Cancer Pain Management & Education

It is not uncommon for patients to feel pain. The tumor itself can cause pain. Sometimes treatments result in pain. However pain can be managed to provide a level of comfort that allows daily activities. We want you to understand about pain and how to control it. 

                                             -----Guangzhou Fuda Cancer Hospital

Why Pain Should Be Treated 

Pain can affect you in many ways. It can keep you from being active, from sleeping well, from enjoying family and friends, and from eating. Pain can make you feel afraid or depressed. Pain may also prevent your full participation in your care and may slow your recovery. 

Most cancer pain is manageable. When there is less pain, you may be more active and interested in doing things you enjoy. Tell your doctor or nurse right away if you are feeling pain. Getting help for your pain early makes pain treatment more effective. 

Causes of Cancer Pain

There are many causes of cancer pain. Most cancer pain occurs when a tumor presses on bone, nerves, or body organs. Cancer treatment can also cause pain. 

You may also have pain that has nothing to do with cancer. Like everyone else, you can get headaches, muscle strains, and other aches and pains. Other conditions, such as arthritis, can also cause pain. Pain from these other conditions can be treated along with cancer pain. Ask your doctor or nurse what you can take for these everyday aches and pains. 

Treating Cancer Pain 

Cancer pain is usually treated with medicine. Radiation treatment, surgery, and other treatments can be used with medicine to give even more pain relief. Ask your doctor or nurse how other treatments can help you. 

There are many ways to decrease pain without medicine too. First we will discuss the use of medicines, and then non-drug choices. 

Choosing the Right Medicine 

Pain medicine works differently for different people. In the beginning, you need to adjust the amount and type of medicine. Work with your doctor to find an effective combination and amount. Tell your doctors and nurses how well the medicine is working. Your feedback helps. 

Talk with them about:

· Pain medicines you have taken in the past and how well they have worked for you.

· Medicines and other treatments (including health foods, vitamins, and other "nonmedical" treatments) you are taking now. This is important because some treatments and medicines do not work well together. Your doctors and nurses can find medicines that may be taken together. 

· Allergies that you have, including allergies to medicines.

· Fears and concerns that you have about the medicine or the treatment. They can answer your questions and ease concerns. 

Types of Pain Medicine 

Many medicines are used to treat cancer pain. Your doctor may give you one or more of them to take. The following list describes the different types of medicines. Ask your doctor or nurse to tell you more about the medicine they prescribe for you. Do not take a new medicine without first checking with your doctor or nurse. Even aspirin can be a problem for some people who are taking other medicines or having cancer treatment. 

For Mild to Moderate Pain 

Nonopioids: Examples are acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. You may buy many of these over-the-counter (without a prescription). Others need a prescription. 

For Moderate to Severe Pain 

Opioids: Examples are morphine, hydromorphone, oxycodone, and codeine. You need a prescription for these. Nonopioids may be used with opioids for moderate to severe pain. 

For Tingling and Burning Pain 

· Antidepressants: Examples are amitriptyline, imipramine, doxepin, and trazodone. Taking an antidepressant does not mean that you are depressed or have a mental illness. You need a prescription for  these. 

· Antiepileptics: Examples are gabapentin and other medications. Taking an antiepileptic does not mean that you are going to have seizures. You need a prescription for these. 

For Pain Caused by Swelling 

Steroids: Examples are prednisone and dexamethasone. You need a prescription for these. 

About Side Effects 

All medicines can have side effects, but not all people get them. Some people have different side effects than others. Most side effects happen in the first few hours of treatment and gradually go away. Some of the most common side effects of pain medicines are: 

Constipation (not being able to have a bowel movement): The best ways to prevent constipation are: drink lots of water, juice, and other liquid and eat more fruits and vegetables. Exercise also helps to prevent constipation. Your doctor or nurse may give you a stool softener or a laxative.

· Nausea and vomiting: When this happens, it usually only lasts for the first day or two after starting a medicine. If it continues, tell your doctor or nurse. They can give you medicine to stop these side    effects. 

· Sleepiness: When first taking opioids, some patients feel drowsy or sleepy. For most patients, this side effect usually disappears within one to three days. Talk to your doctor or nurse if this is a  problem for you. 

· Slowed breathing: This sometimes happens when the amount of medicine you are taking is increased. Your doctor or nurse can tell you what to watch for and when to report slowed breathing. 

