Professor Paul Glare, pain management specialist
The thing about cancer is that people often think cancer means pain. But is that actually the case? If people do experience pain, what are the best ways to manage it? And is there a difference between acute pain that might happen during cancer treatment and pain that might last for years afterwards?
In this episode of The Thing About Cancer, Julie sits down with pain management specialist Paul Glare, to discuss these questions, and much more.
Paul is well placed to talk about these issues. He has spent much of his working life as a doctor helping people with cancer manage their pain.
— Paul Glare, pain management specialist
Do people with cancer always experience pain?
Not everybody with cancer will experience pain. It can depend on the type of cancer, its stage, and the type of treatment you have.
Paul explains how pain is both a sensory and emotional experience. There’s no real way of knowing what a person is going through – especially as there are so many variables at play, from the actual physical pain, to the associated emotional responses, such as fear, anxiety, depression, and so on.
Seek help from your health care team
Because you can’t see pain, it’s important to describe how it feels to your doctor or nurse. Tissue damage pain is often described as an aching or throbbing sensation, while nerve damage pain is more like burning, shooting or stabbing. Describing how the pain feels to you will help the health care team get an idea of what’s causing the pain and how best to treat it.
— Phil, diagnosed with bowel cancer
Strategies for managing pain
Paul suggests some practical strategies that can help you manage your pain, so it doesn’t disrupt your daily routines too much. Pain-killers such as opioids are typically used to treat strong acute pain caused by cancer or treatment, while pain that persists after treatment is generally treated with a mix of strategies, including pacing, stretching exercises, mindfulness and relaxation.
Paul delves into the complex relationship between a person’s pain and their response to the pain. He explains how cognitive behaviour therapy can help people think about their pain differently and reduce discomfort.
Want more information or support?
If you heard something mentioned in the podcast, you’ll find a link to it below. We’ve also added links to other sources of information and support.
From Cancer Council NSW
- Overcoming cancer pain – learn more about how to manage cancer-related pain, download the Overcoming Cancer Pain booklet and watch a short video which includes real people’s experiences of dealing with cancer pain
- What can I do about pain after treatment webinar – watch this webinar to get some answers about what to do about pain after cancer treatment. You’ll hear from a panel of experts, and also hear their answers to questions from the audience
- Cancer Council 13 11 20 Information and Support service – call 13 11 20 Mon–Fri, 9am–5pm, to talk confidentially to a health professional about anything to do with cancer
- Cancer Council Online Community – a supportive online community for people affected by cancer
- Easy-to-read information about cancer – cancer types, treatments and issues
- Mindful meditation for people with cancer, their families and carers – this recording guides you through the basics of mindfulness so that you can focus more easily on the present
- Relaxation for people with cancer, their families and carers – this recording of simple, gentle relaxation exercises may help you release muscle tension, sleep better and improve the effectiveness of other pain-relief methods
From other organisations
- Pain clinics in NSW – a list of pain management services published on the website of the NSW Department of Health
- Pain apps – a list of apps designed to help with tracking pain and managing pain through a variety of approaches
- NSW ACI Pain Management Network – find a series of videos to watch to help you gain a better understanding of your pain as well as a list of resources about managing chronic pain
- Pain Australia – this national advocacy organisation provides lots of information about managing acute, chronic and cancer pain, and links to helpful resources, including support groups and apps
- Breast Cancer Network Australia: Pain management – read more about developing a pain management plan and tips for those with breast cancer
- Cancer pain management in adults – these Australian guidelines by the Australian Adult Cancer Pain Management Guidance Working Party provide guidance for health professionals about how to assess and manage cancer-related pain in adults
- Self-management resources for patients and families – find tools developed by the Australian Adult Cancer Pain Management Guidance Working Party, including a pain management plan template and pain management goal setting template
The Thing About Cancer podcast, Cancer Council NSW
You’re listening to Managing Cancer Pain, an episode of The Thing About Cancer podcast.
[woman] The very essence of all cancers is a change in the way that cells divide.
[man] I remember sitting in there thinking, you know, it’s not happening, it's not real, it can't be real.
[woman 2] It's something that we don't talk about.
[woman 3] This feeling of being overwhelmed − it will get better once you have a plan and you know what to expect and what's going to happen. It's not going to be like this all the time.
