Understanding the Problem

People with cancer may have pain. It may be due to the tumor, a side effect of the treatment, or unrelated to the cancer or its treatment.

Most cancer pain can be eliminated or significantly reduced. It may take some time to find the best way to relieve the pain. The doctor may need to try different medicines or doses to see what works best.

The person with the pain is the only one who knows how they are feeling. It is very important to tell your health care providers about your pain in detail.

Call your health care provider right away if you have any of the following:

• New area of pain that does not go away in one or two days
• New pain in the back that is severe and may be accompanied by numbness, weakness in the legs, or difficulty urinating or having a bowel movement
• Difficulty sleeping or moving because of pain
• Decreased appetite due to pain
• Pain that is not relieved with pain medication
• Uncomfortable side effects from pain medicine, such as constipation, confusion, nausea, or inability to urinate

General Instructions

Pain medicines are more effective if they are taken on a regular schedule, before the pain builds up. Continue the medicine schedule during the night, unless you are using a time- released capsule or patch that lasts through the night.

Often narcotic or opioid pain medicines are used along with other pain medicines such as Tylenol® or nonsteroidal anti-inflammatories such as Motrin® (ibuprofen) to provide the maximum pain relief.

If you have neuropathic pain (pain with numbness or tingling sensations) medicines such as desipramine, nortriptyline, Neurontin®, or Trileptal® may be added to your pain medication regimen. Your health care team will review these medications and their use with you.

Do not stop taking opioid pain medicine suddenly if you have been on it for several weeks. If you are having a procedure where you may not eat or drink, talk to your doctor about your pain medicines.

Some people have concerns about becoming addicted to pain medicine or feel they should save it for when the pain gets really bad.

It is important for you to know that people who are addicts take drugs to feel high. People who take opioids for cancer pain take them to get relief from physical pain.

People who take pain medicines over long periods of time may become tolerantto their effects. That means that it may take a higher dose to get the same pain relief. That is not a problem because there are pain medicines that can be given at whatever dose is necessary to relieve the pain.

Most Common Opioid Pain Medicines

Your health care provider will instruct you on which ones to take, and how to take them. Do not mix medicines without contacting your health care provider.

Ways to Manage Side Effects of Pain Medications

Constipation

• All opioid pain medicines cause constipation and laxatives may be needed when taking these medicines
• Increased fluids, fiber, and exercise, if appropriate, will decrease constipation

Dry mouth and nose

• Sip on water or suck on crushed ice
• Suck on sugar-free hard candy
• Avoid mouth care products that contain alcohol
• Use a room humidifier if available
• Apply Vaseline® to lips or nasal passages with a cotton swab

Nausea

• Take pain medicine with food unless instructed otherwise
• Nausea is usually mild and goes away after several days
• Medicines to treat nausea may help
• If nausea persists, talk with your health care provider. A different pain medicine may cause you less nausea

Drowsiness

• Expect drowsiness for a few days when pain medicine is started or the dose is increased
• A stimulating environment, i.e. lights, music, etc. may help you feel more alert
• If drowsiness persists after a few days, talk with your doctor

Measures to Increase Comfort in Addition to Medication

Heat

• Heat can relax muscles and give comfort. Use warm showers or baths, hot water bottles, warm washcloths, or heating pads
• Do not use heating pads on skin that has been radiated
• Do not use heat over medication patches, such as fentanyl patches

Cooling

• Cooling can soothe pain, especially pain from inflammation or swelling. Use cool washcloths or ice pack

Positioning

• Use pillows and cushions to create a comfortable position
• An adjustable bed or recliner may be more comfortable than a regular bed

Relaxation techniques

• Pain can cause you to tighten your muscles and use shallow breathing. A variety of techniques can help you relax and reduce pain
• Consider deep breathing exercises, progressive muscle relaxation, meditation, or guided imagery

Massage

• Massage areas that are sore due to pressure, muscle strain, or muscle tightness
• Do not massage areas that are sore due to cancer involvement

Distraction

• Involvement with pleasant activities may allow focusing on something other than the pain for a period of time

This article is intended as a resource for patients receiving their cancer care at Duke University Hospital or Duke Clinic. It is not intended to substitute for medical advice from your health care team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.