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

What is breakthrough pain?
People with cancer have two types of pain, persistent pain and breakthrough pain.

Persistent pain is continuous and present most of the time. You may be on medication around the clock for this type of pain. Pain is an unstable phenomenon, meaning that it may vary due to numerous factors, including disease progression, activity level, specific movements or stress level. Most patients experience many peaks and valleys of pain daily.

Breakthrough pain is a temporary, moderate to severe flare in pain that occurs even though you may be taking medications regularly. It is called breakthrough pain because it "breaks through" your regular pain medication schedule. This does not mean that your around-the-clock medication has failed, or that your pain is uncontrolled. If you have breakthrough pain, your doctor may want to consider adding other medications that work quickly and for shorter periods of time.

There are several types of breakthrough pain:

• Incident pain -- an increase in pain with movement or activity, such as walking, sitting up, going to the bathroom or coughing.

• Idiopathic or spontaneous pain – Pain that has no particular pattern or reason that it increases.

• End-of-dose failure -- Your pain may increase just before you are scheduled to take a dose of your regular pain medicine. This is called end-of-dose failure, and it may not be an actual breakthrough of pain. This type of pain may be best managed by an adjustment to the dose of your around-the-clock pain medication.

Pain is best controlled when both persistent and breakthrough pain are treated. This means that you may be taking a long-acting medication around the clock to prevent your persistent pain, as well as a short-acting medication that is taken only when you experience episodes of breakthrough pain.

Things to remember:

• You should take your short-acting medication as soon as you feel the breakthrough pain. If you let the pain build up and become too severe, it is harder to relieve.

• Adding short-acting medication will not cause more side effects; in fact, it will lessen them. These medications stay in your body for a shorter period of time. Side effects are similar to long-acting medications, such as drowsiness, occasional nausea, or constipation.

• The short-acting medications should relieve most of your breakthrough pain without causing unacceptable side effects such as constant nausea. Your doctor or nurse may adjust the dose of your breakthrough medication to give you the best relief with the least amount of side effects. Contact them if you are not getting relief from your pain, or if breakthrough pain is occurring more than four times a day.

• If your pain is not being relieved and your doctor has exhausted all of his or her options, ask to see a doctor who specializes in pain management. They may be anesthesiologists, oncologists, neurosurgeons or a team of specialists that can evaluate your situation and let you know your options.

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Reducing pain without drugs
Contrary to what some people believe, there are many ways to relieve pain without drugs. It is important to continually diagnose treatable, reversible causes of pain. Treating the cancer with surgery, radiation, and/or chemotherapy can reduce or eliminate pain related to the cancer.

Non-drug approaches may be helpful alone, or as an added boost to the pain medication you are taking. The Karpas Cancer Library and the health section of most libraries have more information on the following techniques to help you help yourself.

Relaxation and Meditation
Relaxation and meditation can help reduce tension by relaxing your muscles or inducing a deeply relaxed state. These techniques include simple breathing exercises, progressive muscle relaxation, and visualization that reduces tension and anxiety.

All of these methods may help you feel more energized and focused and, in turn, relieve pain. Distraction or focusing your attention on something other than your pain is one approach that can be helpful. Listening to music, watching television, reading, cooking, or talking to family and friends can all work to take your mind off the pain. Relaxation and meditation are often useful during procedures that may be brief but painful.

Imagery
Imagery for pain control is a method of allowing your mind and powers of concentration to focus on soothing images. It is a way for you to further extend the benefits of relaxation and distraction for your own benefit. For example, visualize that your pain is like hot coals and your relaxation techniques are like water pouring over the coals and putting them out the fire.

Another way to use imagery is to imagine you are in your favorite place relaxing. You could imagine yourself walking along a beautiful beach, noticing all the details, such as how the sounds and smells and the warmth of the sun. There are many good audiotapes available to guide you through imagery, which have been effective in relieving stress and discomfort for many people.

Skin stimulation
Skin stimulation refers to methods you use to alleviate pain, such as massage, heating pads, or ice packs. Skin stimulation can be used alone or in combination with other methods for relieving pain. Your doctor or nurse will be able to tell you which forms are likely to be more effective in relieving your type of pain. For example, some pain responds better to heat than to cold. Be especially careful with extreme temperatures, especially heat, which can cause burns or affect your blood circulation.

Exercise
Exercise can help relieve tension, depression and fatigue. Exercises like swimming or walking can be comforting and can increase your energy level. An exercise program should only be started after your doctor gives you a thorough examination, and after he or she gives you approval to begin such a program.

Support groups, either facilitated by a trained professional or with a peer group, may also be beneficial. In a group setting, you can receive emotional support and talk to others who are experiencing the same problems. Together you can share information about coping.

For more information on alternative and complementary therapies to treat pain, click here.

Can Radiation Oncology help with pain?
Radiation Oncology treatments are often used to relieve pain from cancer that has spread to the bones. A consultation with a radiation oncologist as well as a pain specialist can be an important step in the management of bone pain and cancer.

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What are common concerns for patients who experience cancer pain?
• Concern: If I complain too much, I am not being a good patient.
Controlling your pain is important to your doctor. If you feel pain, tell your doctor or nurse, so they can help you.

• Concern: I will become addicted to the pain medication.
Addiction to pain medication is extremely rare. A person with cancer only desires relief from pain and rarely continues to use the medication once the pain is gone.

• Concern: If I take too much medication, it will stop working.
Your medication will not stop working. Tolerance is rare but may develop. If this happens, your doctor can increase your dose or prescribe a different medication.

• Concern: I am worried about the side effects of pain medication.
Your health care team or pain specialist can effectively deal with any medication side effects.

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