Lung Cancer

Finding Relief From Lung Cancer Pain

Pain affects most people with cancer, but you don’t have to accept cancer-related pain as a way of life. When you’re in pain, your body’s disease-fighting abilities are lowered, interfering with your health and recovery in general. Pain affects your ability to sleep, work and maintain your relationships. These harmful effects make pain too important to ignore.

Read on to learn about the typical types of cancer-related pain and the options available for managing them. Although you can’t expect to live entirely pain-free, you can expect your medical team to work diligently toward alleviating your pain.

Common Pain Sources

Cancer-related pain is caused by several different factors. In most cases, it is directly related to the cancer itself and the location of the tumor(s). As a tumor grows, it can press on internal organs, tissues and joints, creating pressure that ultimately leads to pain in that area. Pain also can be caused by cancer that has spread (metastasized) to bone. This pain is typically felt in the back, pelvis and hips, the most common sites of bone metastasis. Cancer-related pain also may be felt in other parts of the body, especially in advanced disease.

Diagnostic procedures and treatments may cause different types of pain. After surgery, pain is usually felt in the area of the surgery but usually lessens as the body heals. The pain or discomfort caused by chemotherapy and radiation therapy can be mild to severe but often (although not always) ends when treatment does. Sometimes, a hormone imbalance or treatment-related nerve damage may contribute to chronic pain.

The side effects of cancer treatments can also cause pain, including loss of motion, lymphedema, peripheral neuropathy and osteoporosis.

Types of Pain

Cancer-related pain is grouped into three categories:

  • Acute pain is pain that occurs suddenly. It is sometimes related to a diagnostic procedure or treatment and usually resolves once the body recovers and heals.
  • Chronic pain, also called persistent pain, lasts for at least one month after treatment. This type of pain is usually related to the direct effects of a tumor or cancer treatment. In a small number of people, chronic pain may be unrelated to either the cancer or the treatment.
  • Breakthrough pain includes severe flares of pain that “break through” during treatment with pain medication. Breakthrough pain can range from mild to severe and can last minutes to hours.

Once your medical team understands your pain, they can recommend the best treatment options for you. You can help further by describing your pain in as much detail as possible:

  • Use descriptive words, such as “shock-like” or “burning.”
  • Rate your pain on a scale of zero to 10 (with 10 being the worst).
  • Note if anything makes it better.
  • Note if anything makes it worse.
  • Describe how it affects your daily life.

Pain Management Techniques

Several pain management techniques are available. Your doctor most likely will start with less intensive pain medications and switch to stronger medications if your pain is unrelieved. This stepped process is known as the analgesic ladder (see Figure 1). You and your doctor will decide how to best manage your pain, using the analgesic ladder as a guide. Because every person responds to treatments differently, you and your medical team will discuss the options that best meet your needs.

Pain medication, known as pharmacotherapy, is a typical way to alleviate pain. Mild pain can often be controlled with over-the-counter pain relievers, whereas more severe pain will likely require stronger medications that must be prescribed by your doctor. Ask your medical team about the different ways strong pain medications can now be taken.

Commonly used medications for pain include the following:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) or non-opioid analgesics are intended to relieve mild-to-moderate pain. These drugs are typically available without a prescription.
  • Opioid analgesics or pain relievers are prescribed to relieve moderate-to-severe pain.
  • Adjuvant analgesics are designed to relieve pain related to damaged nerve cells or nerve swelling by changing how these nerves generate pain signals.
  • Bone-modifying agents help reduce pain related to bone complications from metastatic cancer.

Percutaneous pain techniques include nerve blocks, ablative procedures (those that consist of removing body tissue) and vertebroplasty/kyphoplasty or cementoplasty (filling the bones of the spine with cement to stabilize them and/or reduce pain). These techniques can often be done in an outpatient setting and, for many people, pain relief is often immediate.

Targeted drug delivery may be an option if you cannot find pain relief with other routes of pain medication (oral, intravenous, etc.) or if you have side effects that you cannot tolerate. A targeted drug delivery system consists of a small pump and a catheter that deliver pain medication directly to the intrathecal space or the fluid surrounding the spinal cord. The system has been shown to be safe and effective and can be used for patients at all stages of the care continuum, especially during end-of-life care.

