Aches and pains It’s normal to be scared of pain, and some cancers and cancer treatments can be painful. But there are a range of strategies you and your care team can use to bring that pain under control, with or without drugs.
Pain, cancer and you Pain that’s caused by cancer or cancer treatment isn’t a measure of how serious your cancer is. It’s a very personal thing – what you’re feeling can be very different to what someone else feels in the same circumstances. It’s important to let your care team know about your pain so they can organise appropriate pain relief.
The causes of pain The pain you feel could be caused by quite a few things. It could be because a tumour is pressing on some body tissue or a nerve. It could be because body tissue has been damaged by a treatment such as surgery and radiotherapy. And if you get an infection, there will be an inflammation of the tissue in the affected area and that can cause pain. You’ll also find that stress, anxiety, depression and fatigue will make any pain feel worse – no matter what its source.
How to talk about pain Describing pain accurately can be a hard thing to do, particularly if you are concerned that people will think you are complaining or whingeing (they won’t!). But your descriptions are important; they help your care team get a clearer idea of what’s going on so they can work out the best way to relieve the pain. Here are some useful ways to think about pain.
Where is it? Is the pain restricted to a single location, or does it spread across parts of your body?
How deep is it? Does the pain seem to be close to the surface or does it come from deep inside your body?
When do you feel it? Is the pain there constantly, or does it come and go? And if it does come and go, are there times of the day when it regularly feels better or worse?
How bad is it? Think in terms of a scale of one to 10, where 10 is the worst pain you have ever experienced. Where does this pain sit on the scale?
What does it feel like? There are many descriptive words for pain. Accurately describing the quality of your pain can be a big help to the care team who is trying to help you. Consider some of these words: aching, biting, burning, constant, crushing, dull, electric, niggling, piercing, pricking, gnawing, raw, shooting, splitting, stabbing, tender, throbbing, tingling, twinge.
How does it affect you? Does it stop you from reaching up or stretching? Does it make it hard to walk? Does it make you want to stand up or sit down? Is it affecting your sleep?
Taking painkillers If you’re dealing with intense or prolonged pain, your care team may recommend you take a painkilling medication. It’s better to take painkillers and keep the pain under control than to let it get worse. Severe pain can make you anxious or depressed and can disrupt your sleep. If those things start to happen, it will be even harder to get the pain back under control.
Painkillers commonly come as pills or a liquid. But if you are having difficulty swallowing, you could be prescribed a suppository or a skin patch. If necessary, painkillers can be injected into your bloodstream or given through a drip.
For mild pain Mild painkillers include commonly available drugs such as aspirin, paracetamol and ibuprofen. They can cause indigestion or irritate the stomach lining in some people, so don’t take them on an empty stomach.
For moderate pain Moderate painkillers are described as low-dose opioid drugs. They are usually taken combined with paracetamol in a pill. These medications may make you drowsy. They may also make you constipated and your care team could prescribe a laxative to offset this.
For strong pain Strong painkillers are called opioid analgesics and include drugs such as morphine. You’ll usually be started on a low dose which is then increased until you’re feeling some pain relief. Strong painkillers are highly likely to make you drowsy. They often cause constipation, so you may be prescribed a laxative at the same time. Some of these drugs cause nausea, so anti-nausea medication could be offered to you. A dry mouth could also be a side effect so up your intake of water and try chewing gum.
Other options Painkillers aren’t the only drugs that can help when cancer or cancer treatment is causing you pain. Some of these medications are available over-the-counter at chemists, but get advice from your care team before taking any new drug as it may interfere with a treatment you’re already receiving. There are also non-drug treatments that you may find effective. Talk to your care team for more information.
Anti-inflammatory drugs Certain types of pain in your skin, muscles and bones can be relieved by reducing inflammation and swelling with anti-inflammatory drugs. Be aware that they can irritate your stomach, so always have something to eat before taking them.
Steroids Pain caused by a tumour pressing on a nerve can be relieved by steroids. Like anti-inflammatories, steroids can irritate your stomach, so it’s best to take them after a snack. You may notice your appetite increases when you’re taking steroids and you may start putting on weight. Your care team may suggest you do some light exercise to compensate. Some people find steroids make them irritable or disrupt their sleep. If you have concerns, talk to your care team.
Antibiotics If an infection is causing you pain or discomfort it can usually be treated with an antibiotic.
Muscle relaxants If you’re experiencing painful muscle spasms, your care team may recommend a muscle relaxant.
Nerve blocks A nerve block treatment involves injecting a local anaesthetic into or around the nerves in the pain-affected area. As a result, the nerve impulses are ‘blocked’ and the pain messages don’t reach the brain.