[various voices] The Thing About Cancer: A podcast from Cancer Council NSW. Information and insights for people affected by cancer.
Julie McCrossin: Hello, I’m Julie McCrossin. And today, the thing about cancer is that one of the things people are really afraid of is pain. But does cancer and its treatment always cause pain? And if pain occurs, what is the best way to manage it?
Paul Glare: Patients shouldn't be frightened of telling the doctor or the nurse that they've got pain and they want some help with it. If it's related to a side effect of their treatment it will probably get better, just taking a bit longer. If it's from the cancer then the good news is that treatment of cancer's improving all the time, there's more and more options, and eliminating the cancer is the best way to deal with the pain.
Julie: We’re talking to Professor Paul Glare, who’s the director of the Pain Management Research Institute based at the University of Sydney. Paul has helped many people with cancer manage their pain.
Just to be clear, this podcast contains general information only, so we recommend that you talk to appropriate professionals about your individual situation.
You can also call Cancer Council 13 11 20 if you have any questions.
We’ll hear more from Paul in a moment, but first let’s hear from Phil talking about how difficult it was to explain the pain he experienced after cancer treatment.
Phil: Now I could say “My feet hurt” − what does that mean? So they give you some drugs and that helps the pain a bit, but no-one really knows because you can't really explain a pain, or the intensity of the pain, to someone who thinks they've got an appreciation of it but they still don't really know.
Julie: At the start of this episode, pain expert Paul Glare noted that if you are experiencing pain, it’s important to let your cancer treatment team know. And welcome to the podcast, Paul. First up, I’m interested in understanding what pain actually is. How would you describe pain?
Paul: For a lot of people, pain is thought to be some kind of a warning, that there's a problem that needs to be fixed up, and that's the case for people who've got acute pain, meaning pain that's come on recently, but for a lot of people, including people with cancer, they get more chronic pain, chronic in the sense of being there for more than three months. And by that time it’s not really serving a warning purpose anymore, and it’s really affecting their life.
Julie: I understand that the International Association for the Study of Pain define pain as both a sensory and an emotional experience. What does that actually mean?
Paul: The key word's experience, meaning that it’s what the person feels. Pain is pain for a person, and there's no real way of proving that a person's in pain or not or how much it’s affecting it. The sensory part of it is like how severe it is, how much it’s interfering with doing things, and the emotional side of it is like their mood, anxiety and depression, and then also issues about how they're coping with their pain − a concept called self-efficacy or your confidence to do things despite the pain; a thing called catastrophisation, where people spend a lot of time thinking about their pain all the time, dominating their thoughts, you know, letting it kind of get out of proportion, and dramatising it, more than it needs to be.
Julie: There’s also different types of pain aren’t there?
Paul: There are two types of pain, there's pain like when you break your arm or you burn yourself, cut your finger, so that the tissues are damaged and they're sending off signals up the nervous system. And when the problem is coming from injury or damage to nerves, that's called neuropathic pain. So in somebody with cancer, it could be a tumour pressing on a nerve, or it could be actually destroying the nerve, or the nerve could have been damaged by treatment, surgery or radiotherapy or some kinds of chemotherapy can damage nerves. So even though there's no actual damage to the skin or the muscles or the other tissues, the nerves are acting like there is because they're firing off as if they're carrying pain signals, because they're damaged themselves.
Julie: So speaking up and letting your clinical team know you're experiencing pain is critical, because there's nothing for them to see either externally or possibly even internally. You've got to tell them.
Paul: Yeah and the thing is that... those two different kinds of pain are generally described differently. Tissue damage pain is usually aching or throbbing, and then nerve pain is usually burning or shooting or stabbing, so as well as saying “I'm in pain”, trying to explain to the doctor or the nurse what it feels like will help them get an idea of what's causing it, because it would impact on the kind of treatment that was offered.
Julie: So Paul, give us a sense of how many people who have a cancer diagnosis and treatment actually experience pain.
Paul: Well, the first thing is it's not everybody. And then it depends a bit on where it is in their cancer journey. So some people will have pain when they're diagnosed but many people don't. If you have an operation, you'll often have some pain after the surgery, but then you'd be hoping that there's no pain. It’s been estimated that people having chemotherapy, it's about a third of people who've got some pain while they're on chemotherapy. If you end up having more advanced cancer then the number goes up, and it's probably 90% of people in a palliative care unit who've got pain.
