• Coping With Pain Related to Cancer and Chemotherapy

    image for chemotherapy articleChemotherapy drugs can cause some side effects that are painful. The drugs can damage nerves, leading to burning, numbness, tingling, or shooting pain, most often in the fingers or toes. Some drugs can also cause mouth sores, headaches, muscle pains, and stomach pains.
    Not everyone with cancer or who receives chemotherapy experiences pain from the disease or its treatment. But if you do, it can be relieved. The first step is to talk with your doctor, nurse, or pharmacist about your pain. They need to know as many details about your pain as possible. You may want to describe your pain to your family and friends. They can help you talk to your caregivers about your pain, especially if you are too tired or in too much pain to talk to them yourself.
    You need to tell your doctor, nurse, or pharmacist, as well as your family and friends:
    • Where you feel pain
    • What it feels like—sharp, dull, throbbing, steady
    • How strong the pain feels
    • How long it lasts
    • What eases the pain
    • What makes the pain worse
    • What medicines you are taking for the pain and how much relief you get from them
    Using a pain scale is helpful in describing how much pain you are feeling. Try to assign a number from 0 to 10 to your pain level. If you have no pain, use a 0. As the numbers get higher, this means that your pain is getting worse. A 10 means the pain is as bad as it can be. You may wish to use your own pain scale using numbers from 0 to 5 or even 0 to 100. Be sure to let others know what pain scale you are using and use the same scale each time, for example, "My pain is 7 on a scale of 0 to 10."

    Preventing and Treating Pain

    The goal of pain control is to prevent pain that can be prevented, and treat the pain that can't. This is usually accomplished by taking a combination of long- and short-acting pain medications with a variety of co-analgesics (ie, medications that have been traditionally used for conditions other than pain, but have been found to be effective for pain control). For example, gabapentin is a antiseizure medication that has been used effectively in treatment of cancer-induced neuropathies.
    • If you have persistent or chronic pain, take your pain medicine on a regular schedule (by the clock) as prescribed.
    • Do not skip doses of your scheduled pain medicine. Pain is harder to control if you wait to take pain medicine only when you feel pain.
    • Try using relaxation exercises in addition to taking medicine for the pain. This may help lessen tension, reduce anxiety, and manage pain.
    • Talk to your doctor about alternative treatments for cancer pain. For example, acupuncture may be effective in reducing your pain.
    • Some people with chronic or persistent pain that is usually controlled by medicine can have breakthrough pain. This occurs when moderate to severe pain "breaks through" or is felt for a short time. It may be related to movement or happen at the end of the dosing interval. If you experience this pain, use a short-acting medicine prescribed by your doctor. Don't wait for the pain to get worse. If you do, it may be harder to control.
    There are many different medicines and methods available to control cancer pain. You should expect your doctor to seek all the information and resources necessary to make you as comfortable as possible. If you are in pain and your doctor has no further suggestions, ask to see a pain specialist or have your doctor consult with a pain specialist. A pain specialist may be an oncologist, anesthesiologist, neurologist, neurosurgeon, other doctor, nurse, or pharmacist. Many cancer centers have a pain specialist on staff.

    RESOURCES

    American Cancer Society http://www.cancer.org

    National Cancer Institute http://www.cancer.gov

    CANADIAN RESOURCES

    BC Cancer Agency http://www.bccancer.bc.ca/default.htm

    Canadian Cancer Society http://www.cancer.ca

    References

    Cleeland CS, Gonin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med . 1994; 330:592.

    Coyle N, Adelhardt J, Foley KM, Portenoy RK. Character of terminal illness in the advanced cancer patient: Pain and other symptoms during the last four weeks of life. J Pain Symptom Manage . 1990; 5:83.

    Marcus NJ. Pain in cancer patients unrelated to the cancer or treatment. Cancer Invest . 2005; 23:84.

    Chemotherapy and you: support for people with cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/chemotherapy-and-you.pdf . Updated May 2007. Accessed May 14, 2012.

    2/14/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Paley C, Johnson M, Tashani O, Bagnall A. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev. 2011;(1):CD007753.

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