Transcutaneous electrical nerve stimulation (TENS) This is a medical method of relieving pain without using drugs. It involves applying a mild electric current to the skin where the pain occurs, triggering the body to release its own natural painkillers. The electric current produces a pleasant sensation and relieves some types of pain.
Keeping on top of your drug routine When you’re in the thick of treatment, you could be taking a dozen or more medications through the day. For many of these drugs, it’s important that they’re taken consistently and at exactly the right time. One way to keep track is to draw up a chart listing each medication, what it’s for, how much to take and when to take it, with space to tick off each dose.
Another way is to get the medications put into a Webster-pak at your local pharmacy. A Webster-pak is a large-scale blister pack. Each blister contains all the medications that you’ll need to take at a given time. The Webster-pak covers seven days and there are four blisters for each day, making it easy to see at a glance if you have already taken or accidentally skipped any medications.
Pain control without drugs Drugs are not the only way to treat pain. There are some simple things you can do to reduce pain before you start using drugs, or to make drug treatment more effective.
Cushion the blow If you’re spending lots of time in bed, you could find that some support pillows make you feel a lot more comfortable. Your care team can advise you on what wedges and support pillows you can use to alleviate pain in your neck and back.
Shift and turn Sitting or standing in one spot for a long time can put strain on your body. If you’re feeling weak, ask someone around you to help you shift your weight in the chair or turn over in bed.
Lift the load Heavy blankets can be too much pressure for weak limbs or stressed skin. A bed cradle will support the bedding so that it doesn’t weigh so heavily on a tired body.
Take a bath Relaxing in warm water can soothe aching joints and relax tensed muscles.
Hot and cold Hot-water bottles, heat packs and ice packs can give short-term pain relief. You may find that alternating between heat packs and ice packs is especially beneficial.
Gentle massages Muscles in an affected area can get tense, and rubbing the area may help relax the muscles and ease pain. But massage is not recommended for areas where the skin is affected by radiotherapy or for people with bone cancer.
Complementary therapies Many people with cancer use techniques known as ‘complementary therapies’ to help them feel physically better and mentally more positive during their treatment. Some use them specifically to deal with pain.
Acupuncture A traditional Chinese therapy, acupuncture involves inserting small needles at specific points in the body to stimulate nerve impulses. When used for pain management, acupuncture can help to control pain sensations.
Physiotherapy When you’re in pain, it’s natural to change the way you move so that the affected area hurts less. The hitch is that this can lead to other problems including joint stiffness, muscle wastage and increased or prolonged pain. A physiotherapist can work with you to get your body moving the way it used to.
Massage Not only is massage a pleasant diversion, it can actually reduce pain by stimulating blood flow and relaxing tight muscles.
Meditation There are many different techniques used in meditation, but the basic idea is to be quiet and still and focus your thoughts. Meditation can help you to feel calm or relaxed about your pain, which in turn can actually have the effect of easing your pain.
Other complementary therapies that have proven to be safe and effective in clinical trials include aromatherapy, reflexology, yoga, art therapy, music therapy, tai chi and qi gong. Complementary therapies are generally safe to use alongside the conventional treatments you may be getting, but it’s best to discuss any plans you have with your care team before you begin. They may also be able to advise you on which therapy would be most suitable for your situation.
Words to know
Addiction a psychological dependence on a drug; a compulsion to use drugs for non-medical purposes
Complementary therapy non-medical techniques used to help manage symptoms and side effects
Massage the manipulation of muscle and connective tissue to enhance body function and promote relaxation and wellbeing
Meditation a technique of calming and focusing the mind and body
Nerve block the use of local anaesthetic to prevent nerve impulses indicating pain from reaching the brain
Suppository a small plug of medication that dissolves slowly after being inserted into the rectum or other body cavity
Transcutaneous electrical nerve stimulation (TENS) the use of electric currents to stimulate the body’s natural painkillers
Things to ask
Will this painkiller be addictive? Long-term use of painkillers is not the same as an addiction to painkillers. To have an addiction, you’d have to be using the painkiller long after the physical need for it had stopped. Your care team will prescribe an appropriate painkiller for you for as long as your pain lasts. This may be weeks or months. If you have concerns, talk to your care team.
Will I experience withdrawal when I stop taking the painkillers? If painkillers are stopped suddenly you are likely to experience the symptoms of withdrawal. For this reason, your care team will gradually reduce your dose when you no longer need painkillers, so that your body can adjust slowly.
Should I hold off as long as I can before taking this painkiller? It’s usually best to take the recommended painkiller as soon as you start to feel pain. If you let pain get overwhelming, it can be hard to bring it back under control.