Julie: So cancer doesn’t necessarily mean pain?
Paul: So it varies across the trajectory but if people have got early-stage cancer, it could be not at all. And it also varies with the kind of cancer as well. The bottom line is many people with cancer don't have any pain, and cancer and pain aren't synonymous basically.
Julie: We’ll talk a bit more with Paul about how to manage acute pain, but first we’ll hear from Annmaree, who had to deal with some acute pain after her surgery for breast cancer.
Annmaree: After my big operation I had quite a bit of pain and I would just basically either take the Endone that they gave you or just try and get into a comfortable position with the pillows around you and try and think that it's not going to last forever. And that after the morning, say, you'd be feeling better.
Julie: Paul, what I’d like to do now is focus in on the causes of acute cancer pain, both from the condition itself or from the treatment. So why do people with cancer experience pain?
Paul: It’s traditionally been that if someone's got cancer and they've got pain, it's coming from the cancer. And in the past, the vast majority of people, that would be the cause. And that a small percentage of people could have other things going on, so you might have a bad back, and then get cancer. And cancer treatment could cause pain, and then from being sick and lying around in bed you can get debilitated and get muscular aches and pains, but generally it’s been always considered that the cancer itself was the main cause of pain. But that is changing.
Julie: And what about flare-ups of pain? What’s going on there?
Paul: Aside from pain at the time of diagnosis or with the initial treatment, there's really acute kind of flare-ups of pain on the background of some chronic cancer pain. And there's two kinds of acute flare-ups, there could be some real kind of emergency like there’s a tumour in a bone that's broken, or there's a tumour in the spinal cord, or in the vertebral column pressing on the spinal cord. Those are emergencies, you need to go to the emergency department, get taken care of, but then there's this other thing called breakthrough pain, which is where the pain might be well controlled most of the time but then it just flares up, and that could either be spontaneous or could be predictable because every time you go to the bathroom or swallow whatever, it hurts.
Julie: So let's turn to that acute situation, and talk about what can help people in that acute phase. How do you manage the pain in the acute phase, so that even though you're having some treatment, you don't suffer?
Paul: Acute pain needs to be looked into and understood well, what's really causing it. And what’s the right way to deal with it. Less severe acute pain could be paracetamol or an anti-inflammatory. But opioids would generally be for severe acute pain.
Julie: And what does that word “opioid” mean?
Paul: Opioid means it’s a derivative of the opium poppy, it’s an extract from the opium poppy like morphine or codeine, or else that molecule's been modified in a lab to produce newer ones like oxycodone, fentanyl. So it's based on what came out of the opium poppy and also works on what are called opioid receptors in the brain and the spinal cord, which interfere with pain messages going up to the brain.
Julie: So what’s the role of opioids in cancer care?
Paul: You know, over the past 30 years, painkillers like morphine have been really the cornerstone of cancer pain treatment, and I think for acute pain and for terminal care, definitely that's the place for those drugs. So if it’s pain from a cancer operation, like many people, probably you end up with patient-controlled analgesia that people often are put on when they're in a surgical ward after their operation. They press it for a few days and then they can get a shot of pain relief every few minutes and then that will probably get changed over to, once they're eating again, to some kind of tablets. And they may or may not need that after they go home.
Julie: And in some circumstances the doctor may give you your regular pain medication but also provide you with additional medication for breakthrough pain...
Julie: And encourage you to take that before you come back to the next appointment.
Paul: Yeah, yeah, or keeping a kind of a diary at least for a few days is helpful to show the doctor because if you're taking a lot of breakthrough medication then you're probably better off increasing the regular medication. Just really for convenience because who wants to be watching the clock.
Julie: From my own experience as a cancer patient, at every encounter that I had with my various oncologists during the course of my treatment, they assessed my overall wellbeing as well as my experience of pain, and they changed my pain management regime almost every week. I guess what I got out of this is that it’s important to talk to your doctors about what’s happening to you and ask what help is available.
