Managing Cancer Pain

You or someone you love has cancer. Naturally, you are worried about pain, which is why it is important to get as much information as soon as possible about pain relief, says board-certified anesthesiologist and interventional pain management physician Dr. Abhilasha Solanki at Weill Cornell Medicine (WCM). “You need to see a specialist who can give you detailed information about all your options,” Dr. Solanki says. “Often times, when you get a cancer diagnosis, you’re bombarded with a lot of information regarding surgery, chemotherapy, and radiation and pain may take a back seat. But if you’re in pain 24/7, going through these treatments is a lot harder. Having a pain treatment plan can help you through chemotherapy and surgery, and aid your recovery.”

Cancer pain varies

Cancer pain occurs in various ways. It may be temporary or chronic, mild or severe, localized or widespread. A tumor pressing on bone, nerves, or organs causes most cancer pain. Treatments, such as chemotherapy, radiotherapy, or surgery may also cause pain.

Talking openly and honestly about your pain is the first step toward controlling it, Dr. Solanki says. “Patients need to feel comfortable talking with their physician, family members, or other caregivers about their pain, and the stress and anxiety that come with it,” she says. “Listening to them carefully is most important for understanding how their pain needs to be treated.”

Your oncologist or other providers will probably ask you to rate your pain on a scale ranging from 0 to 10: 0 is no pain, and 10 is the worst. They may also ask you to describe your pain threshold, which is the point at which you notice pain. This information will help them determine how well your pain control plan is working. You might want to record your pain, either in a diary or journal, so you can refer to it when your providers ask:

• Where you have pain
• What it feels like (sharp, dull, throbbing, constant, burning, or shooting)
• How strong your pain is
• How long it lasts
• When it happens
• If it interrupts your daily activities
• What eases or increases it

Educate yourself

Dr. Solanki emphasizes the need for cancer patients, their families, and caregivers to educate themselves about the wide variety of pain treatment options. “For mild pain we usually prescribe acetaminophen, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and neuropathic pain medications like gabapentin,” Dr. Solanki says. “For more intense pain, we may prescribe opioid-based medications.” Opioid use may raise fears of dependence, which she encourages patients to discuss with their doctor. “As long as you follow your doctor’s directions, it’s unlikely that you’ll get addicted,” she notes.

Patients who do not respond to oral pain medication may find relief in:

• Nerve blocks
• Advanced treatment options for patients who can’t take opioids by mouth, including transdermal patches and implantable intra thecal drug delivery systems

“Prior to implanting an intrathecal drug delivery system, we do a trial to ensure that it is providing adequate pain relief without any side effects” she says, referring to the nausea, drowsiness and confusion that commonly result from orally ingested opioids.

Alternative, multi-modality approaches

Your provider may recommend non-drug treatments, such as biofeedback, breathing and relaxation exercises, or hypnosis, to augment your pain treatment plan. Dr. Solanki, who works closely with WCM’s Integrative Health and Wellbeing Program, says she often prescribes acupuncture, meditation, or massage therapy, depending on patients’ particular needs. “A multi-modal approach is key to getting back to a normal, functioning life,” she says.

Don’t wait until your pain is intolerable before talking to your provider about it. Stopping pain before it worsens is key to controlling it. “Talk to your provider freely about your pain, and consult with a pain specialist,” Dr. Solanki urges. “We will come up with a plan to help you get through treatment, function at a comfortable level, and improve your overall quality of life. We’re here to help you through this journey, however difficult it may be.”

For more information or to schedule a consultation with one of our pain management experts, please call the WCM’s Division of Pain Management at (646) 962-7246.