Managing cancer pain

One of the things many newly diagnosed cancer patients worry about is pain. This guide will help you understand how pain is managed and how cancer pain management treatments are coordinated by the many physicians involved in your care.

Coordinating care

When you are diagnosed with cancer, you will begin meeting with a team of doctors. You will now have an oncologist – a cancer specialist who will coordinate care with other specialists. If you are given chemotherapy or radiation therapy, you will see a different physician for each. Other health problems, such as a heart condition, will continue to be treated by your cardiologist. That said it’s very important to make sure that either your oncologist or primary care physician acts as the “air traffic controller” of your care. Ask them to decide who will be her central point of command. Who do you call when you’re in trouble? Who receives the results of any tests, lab work and treatments and interprets them for you? Make sure this decision is nailed down right away. For more information, read our guide to prioritizing medical conditions.

The pain management team

Your oncologist should schedule you to meet with a pain management team – also referred to as palliative care – which usually includes physicians, pharmacists and nurses. Their goal is to get you through your cancer as comfortably as possible. They are experts in pain management and know how to respond to the various kinds of cancer pain you may experience, including the side effects of various cancer treatments like chemotherapy. But, in order for them to be effective, you have to be an active team member; these experts rely on your assessment and description of your pain. Not until they understand the nature and degree of your pain can they diagnose and prescribe the best treatment regimen for you. It will be very helpful to the pain management team and oncologist if you keep a diary of your pain. Here are some of the things you should keep track of:

• The time of day that the pain hit (does it change during the day or night?).

• Did you experience any symptoms prior to the pain (e.g., flushing, dizziness, nausea)?

• Were you doing anything prior to the pain (e.g., eating, getting out of a chair)?

• The location of the pain.

• Ranking of the pain on a scale of 1 to 10, with 10 being the worst. You should ask your doctor for a pain rating scale so you are on the same page.

• How quickly the pain came and how long it lasted.

• Did anything reduce the pain (e.g., ice, heat, massage, medication) and how much did it reduce your pain (using the rating scale)?

• How long did it give you relief?

• What did the pain feel like (e.g., stabbing, burning, electric, throbbing, dull, or aching)?

With this type of diary, the pain team is in a better position to pick up patterns and determine the causes of your pain. The diary is also a way for you to take some control of your disease and your care rather than feel helpless.

Palliative care teams frequently tell their cancer patients to be sure to report their pain early and not wait until they can’t bear it any longer. If you wait that long, it is more difficult to get ahead of the pain and reach a plateau of comfort.

Breakthrough pain

One thing you need to be aware of is “breakthrough pain.” This is pain that can break through the pain medication and/or treatment you are receiving. While it usually comes on suddenly and lasts for a short period of time, it can happen repeatedly during the day. This type of pain can be triggered by an incident like getting out of a chair; can be “spontaneous,” coming out of nowhere and for no identifiable reason; or caused by an “end-of-dose failure,” which is when a long-acting drug wears off before it’s expected. It will be important to tell the doctor which type of breakthrough pain you thinks you are experiencing because this will help the physician decide what type of drug to prescribe.

Available drugs

There is a wide range of short-acting opiates, and one is available as a lozenge that takes effect within 15 minutes. If your pain is continuous and can’t be controlled any other way, your doctor may prescribe a “PCA” or “patient controlled analgesia” pump. This pump continuously dispenses small doses of pain medication intravenously, 24/7. If you feel breakthrough pain, you can simply push a button to get an extra boost of the painkiller. If the pain is severe, the pain team might recommend that the pain medication be delivered directly into your spine (intra spinal) through a pump that can either be placed under your skin or within your body.

The bottom line is that your oncologist has a wide range of devices, medications and resources to keep you as comfortable as possible. If you are under hospice care, these medication expenses should be covered – so costs need not deter you. The important thing is to know how to report your pain and to not be shy about doing so. 

The bottom line

• Cancer patients are cared for by a team of doctors. Care should be coordinated by the oncologist or the primary care physician. The coordination of care should be determined immediately in order to ensure the best possible care.
• Among these doctors is a pain management team – also referred to as palliative care – responsible to getting you through the cancer treatment as comfortably as possible.
• It is important that you learn how to report your pain – in terms of type and severity – so that the cancer pain management team knows what kinds of drugs to prescribe.
• Many drug options are available, and they are prescribed depending on severity and type of pain. Some can be taken orally, others are delivered directly into the spine.