Paul: I think the first principle is to make sure that the patient tells the doctor whether they’re in pain or not. Because, it's been shown in the past that patients were reluctant to tell the oncologist they were in pain for a couple of reasons. They didn't want to be a complainer, also maybe they didn't want to distract the oncologist from treating the cancer, which is a real thing. But you know, um, I haven't been in your situation, but being in terrible pain could interfere with actually staying the course with treatments.
Julie: And also the impact of pain, can you flesh it out? It's not just a sensory experience, it can cause a limit on your social life and your relationships.
Paul: Yeah, yeah, aside from the intensity of the pain it can interfere with being able to do things, can make you depressed and anxious, and then if you were trying to work during treatment or after treatment, it could interfere with being able to work, and then lying around in bed you get secondary aches and pains, and so really comprehensive management of pain really requires addressing all of those things.
Julie: With the opioid pain management and other medications, my understanding is that it’s important to take it exactly on time because it’s designed that if you don't do it exactly on time, pain may re-emerge, whereas if you do it on time you avoid the emergence of pain.
Paul: That could be changing a little bit. I mean, again it depends on what kind of acute pain it is, and again, if we're talking about pain from treatment like an operation or radiotherapy and that's resolving, then taking pain medications around the clock might not be so relevant towards the end. Ah, maybe you only need to take something, you know, a couple of times a day.
Julie: And do chemotherapy and radiotherapy, or radiation therapy, have a role to play in managing acute cancer pain?
Paul: Definitely they've got a role, but they don't necessarily work straightaway. You'd be probably taking painkillers until they've kicked in, you know, which could be several weeks or months before they've worked. But once they're working, I think it’s important these days to get off the painkillers and not stay on them.
Julie: We haven't mentioned side effects. What are the key side effects a patient and family should look out for, and what if anything can we do about them in that acute phase.
Paul: Well with the opioids, predominantly, like your morphine and oxycodone and so on, if people have never been on those pain medications before, you do have to start low and build it up gradually, because you don't want to cause an overdose and people could stop breathing. But once you've been on it for a while, say for a week or a couple of weeks, your body becomes very tolerant to especially the effects on breathing and it doesn't have any impact on your breathing. Then you're left with these more chronic side effects like drowsiness, fatigue, constipation, maybe nausea. They're predictable and they can be treated, but then you end up on more pills and things, so you've got to kind of balance it out.
Julie: You're listening to The Thing About Cancer, a podcast from Cancer Council NSW.
I'm Julie McCrossin and I'm talking to pain management specialist Paul Glare about managing cancer-related pain. If you have any questions about this topic, or just want to talk to someone about your concerns, you can call Cancer Council 13 11 20. They can send you a free copy of Cancer Council’s booklet Overcoming Cancer Pain, which is full of information about how to understand and manage pain.
For links to the online version of that booklet or any of the services we mention – or to listen to more podcasts – visit cancercouncil.com.au/podcasts and click through to the “Managing Cancer Pain” episode. We'll go back to Paul in a moment and ask him about strategies for managing chronic pain, but first we're going to hear from Matt, who worked out his own way to manage the ongoing pain he experienced after his treatment.
Matt: My experience was so variable with health professionals that I thought, you know, okay, I'll just try whatever I can myself because I really don't want to go back into the system if I can avoid it. So it was more that, but I did find a peer support group was quite helpful with that. Just listening to everybody's views on this and what different people did. That gave me options I hadn't thought about.
Julie: Now Paul I’d like us to turn to chronic pain and cancer. What does that word chronic mean?
Paul: People use chronic to mean it's like it's very distressing or really affecting them. In the pain world, it’s specifically about how long it’s there for. And three months is chosen as a time at which tissue damage should have healed up, so if you break your arm, you have an operation, everything should be better in three months, and so it should stop sending off signals. It's a bit different where you've got a persistent medical condition causing pain, like rheumatoid arthritis or cancer, where there's probably ongoing persistent and acute pain.
Julie: And what proportion of people who have treatment for cancer actually do develop chronic pain?
