Pain Management: Cancer Pain

The majority of people with cancer will experience pain at some time or another. The pain can result from the cancer itself, or from the cancers treatment. In addition, some people who have been cured of their cancer can continue to suffer from pain.

Cancer pain, or the discomfort that stems from cancer and its treatment, can be controlled most of the time. There are many different medicines and methods available to control cancer pain. People who have cancer and are feeling pain need to inform their doctor immediately. The earlier pain treatment is started, the more effective it is.

There are many causes of cancer pain, but most cancer pain occurs when a tumor presses on nerves or body organs or when cancer cells invade bones or body organs. Cancer treatments such as chemotherapy, radiation, or surgery also may cause pain.

The symptoms of cancer pain vary from person to person. The amount of pain present may depend on the type of cancer, the stage or extent of the disease, and the person's pain threshold (tolerance for pain). Pain can range from mild and occasional to severe and constant.

Mild to Moderate Pain

Pain relievers: Tylenol and a group of pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Motrin and Aleve) can treat mild to moderate pain. Many of these are over-the-counter drugs that do not require a prescription, but some do require a prescription. Patients should check with a physician before using these medicines, especially if chemotherapy is being administered. NSAIDs can slow blood clotting.

Moderate to Severe Pain

Narcotic pain relievers: These drugs include morphine, Actiq, Duragesic, Dilaudid, oxycodone (sold under the brand names OxyContin, Percocet, and Tylox) and codeine. Narcotic pain relievers require a prescription and may be used along with mild pain relievers for moderate to severe pain.

Breakthrough Pain

Onset narcotic pain relievers: Onset narcotic pain relievers, which require a prescription, are used to treat breakthrough pain (a flare-up of pain characterized by rapid onset, severe intensity and short duration). Immediate-release oral morphine is among these drugs.

Tingling and Burning Pain

• Antidepressants: antidepressants are used to relieve pain regardless of if the person is depressed. Elavil, Pamelor, Norpramine are antidepressants prescribed to treat pain.
• Anticonvulsants (anti-seizure medications): Despite the name, anticonvulsants are used not only for seizures, but also to control burning and tingling pain, painful symptoms of nerve damage. Tegretol and Neurontin require prescriptions
• Other drugs: Corticosteroids such as Deltasone are used to lessen swelling, which often causes pain.

Although cancer pain is usually treated with medicine, surgery to remove a tumor or radiation therapy to shrink a tumor can be used along with medicine to provide additional pain relief. In most cases, doctors treat cancer pain with pain-relief medicines called analgesics or with non-drug treatments such as physical therapy and rehabilitation, imagery, biofeedback and relaxation techniques. Other treatment options for cancer patients include nerve blocks , which involve the injection of pain medicine into or around a nerve or the spine; and neurosurgery, a procedure in which pain nerves are cut to alleviate pain.

Reviewed by the doctors at The Cleveland Clinic Neuroscience Center.

Edited by Charlotte E. Grayson, MD, WebMD, June 2004.

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