More serious side effects of pain medicines are rare. As with the more common side effects, they usually happen in the first few hours of treatment. More serious side effects include trouble breathing, dizziness, and rashes. If you have any of these side effects, you should call your doctor or nurse right away. 

How to Take Pain Medicine

Most pain medicine is taken by mouth (orally). Oral medicines are easy to take and usually cost less. Most oral medicines are in tablet form. Sometimes they are liquids that you drink. If it is difficult for you to swallow or you cannot take medicine orally, there are other options. These include: 

· Rectal suppositories: Medicine that dissolves in the rectum and is absorbed by the body.

· Transdermal patches: Patches that contain medicine and adhere to the skin.

· Injections: Most injections use a tube or needle to place medicine directly into the body.

Types of injections include: 

1. Subcutaneous - medicine is injected just under the skin.

2. Intravenous (IV) - medicine is injected directly into the vein through a needle that stays in the vein.

3. Epidural or intrathecal - medicine is injected directly into the back around the spine. Most of these injections give pain relief that lasts for many hours.

4. Subdermal and intramuscular - Commonly known as "shots." A needle is used to inject medicine more deeply into the skin or muscle. This is not recommended for long-term cancer pain treatment. 

When to Take Pain Medicine 

Take your medicine on a regular schedule (by the clock). Taking it regularly helps to keep pain under control. Do not skip a dose or wait for the pain to get worse. Your doctor will usually give you additional medicine for "breakthrough pain" (brief and often severe pain that occurs even though the patient is taking pain medicine regularly).

Ask your doctor or nurse how and when to take extra medicine. If some activities increase your pain, such as riding in a car, you may need to take extra doses of pain medicine before these activities. The goal is to prevent the pain. Once you feel the pain, it is more difficult to control. 

Treating pain is important. There are many medicines and treatments to provide relief. If one does not work, other options are available. Your doctor can adjust your dose schedule or the way you take the medicine. Talk to your doctor and nurse. They can work with you to find the plan that helps you the most. It is helpful for you to keep a record of how the medicine is working. Keeping a record and sharing it with your doctor or nurse helps them make your treatment more effective. 

Non-drug Treatments for Pain 

Your doctor or nurse may recommend that you try non-drug treatments for pain. These techniques, along with your medicine, may give you more relief. Use these methods with your medicine, not instead of your medicine. 

You may use the following non-drug treatments along with your regular medicine: Ask your doctor or nurse how and when to take extra medicine. If some activities increase your pain, such as riding in a car, you may need to take extra doses of pain medicine before these activities. The goal is to prevent the pain. Once you feel the pain, it is more difficult to control. 

Treating pain is important. There are many medicines and treatments to provide relief. If one does not work, other options are available. Your doctor can adjust your dose schedule or the way you take the medicine. Talk to your doctor and nurse. They can work with you to find the plan that helps you the most. It is helpful for you to keep a record of how the medicine is working. Keeping a record and sharing it with your doctor or nurse helps them make your treatment more effective. 

Non-drug Treatments for Pain 

Your doctor or nurse may recommend that you try non-drug treatments for pain. These techniques, along with your medicine, may give you more relief. Use these methods with your medicine, not instead of your medicine. 

You may use the following non-drug treatments along with your regular medicine:

· Biofeedback 

· Breathing and relaxation exercises 

· Prayer or meditation 

· Imagery 

· Massage, pressure, and vibration 

· Transcutaneous electrical nerve stimulation (TENS) 

· Distraction 

· Heating pads and hot or cold packs 

· Rest 

Talk to your doctors and nurses about these treatments. 

When Medicine and Non-Drug Treatment Is Not Enough 

Sometimes people need more help to relieve pain. If so, your doctor may suggest:

· Radiation therapy: This reduces pain by shrinking a tumor. A single dose of radiation may be effective for some people. 

·  Nerve blocks/Implanted Pump: Certain nerve blocks, temporary or permanent, may help relieve pain. Implanted pain pumps can be of great benefit in some instances.

· Neurosurgery: In this treatment, pain nerves (usually in the spinal cord) are cut to relieve the pain.

· Surgery: When a tumor is pressing on nerves or other body parts, operations to remove all or  part of the tumor can relieve pain. 

Talk to your doctor about other pain treatments that may work for you. 

Biofeedback 

· Breathing and relaxation exercises 

· Prayer or meditation 

· Imagery 

· Massage, pressure, and vibration 

· Transcutaneous electrical nerve stimulation (TENS) 

· Distraction 

· Heating pads and hot or cold packs 

· Rest 

Talk to your doctors and nurses about these treatments. 