Neurosurgical options are procedures designed to stop pain at its source by modifying specific brain and spinal cord fibers that carry pain signals. These procedures are performed by a neurosurgeon — a specialist in surgery on the brain and other parts of the nervous system, including the spinal cord — who has expertise in treating pain. Neurosurgical options include neurostimulation, neuroablation, cordotomy, myelotomy and radiosurgical hypophysectomy.

Integrative oncology addresses symptom control with therapies other than pain medications or procedures. Complementary therapies are treatments to control symptoms, and they are used in combination with traditional cancer treatments. Integrative oncology includes only complementary therapies that studies have shown to be beneficial and safe. The most commonly used integrative therapies for cancer-related pain include mind-body therapies, acupuncture, and manipulative and body-based therapies. Choosing complementary therapies can help you take a more active role in your care. Many of them are also effective at reducing stress and anxiety, which can help you cope with pain. Integrative oncology does not include alternative therapies, which are treatments given instead of traditional cancer treatments.

Palliative treatment uses conventional anti-cancer treatments, such as radiation therapy, chemotherapy and surgery, to shrink a tumor or to improve a person’s quality of life. These treatment options have risks as well as benefits. It is essential to ask questions and discuss your expectations with your medical team.

Rehabilitation care is an important part of overall cancer care because it can help reduce the level of pain you experience during or after treatment. Health care professionals work as a team to provide rehabilitation care to help patients improve their physical strength, increase their ability to care for themselves and manage pain and other symptoms.

Effectively managing pain relies on open communication between you and your medical team. Some people hesitate to talk about pain because they don’t want to seem as if they’re complaining. But reporting pain is the first step to feeling comfortable and having a good quality of life.

Speak up about cancer pain

Cancer pain is often undertreated because many patients are reluctant to discuss it. Don’t fall into that category. Ask about pain management right from the start, and continually alert your doctor at the first sign of pain. A pain diary, as discussed in the box below, can help you monitor your pain, know what to report and decide when to call your doctor. Pain relief works best when it’s done proactively rather than reactively, and ideally, pain should be addressed long before it becomes an emergency.

In addition, if you’re having unacceptable side effects from pain medications, such as extreme fatigue, constipation, etc., discuss those issues with your doctor as well. Efforts can be made to employ different strategies to both get you the necessary pain relief and avoid unacceptable side effects. The goal is a satisfactory quality of life.

Keeping Track of Cancer Pain

A pain diary is an easy way to track what pain you’re experiencing and what pain-relief methods are working, and it will help your medical team modify your care to make you as comfortable as possible. Use a consistent pain scale, like rating your pain from 0 to 10 (with 0 being no pain and 10 being the worst pain imaginable), and write down answers to questions like:

  • What does the pain feel like?
  • Is it mild or severe?
  • Is it constant or does it come and go?
  • Is it dull or sharp?
  • When do you feel pain (morning, night, random times)?
  • Are there specific triggers, like bending or stooping?
  • How long does the pain usually last?
  • What helps relieve your pain?
  • Are you experiencing any side effects from your pain medications?

 

Combatting Pain: Around-The-Clock Dosing

Pain medication is much more effective when it is taken at regular intervals around-the-clock rather than when you have pain. Around-the-clock dosing can help you “stay ahead” of pain. Take your pain medication exactly as your doctor prescribes. Make sure to discuss with your doctor how to handle breakthrough pain.

 

Managing Cancer Pain: Myth vs Fact

Myth: Increasing pain means that my disease is getting worse.
Fact: Pain and severity of disease are not necessarily related, but increasing pain should prompt a conversation with your doctor to evaluate the cause and develop a plan for more acceptable pain relief.

Myth: I don’t want to have unpleasant side effects from pain medications.
Fact: Side effects may occur with some pain medications, but they can be managed and some will decrease or disappear over time on their own. If you become tolerant to your medications (more doses are required to have the same effect) or the side effects are too difficult, a health care provider with expertise in cancer pain can help guide you through other options.

Myth: If I take narcotics (opioids) regularly, I may become addicted.
Fact: Although people can become tolerant to a pain medication, tolerance is not the same as addiction. People with cancer who take pain medications as directed usually don’t become addicted. If you are concerned, talk with your doctor.

Myth: If I start taking pain medication early on, I will run out of options for pain relief in the future.
Fact: Many pain-relieving medications and procedures are available throughout the treatment process.

Myth: I don’t want to bother the doctor. Having pain should be expected.
Fact: Although pain is common, your doctor and other members of your treatment team should always be willing to help find ways to control your pain so you can enjoy a better quality of life.

Additional Resources

 

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