Paul: I'd say 5 or 10% of people could have chronic pain caused by their treatment. Say, someone, say like you, who've had cancer and had it treated and the cancer seems to have gone away, there's a chance that certain treatments will turn into chronic pain, just like other operations can leave people with chronic pain. And the ones that are particularly bad are breast surgery, and lung cancer surgery. That upper part of the body seems to be very sensitive for causing chronic pain. Abdominal surgery doesn't generally, like hernia repairs can cause chronic pain, but it seems like having the bowel removed for bowel cancer, for example, doesn’t cause chronic pain. Radiotherapy can sometimes cause pain, so some men who've had prostate cancer treated can end up with chronic pain in the pelvis.
Julie: Can you run me through what the options are for managing chronic and persistent pain over time?
Paul: I don't think there's an automatic answer to that, it comes back to assessing the person and finding out what's wrong with them. But if the disease is gone, then I wouldn't be relying on medications so much and treating it like other kinds of chronic pain. But if we're talking about cancer that unfortunately hasn't been fully eliminated and it’s cancer itself that's causing it, then, we’re generally talking about opioids. But if you're in this situation of having some residual cancer but it’s under control, the chemotherapy or whatever is maintaining it at a low level, then I think it’s not quite so clear now. I think that probably still you'd be taking opioids but I think you'd be wanting to look into other kinds of things. If it's an acute kind of a pain or somebody with more advanced cancer, taking the opioids is probably very important, but thinking that that's going to be the magic bullet that solves the whole pain problem is unlikely to be correct.
Julie: I wanted to just say my understanding is that sometimes antidepressants or even anticonvulsives or anti-seizure medication can be used in chronic pain. Is that correct?
Paul: Oh yeah, in two ways. For where it’s that kind of nerve damage pain, or neuropathic pain as it’s called, those things seem to work quite well. It’s always been controversial about whether opioids like your morphine kind of medication work for that kind of pain. It probably does a bit but probably need higher doses. So those kinds of medications can reduce the amount of other painkillers that's needed and reduce the amount of side effects. Then there's the other part of it, which we haven't talked about − pain generally doesn't exist in isolation. It’s often in a cluster with other things like depression and anxiety, difficult sleeping, fatigue, and so those kind of medications, like especially antidepressants, can help treat those other symptoms as well, and it’s always good to use something that's got multiple activity. So if there's one pill that's going to help your pain and your mood and your sleeping then that's better than taking three different ones for each of those problems. So, yeah, we'd have a low threshold for introducing those if we thought there was either nerve damage pain or the pain was associated with other kind of symptoms.
Julie: We mentioned that pain often exists in a cluster of symptoms and it may help to address some of those other symptoms as well as the pain. And in this podcast series, we also have episodes about fatigue and sleep. And you can find other episodes and links to resources at cancercouncil.com.au/podcasts.
Now Paul, what practical lessons can we learn and share with our patients and families about what they can do to try to prevent themselves falling into that group that have chronic pain?
Paul: So if the issue is that they're not coping very well with having pain, there are probably five strategies that they can learn. They might have worked them out themselves. So, if you've got pain that's interfering with doing things you can set yourself some goals, and say okay, and make them realistic and achievable goals. So if you get pain when you walk, you don't plan to walk to the city and back, you plan to walk to somewhere closer − a concept called pacing, so, okay, you walk to the front gate, then tomorrow you try and walk to the corner, then to the bus stop, etcetera, so gradually pacing up your activity.
Julie: And aside from setting goals and pacing your activity, what are the other strategies?
Paul: Provided the cancer isn't damaging the bones too much, doing stretching before you start moving is helpful and then there are things about, more the psychological coping with it, so, you know, relaxation kind of techniques. There might be things like having a massage, but also doing a kind of mindfulness which a lot of people know about now. And getting in the moment rather than thinking about why I got this pain or what it’s going to mean in the future, but just try and be in the present and deal with the pain today. And then the final thing, which probably needs teaching from a professional, is what's called desensitisation, which again is a kind of relaxation thing but try and not think about the pain as indicating damage but it’s just an unpleasant sensation and you can gradually control how you respond.
Julie: So that’s five key strategies: setting goals; pacing up activity towards those goals; stretching exercises; mindfulness; and desensitisation, reducing unhelpful thoughts. And I’ll just mention that Cancer Council has both relaxation and meditation recordings, and it’s available on our website. You’ll find the link at cancercouncil.com.au/podcasts, and just click through to this episode “Managing Cancer Pain”.
And now let’s hear from Phil, who used some of these strategies to deal with pain in the months and years after his treatment for bowel cancer.
