety drugs for muscle spasms; or local anaesthetics for nerve pain.
If the pain is hard to control, a pain specialist may consider a nerve block. The type of nerve block you are offered will vary depending on the type of cancer you have. Delivering the pain medicine directly into the nerves in the spine via a tube (epidural) usually provides short-term relief. If longer-term pain control is needed, the epidural can be connected to a pump.
Cancer treatments for pain reliefChemotherapy, radiation therapy and surgery may also be used to control pain.
Chemotherapy – Uses drugs to shrink a tumour that is causing pain because of its size or location. It can also slow the growth of the cancer and help control symptoms, including pain, loss of appetite and weight loss.
Radiation therapy – Uses radiation, such as x-rays, to shrink a tumour and reduce discomfort. For example, it may relieve headaches by shrinking cancer that has spread to the brain from another part of the body. Often a single treatment can be used.
Surgery – An operation can remove a single tumour in the soft organs; treat a bowel obstruction that is causing pain; or improve outcomes from chemotherapy and radiation therapy by reducing the size of a tumour.
Prof Nicholas Glasgow, Head, Calvary Palliative and End of Life Care Research Institute, ACT; Kathryn Bennett, Nurse Practitioner, Eastern Palliative Care Association Inc., VIC; Dr Maria Ftanou, Head, Clinical Psychology, Peter MacCallum Cancer Centre, and Research Fellow, Melbourne School of Population and Global Health, The University of Melbourne, VIC; Erin Ireland, Legal Counsel, Cancer Council NSW; Nikki Johnston, Palliative Care Nurse Practitioner, Clare Holland House, Calvary Public Hospital Bruce, ACT; Judy Margolis, Consumer; Linda Nolte, Program Director, Advance Care Planning Australia; Kate Reed- Cox, Nurse Practitioner, National Clinical Advisor, Palliative Care Australia; Helena Rodi, Project Manager, Advance Care Planning Australia; Kaitlyn Thorne, Coordinator Cancer Support, 13 11 20, Cancer Council Queensland.
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