When Medicine and Non-Drug Treatment Is Not Enough 

Sometimes people need more help to relieve pain. If so, your doctor may suggest:

· Radiation therapy: This reduces pain by shrinking a tumor. A single dose of radiation may be effective for some people.

· Nerve blocks/Implanted Pump: Certain nerve blocks, temporary or permanent, may help relieve pain. Implanted pain pumps can be of great benefit in some instances.

· Neurosurgery: In this treatment, pain nerves (usually in the spinal cord) are cut to relieve the pain.

· Surgery: When a tumor is pressing on nerves or other body parts, operations to remove all or part of the tumor can relieve pain. 

Talk to your doctor about other pain treatments that may work for you. 

The First Step 
 

The key to getting the best pain relief is talking with your doctor and nurse about your pain. They will want to know how much pain you feel, where it is, and what it feels like. Answering the questions below may help you describe your pain. You may wish to write your answers in the space after each question. 

Where is the pain? You may have pain in more than one place. Be sure to list all of the painful areas. 

What does the pain feel like? Does it ache, throb, burn, or tingle? You may wish to use other words to describe your pain. 

How bad is the pain? You can also use a number scale and rate your pain from 0 to 10: 0 means no pain and 10 means the worst pain you can imagine. You can also describe your pain with words such as "none", "mild", "moderate", "severe", or "worst possible pain". 

What makes the pain better or worse? You may have found ways to relieve your pain (for example, using heat or cold, or taking certain medicines). You may have also found that sitting or lying in certain positions or doing certain activities affects the pain. 

If you are being treated for pain now, how well is the treatment working? You may want to describe how well the treatment is working by saying how much of the pain is relieved, such as all, almost all, none, etc. 

Has the pain changed? You may notice that your pain changes over time. It may get better or worse. Or it can feel different. For example, the pain may have been a dull ache at first and has changed to a tingle. Report changes in your pain. Changes in pain do not always mean that the cancer has come back or grown. Describe how the pain was before and how it is now. 

After talking with you about your pain, your doctor or nurse may want to examine you or order x-rays or other tests. These tests will help the doctor or nurse find the cause of your pain. 

Have a Plan 

You can work with your doctor or nurse to write a pain control plan to meet your needs. In a pain control plan, you and your doctor or nurse plan your pain control activities. This plan includes when to take your medicine, how and when to take extra medicine, and other things you can do to ease and prevent your pain. 

Benefits and Risks of Treatment 

The information below describes the benefits and risks of the different types of medicines used to relieve cancer pain. 

Nonopioids 

Benefits: Controls mild to moderate pain. Some can be bought without a prescription.

Risks: Some of these medicines can cause stomach upset. They can also cause bleeding in the stomach, slow blood clotting, and kidney problems. Acetaminophen does not cause these side effects, but high doses can hurt the liver. 

· Opioids

Benefits: These medicines control moderate to severe pain and do not cause bleeding.

Risks: May cause constipation, sleepiness, nausea and vomiting. Opioids sometime cause problems with urination or itching. They may also slow breathing, especially when they are first given, but this is unusual in people who take opioids on a regular basis for pain. 

·  Antidepressants 

Benefits: Antidepressants help to control tingling or burning pain from damaged nerves. They also may improve sleep.

Risks: These medicines may cause dry mouth, sleepiness, and constipation. Some cause dizziness and lightheadedness when a person stands up suddenly.

·  Antiepilectics 

Benefits: Help to control tingling or burning from nerve injury.

Risks: May hurt the liver and lower the number of red and white cells in the blood. It is important to have regular blood tests to check for these effects.

·  Steroids 

Benefits: Help relieve bone pain, pain caused by spinal cord and brain tumors, and pain caused by inflammation. Steroids also increase appetite.

Risks: May cause fluid to build up in the body. May also cause bleeding and irritation to the stomach. Confusion is a problem for some patients when they take steroids. 

Call your doctor or nurse immediately if your pain increases or if you have new pain. Also call your doctor early to receive a refill of pain medicines. Always have a three or four days’ supply of your medicine. 

Common Concerns 

If you are being treated for cancer pain, you may have concerns about your medicine or other treatments. Listed below are common patient concerns and the facts about them. 

Concern: I can only take medicine or other treatments when I actually have pain. 