Phil: There are still times when, like when I'm walking, I think it’s okay and then these stabbing pains will come through, and the first times I would say “there's something in my shoe!” Take my shoe off, there’s nothing there, put the shoe back on and keep on walking and it’s okay. So I recognise what causes the pain and it’s nothing to do with what’s in my shoe but you just got to keep on doing it and of course it gets better and better and better because of the exercise. And that's all I can recommend to anybody, is that whether it's your head, hands or your feet, exercise everything.
Julie: So Paul, it appears that how a person thinks about their pain may influence how they experience pain. Cognitive behaviour therapy is talked about as being helpful for this. What is cognitive behaviour therapy?
Paul: If you have pain and you have this unpleasant experience, that can be influenced by how you think about it and what you do in response to it. So people can learn to do more helpful thoughts and actions and less unhelpful thoughts and actions. People who are in pain clinics for cancer have got the same kind of issues as people with chronic back pain, so they’re depressed and they’re anxious, they're not confident to do things, they're often catastrophising their pain and they're feeling like, well, “why me, why have I got this pain, why did my operation cause pain when someone else's didn't”, and then a fear of moving, because goes back to the whole thing of acute pain being an injury and generally, okay, you know, you lie in bed take some pain-relievers and wait for the injury to recover. And people even with cancer pain will often think the same way.
Julie: That’s understandable because it can be really hard to live with pain. So where can people go to learn more about helpful strategies, whether that’s through cognitive behaviour therapy, exercise or something else?
Paul: So the reality is that it's estimated something like 20% of the Australian population’s got chronic pain, a third of people over the age of 65, most of them are getting on with their life and they don't go to their doctor, let alone to a pain clinic. You can often work this stuff out yourself, but if it's really distressed you or you just have never experienced it like that, then you might need help from a doctor or a physiotherapist or psychologist to teach you these things. And there's plenty of resources, there's books in the library, there are plenty of apps online.
Julie: And we’ve put some links to resources that might be helpful on our podcast page at cancercouncil.com.au/podcasts.
So, not everybody needs to go to a specialised chronic pain management clinic, but they do exist and might be the answer for some people. Roughly how many of them are there in Australia?
Paul: Well there's more now. I think in NSW there's 19, I think. Pretty much all the major hospitals have got a pain clinic.
Julie: And so, who do you think should talk to their GP and say can I have a referral to a chronic pain clinic?
Paul: Whether it’s the GP or the oncologist, I think it's really where you’re trying things and it’s not really controlling it adequately. And to know that there are options, so if a person isn't responding to things then it’s probably more complex and they've got more complex psychological issues and so on, and more distress. And that's where it needs to be escalated to a specialist. In Australia less than 5% of people in pain clinics have got cancer, so between GPs, oncology and palliative care, there's good care for cancer-related pain available in Australia.
Julie: Yes again, I feel what I'm hearing from you whether you're in a specialist pain clinic or with your oncologist or your GP is that you need a comprehensive assessment of both your physical, emotional health and your overall life activity in order to manage pain. It's a whole life assessment.
Paul: The thing that makes it more challenging also is that with a thing like pain, especially being a symptom and having this individual experience rather than a disease per se, needs ongoing reassessment and it’s time-consuming. That's one of the big challenges, so I think if patients and the family have a doctor and an oncologist and they stick with them and they know them it makes that easier than if you go to a different person every time.
Julie: I'm wary that people shouldn’t become unwilling or fearful about the use of opioids because when they’re needed, they're really needed, and so long as you stay in a close relationship with your oncologist, take their advice and take the medication.
Paul: Yeah, so they help most people. It’s kind of like crossing a road, you’ve got to just be careful and, you know, you don't just run across the road. And the problem was, before it used to be said oh, look they're totally safe, you know, there's no problems with them. The reality is that's true for 90% of people. 10% of people who are put on chronic opioid therapy for whatever reason will end up with problems.
Julie: I'm thinking of someone listening to this who's perhaps struggling at the moment with pain, whether it’s acute or chronic. What’s your basic message to them of reassurance about the future and the capacity to either eliminate pain over time or at least to continue to reduce it so they can enjoy their life?
