Symptom Specific Services

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Pain
• Will I experience pain?
• What causes pain?
• What are the goals at Continuum Cancer Centers of New York for treating pain?
• How can I get pain relief?
• Types of pain medicine
• How is pain medicine given?
• What is breakthrough pain?
• Reducing pain without drugs
• Can Radiation Oncology help with pain
• What are common concerns for patients who experience cancer pain?
• How can I benefit from the specialized services of the Department of Pain Medicine?
• How to evaluate and describe your own pain
• Other useful tips

Will I experience pain?
Many people with cancer fear pain and, at the same time, believe it to be an unavoidable part of the disease. However, only 30 percent to 40 percent of patients treated for cancer report pain.

Not everyone with cancer has pain, and those who do can control it with medication and other state-of-the-art treatments.

Pain left untreated can cause fatigue, depression, anger and stress. It can keep you from sleeping well, enjoying family and friends, and eating properly. If you have cancer and are feeling pain, you need to tell your doctor or nurse. Getting help for your pain early on can make treatment more effective.

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What causes pain?
Pain has many causes in people with cancer, including:

• Pressure from a tumor on bone, nerves, or other sensitive organs

• Cancer treatments such as chemotherapy, surgery, or radiation

• Other conditions, such as arthritis

Pain caused by the actual cancer can be divided into two categories, nociceptive pain and neuropathic pain.

Nociceptive pain is caused by damage to tissue. It is usually described as a sharp, aching, or throbbing pain. Nociceptive pain may be due to:

• Cancer that is growing

• Cancer that has spread to the bones, muscles or joints

• A blockage of an organ such as the colon, or parts of the digestive system

• A tumor in the esophagus or throat

• Swelling from blood vessels blocked by a tumor

Neuropathic pain occurs when there is actual nerve damage. It is usually described as a burning or heavy sensation, or numbness. Neuropathic pain may be due to:

• A tumor pressing on or intruding on a nerve or a group of nerves

• A tumor pressing on the spinal cord

Cancer treatments can also cause pain.

Surgery is sometimes necessary for cancer treatments, to remove a tumor or reduce the size of a tumor to relieve pressure. Pain from surgery can be treated and may go away quickly, after the surgical incision heals. Doctors may prescribe medicines like Advil (ibuprofen), Tylenol (acetaminophen), or patient-controlled analgesia (PCA), a mechanism that allows patients to manage their own intravenous pain medication.

Chronic (long-term) pain can result from surgery if there has been nerve damage or other changes in the body due to surgery. This type of pain may be more difficult to control, and treatment must be tailored to each patient.

Chemotherapy can cause pain in a variety of ways:

• Some chemotherapy drugs, called vesicants, can harm surrounding tissue if they leak out of the vein. Staff members who administer chemotherapy now use special IV catheters that help reduce the chance of this occurring. They will alert your doctor or nurse if you feel any burning or pain while chemotherapy is being administered to you.

• Repeated needle sticks bother some people when they receive several cycles of chemotherapy. You should ask your doctor if you are a candidate to receive a port, which is an access device placed just under the skin through a minor outpatient procedure. A port allows you to receive chemotherapy and have blood drawn from the exact same spot without repeated needle sticks.

• Chemotherapy can cause sores in the mouth (stomatitis), which can be painful during eating or drinking, and sores in the lining of the intestines (mucositis), which can cause cramping and diarrhea. Inform your doctor or nurse if these problems occur. Your doctor can prescribe medications to numb your throat and treat your intestinal discomfort.

• Peripheral neuropathy, a tingling, numbness or pain in the extremities, (hands, fingers, toes, and feet) can be one effect of chemotherapy. Certain chemotherapy drugs (Vincristine, Cisplatin, Taxol, and Vinblastine) are more likely to cause this type of problem when given long-term in high doses. While this may not be preventable, alerting your health care provider to these symptoms will allow them to modify your therapy.

• Nausea and vomiting are common side effects of chemotherapy. Your doctor can prescribe effective treatments to reduce or even halt these side effects. For quick, practical tips on coping with nausea, click here.

Radiation treatment can damage normal cells and tissues as it destroys cancer cells, sometimes causing pain and discomfort. Skin dryness, difficulty swallowing, or skin sores may occur. Your radiation oncology nurse can recommend a skin care program to alleviate these reactions.

Fatigue can also be a disabling side effect of cancer and treatment, restricting a person's ability to manage their usual activities. For more information on how to deal with fatigue, click here.

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What are the goals at Continuum Cancer Centers of New York for treating pain?
At Continuum Cancer Centers of New York, our goal is to relieve pain safely and effectively. We strive to:

• Assess and treat each person's pain individually

• Provide access to an interdisciplinary group of professionals who can implement an array of state-of-the-art approaches, psychological treatments, and pain management approaches

• Encourage patients to be active participants in their treatment, drawing on non-medical interventions in addition to, not instead of, medical treatment

• Educate patients and their families about pain and its treatment, as it relates to cancer

• Reassess the treatment plan regularly, responding promptly to changes in pain or the development of new pain

Physicians, nurses, social workers and other health professionals are trained to ask about your pain and provide you with the means to relieve it. Your physician or nurse will also ask what makes the pain feel better or worse.

Your answers should include a description of the body positions and activities that increase or decrease pain. Also consider how well your pain medication is working, and the degree to which you feel relief and for how long. All of this information will help your doctor manage your pain as effectively as possible.

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