Fact: You should not wait until the pain becomes severe to take your medicine. Pain is easier to control when it is mild. Take your pain medicine regularly as you have been instructed. This usually means taking it on a regular schedule around-the-clock. Take it even when you are not feeling the pain. You can also use other treatments, such as relaxation and breathing exercises, and hot and cold packs, as often as you want to. 

Concern: I will become "hooked on" or "addicted to" pain medicine.

Fact: Studies show that getting "hooked on" or "addicted to" pain medicine for cancer pain is very rare. Remember, it is important to take pain medicine regularly to keep the pain under control. 

Concern: If I take too much medicine, it will stop working. 

Fact: The medicine will not stop working. Sometimes, however, your body gets used to the medicine. This is called tolerance. Tolerance is not usually a problem with cancer pain treatment because the amount of medicine can be adjusted or other medicines can be added. Cancer pain can be managed; so don't deny yourself pain relief. 

Concern: If I complain too much, I am not being a good patient. 

Fact: Controlling your pain is an important part of your care. Tell your doctors and nurses if you have pain, if your pain is getting worse, or if the pain medicine you are taking is not working. They can help you manage your pain. 

Sugar and cancer: What's the connection?

Many popular diets target this simple carbohydrate as a dietary villain. The volume of information on sugar and health can be overwhelming spoons of sugar and sometimes misleading.

“Carbohydrates, which break down into glucose, are the primary fuel source for your body. You require a normal level of glucose in your bloodstream to maintain body function,” says Clare McKindley, clinical dietitian.

 

You get sugar naturally in foods like fruits, vegetables and dairy products, which are packed with nutrients like fiber, vitamins and minerals essential for a healthy diet.

 

Added sugars are a different story. Sugars that are added to foods and beverages translate to extra calories. Those added calories can have an impact on your health.

The problem with added sugar

 

While sugar doesn’t contain unique metabolic qualities that cause weight gain, it does provide additional and unnecessary calories without additional nutritional benefit. This can result in weight gain.

 

The link between obesity and several types of cancer is well established. The American Institute for Cancer research says consuming less sugary drinks and energy dense foods is among the top ways to reduce your cancer risk.  

 

Energy dense foods tend to be processed foods with sugar and fat to improve the taste. The result is more calories per ounce.

 

So how much added sugar is too much?

 

The American Heart Association recommends no more than six teaspoons of added sugar per day for women and nine teaspoons per day for men. That adds up to about 100 calories for women and 150 calories for men.

 

Americans consume significantly more than that. The average person eats about 22 teaspoons of added sugar per day. That adds up to nearly 2,500 calories a week.

Tips for cutting added sugar

 

If you want to eat a healthy diet low in added sugar, our experts urge you to cut back on processed foods.

 

“You should consume whole foods and reduce processed foods whenever possible,” says Diana Bearden, clinical nutrition supervisor at MD Anderson. “For example, a fresh peach is a whole food, but a canned peach in syrup is a processed food with added sugar.”

 

While tracking added sugar can be tricky – manufacturers don’t list it by teaspoons on their labels – taking the time to do it is a healthy choice.

 

McKindley suggests several ways to trim sugar from your diet.

1  Shop on the perimeter of store. Whole foods like fresh fruits and vegetables are on the outer edges of the supermarket and provide more nutrients than processed foods. You also can study your receipt after you check out. Highlighting the processed foods will help you identify your vulnerabilities.
 

2  Check labels. If sugar is one of the top three ingredients, think about making a better choice. Keep in mind that sweeteners come in a variety of names, including fructose, lactose and sucros

Slowly taper the amount of sugar. Look for the food products you eat that have the highest sugar content and replace them with something healthier. For example, try a baked apple with some cinnamon instead of cake or pie for desert. Also, try to put one less packet of sugar in your coffee or tea.
 

3  Cook from scratch. Making things from scratch gives you more control over your ingredients. And you can make healthy substitutions. 
 

4  Mind what you drink. Soda, sports and energy drinks can be loaded with sugar. So, check your beverage label closely. Also, watch the fruit juice. While it may not contain added sugar, the sugar in juice is concentrated, and many of the nutrients of the original whole food, like fiber, may have been removed. Try to drink more water.  And for more flavor, add fresh cut fruit to your water glass.
 

The bottom line: Reducing added sugars is a good step in improving your diet, reducing your calorie intake and maintaining a healthy weight.

                           Edited by Guangzhou Fuda Cancer Hospital