Paul: So if we're talking about somebody who's recently diagnosed with cancer and had pain that’s from the cancer, or the treatment of the cancer, there’s certainly a lot of awareness that it's a problem. Patients shouldn't be frightened of telling the doctor or the nurse that they've got pain and they want some help with it. If it's related to a side effect of their treatment, it will probably get better, just taking a bit longer. If it's from the cancer, then the good news is that treatment of cancer's improving all the time, there's more and more options, and eliminating the cancer is the best way to deal with the pain. But if there isn't any treatment to impact on the cancer then we've got a better understanding these days about how to use opioids and other drugs, like you mentioned the antidepressants and anticonvulsants better, and that increasing awareness of addressing the other dimensions, especially with phones and apps and stuff, there's lots of resources available now. You know it might have been hard in the past to find a psychologist or afford to see a psychologist, but now you can probably get an app on your phone that teaches you about that cognitive behavioural therapy. So there's a lot of information out there now that there wasn't available. And Cancer Council's got plenty of resources and they've got this Cancer Pain Guideline that they're rolling out to try and prove that you really can improve things across the board and not just in the big centres. So even someone in rural or even remote Australia ought to be able to get better access to pain relief these days.
Julie: And remember that for links to the online version of “Overcoming Cancer Pain” or other helpful resources, you can visit cancercouncil.com.au/podcasts and click through to this episode “Managing Cancer Pain”.
And Paul, for someone who's just had a diagnosis, if you were going to give them brief tips about how to go forward, what would be your tips, I guess with a focus on pain.
Paul: One of the reasons people are living longer with cancer these days is because it’s being diagnosed earlier, treatment’s better but supportive care is better as well. And pain relief comes under that category, and people who are in a lot of pain may give up on their treatment because it hurts too much getting onto the radiotherapy table, or the hormonal therapy's giving them aches and pains, or the chemotherapy's causing numbness and tingling, so if you're getting treatment-related side effects, definitely tell the nurse or the oncologist and they'll attend to that, because stopping the treatment prematurely is going to affect your outcome, and so it's very important to have good pain management while you're going through the initial treatment. If you've got residual cancer and it’s causing ongoing pain, then it's probably going to be using those medications but not just relying on them and making sure that you're using those other kind of modalities as well like relaxation, etcetera.
Julie: So if you do have pain related to cancer or treatment, there are clearly lots of options to help you manage the pain − from pain medicines and cancer treatments such as chemotherapy or radiation therapy, to pacing, exercise and relaxation. But Paul, how do you work out the right option for your particular kind of pain?
Paul: I think in the end it’s about knowing what's out there, what the options are, and then like a smorgasbord, you know, rather than a fixed price or à la carte menu, you want to be able to choose from the items and say “well, I think that works for me”, and if it’s great go back and get some more, if you didn't like it then move on and try something different.
Julie: That's it for this episode of The Thing About Cancer. Thanks to Paul, Matt, Phil and Annmaree for sharing their insights.
If you're looking for more information, you can ring the Cancer Council 13 11 20 Information and Support service from anywhere in Australia, or go to cancercouncil.com.au/podcasts. If you have any feedback on this podcast, we'd love to hear from you, so leave us a review on iTunes or on our website. If you'd like to subscribe to the show, you can do it in Apple Podcasts or your favourite podcasting app.
If you found this episode helpful, you might want to listen to our podcast on sleep and cancer. In that episode, I talk to psychiatrist Catherine Mason about how cancer affects sleep and how you can sleep better.
Catherine Mason: I would caution against getting too fixated upon sleep because one of the ironies about sleep is the more anxious you are about it and the more determined you are to get a good night’s sleep, the more difficult it is to actually get a good night’s sleep. All of us have had periods in our lives where we didn't get much sleep. Good sleep is ideal but it's not catastrophic if you're having problems sleeping.
You can find that “Sleep and Cancer” episode on our website at cancercouncil.com.au/podcasts.
The stories and experiences contained in this podcast represent the views and opinions of the speakers. They do not necessarily represent the views and opinions of Cancer Council NSW. This podcast contains general information only, and Cancer Council NSW recommends you obtain independent advice specific to your circumstances from appropriate professionals.
I'm Julie McCrossin and this has been The Thing About Cancer, a podcast from Cancer Council NSW.