If I get morphine, does that mean I’m really sick? You may be prescribed a strong painkiller like morphine if your pain is severe – but severe pain doesn’t necessarily mean that you have advanced cancer or that your cancer is spreading. Talk to your care team if you’re at all concerned.
Is this complementary therapist registered with any professional organisation? Most complementary therapists are not required by law to be registered. However, you are right to make enquiries to ensure that you’re being treated by a qualified, ethical and reliable practitioner. Before you begin working with a therapist, find out how, when and where they were trained and whether or not they belong to any professional organisations.
Can I afford complementary therapy? Massage, physiotherapy and acupuncture are often covered by private health insurance policies, but many other complementary therapies are not. Make the relevant enquiries with your own insurer. Some of the state-based Cancer Councils provide free access to complementary therapies. Call the Cancer Council Helpline on 13 11 20 to find out what’s available in your area, or ask your care team for guidance.
Expert's insight: Sanchia Aranda Professor Sanchia Aranda specialises in community care, cancer nursing, and nurse-patient relationships. She believes being open about the pain you’re feeling is the first step to managing it well.
“Hearing a cancer diagnosis is a profoundly life-altering experience. People react to that in a lot of different ways but, importantly, most people manage really well. The critical thing is communication.
“People can sometimes keep their symptoms and side effects to themselves, but there’s no reason to do this with all the advances in pain management. Tell somebody on staff and then work with the team to manage it.
“The more stressed and distressed you become, the pain is bolstered. If your body is tense, the more likely it is that you’ll get muscular aches and pains. In some cases, people find benefit in meditation and relaxation, but what works for one person may not work for another.
“Always discuss medication with your doctor as you may go through some trial and error before getting the right balance. Many people fear that they will become addicted to morphine. The reality is that there’s a lot of difference using morphine in a pain context as opposed to pleasure. There’s no emotional dependence when pain’s the reason for taking it. Addiction to morphine is very rare when it’s used therapeutically.
“When I was working in a palliative care team in Melbourne, we were called to see a patient labelled as ‘morphine seeking’. We sat down with her and discovered that she actually had a small fracture in her pelvis that had gone undiagnosed. Every time she was mobilised, the poor woman was in more pain. As a result, she needed a completely different medication.
“The lesson is that if you feel like you’re not getting heard, get a second opinion. Many patients are frightened that they’re insulting their doctors, but cancer’s a team sport. Don’t be afraid to ask.”
More help
Australian Acupuncture and Chinese Medicine Association 1300 725 334 or (07) 3324 2599 www.acupuncture.org.au Search the website or call to find a qualified acupuncturist near you.
Australian Association of Massage Therapists 1300 138 872 or (03) 9691 3700 www.aamt.com.au Find a massage therapist who specialises in cancer care.
Australian Physiotherapy Association (03) 9092 0888 www.physiotherapy.asn.au Search the website or call to find a physio.
Independent Living Centres Australia 1300 885 886 www.ilcaustralia.org For support cushions and other aids that could help you manage pain at home.
Meditation Society of Australia meditation.org.au Free online courses on meditation.
Pain Link Helpline 1300 340 357 www.painmanagement.org.au Get advice on dealing with pain from the Australian Pain Management Association.
The Australian Psychological Society 1800 333 497 www.psychology.org.au Call or search the website to find a psychologist who specialises in pain management.
Photo by Nick Cubbin
KEN MILLER Ken Miller was prescribed drugs for the pain associated with his advanced cancer, but found that other strategies offered him a better quality of life.
Two years ago, when he was in his mid-60s, Ken was diagnosed with advanced prostate cancer and spinal cancer. He was given five years to live.
“When I was first diagnosed with cancer I was given pain-control drugs by the doctor, but I didn’t like taking them. They made me feel a bit dopey and I wasn’t myself. I thought if I only have a small amount of life left, I want to be around for it. So I stopped taking the drugs and thought about what else I could do.
“My daughter is a naturopath and she suggested I try to improve my overall wellbeing with some supplements. I have since tried gingko biloba (thought to increase blood flow and immunity) and co-enzyme Q10 that is supposed to increase energy. But I didn’t really feel I was getting any benefits from vitamin supplements.
“What I do now is use relaxation therapy to reduce pain and increase my wellbeing. I don’t do anything structured, I just tried to think about how I could expand the time I spend on things I enjoy that reduce stress.
“This includes meditative activities such as quiet reading and gentle exercise including walking and bowling. They are a distraction as much as anything else and that stops me thinking about any aches and pains I may have.
“I also practise positive thinking. That’s important. I try not to let things get me down and I don’t focus on the negatives, including pain.
“The only other thing I do to reduce pain is have a cold beer at the bowls. You couldn’t call that complementary therapy, I suppose. But living with cancer, it’s about doing the little things you enjoy.”