Pain is a sensation that hurts. It may cause discomfort, distress or agony. It may be steady or throbbing. It may be stabbing, aching, or pinching. However you feel pain, only you can describe it or define it. Because pain is so individual, your pain cannot be “checked out” by anyone else. Pain may be acute or chronic. Acute pain is severe and lasts a relatively short time. It is usually a signal that body tissue is being injured in some way, and the pain generally disappears when the injury heals. Chronic pain may range from mild to severe, and it is present to some degree for long periods of time.

What Causes Pain For People With Cancer?
Cancer patients may have pain for a variety of reasons. It may be due to the effects of the cancer itself, or it could result from treatment methods. For example, after surgery a person feels pain as a result of the operation itself. Or the pain could be unrelated to the cancer - a muscle sprain, a toothache, or a headache. Remember that not all people with cancer have pain. And those who do are not in pain all the time. Cancer pain may depend on the type of cancer, the stage (extent) of the disease, and your pain threshold (or tolerance for pain). Cancer pain that lasts a few days or longer may result from:

 
• Poor blood circulation because the cancer has blocked blood vessels.  
• The tumor causing pressure on organs, nerves, or bone.  
• Blockage of an organ or tube in the body.  
• Metastasis - cancer cells that have spread to other sites in the body.  
• Infection or inflammation.  
• Side effects from chemotherapy, radiation therapy , or surgery.  
• Stiffness from inactivity.  
• Psychological responses to illness such as tension, depression, or anxiety.

Whatever the cause, pain can be relieved.

What Can Be Done for Cancer Pain?
The best way to manage pain is to treat its cause. Whenever possible, the cause of the pain is treated by removing the tumor or decreasing its size. To do this, your doctor may recommend surgery, radiation therapy, or chemotherapy. When none of these procedures can be done, or when the cause of the pain is not known, pain-relief methods are used. This booklet describes many methods for controlling pain. They include pain medicines, operations on nerves, nerve blocks, physical therapy, and techniques such as relaxation, distraction, and imagery. Only you and your doctor and nurse - who know where your pain is, how bad it is, the kind of cancer you have, and your general health - can decide which methods might be best for you.

What Do I Tell Those Caring For Me About My Pain?
If you are feeling pain, you need to be able to describe it to those who are trained to help you. Some people find pain very hard to explain. Try to use words that will help others understand what you are feeling. Your doctor and others who are caring for you need to know:

 
• Where do you feel your pain?  
• When did it begin?  
• What does it feel like? Sharp? Dull? Throbbing? Steady?  
• How bad is it?  
• Does it prevent you from doing your daily activities? Which ones?  
• What relieves your pain?  
• What makes it worse?  
• What have you tried for pain relief? What helped? What did not help?  
• What have you done in the past to relieve other kinds of pain?  
• Is your pain constant? If not, how many times a day (or week) does it occur?  
• How long does it last each time?

Pain has different effects on different people. Be sure that those who are caring for you know about the effects. Don’t hesitate to talk about your pain to those who can help you. You have a right to the best pain control you can get. Relieving your pain means you can continue to do the everyday things that are important to you. Remember, only you know what you are feeling.

Some of the Effects of Pain
Symptoms accompanying your pain: nausea, headache, dizziness, weakness, drowsiness, constipation, diarrhea, perspiration.

Emotional effects: anger, depression, crying, mood swings, irritability, suicidal feelings.

Lifestyle changes: work, recreation, interpersonal relationships, ability to get around, self-care activities.

How Can I Describe How Bad or Intense the Pain Is?
Understanding how bad your pain is helps your doctor decide how to treat it. You can rate how much pain you are feeling by using a pain scale like the one below. Try to assign a number from 0 to 5 to your pain level. If you have no pain, use a 0. A 5 means the pain is as bad as it can be. As the numbers get larger, they stand for pain that is gradually getting worse. You may wish to make up your own pain scale using numbers from 0 to 10 or even 0 to 100. Be sure to let others know what pain scale you are using: for example, “My pain is a 7 on a scale of 0 to 10.” You can use a rating scale to answer:

 
• How bad is your pain at its worst?  
• How bad is your pain most of the time?  
• How bad is your pain at its least?  
• How does your pain change with treatment?

How Can I Remember All the Details About the Pain I Have, and What I Do To Relieve It?
You may find it helpful to keep a record or a diary about your pain and what you try for pain relief. The record helps you and those who are caring for you understand more about your pain, the effects it has on you, and what works best to ease your pain. Items that should be included are:

• The number from your rating scale that describes your pain before and after using a pain-relief measure.  
• The time you take pain medicine.  
• Any activity that seems to be affected by the pain or that increases or decreases the pain.  
• Any activity that you cannot do because of the pain.  
• The name of the pain medicine you take and the dose.  
• How long the pain medicine works.  
• Any pain relief methods other than medicine you use such as rest, relaxation techniques, distraction, skin stimulation, or imagery.

Can Anxiety Or Depression Cause Pain?
No, but these feelings can make the pain seem worse. People often have an emotional reaction to pain. You may feel worried, depressed, or easily discouraged when you are in pain. Some people feel hopeless or helpless. Others feel alone or embarrassed, inadequate or angry, frightened or frantic. People with cancer have many reasons for feeling anxious or depressed even when they are not in pain. Try to talk about your feelings with your doctors, nurses, family members, friends, a member of the clergy, or other cancer patients. Talking with family members is often helpful, even though this might be hard for you to do at first. In some communities, cancer patients meet informally to talk about their feelings and share how they have coped with this disease. Just understanding that others feel the same way as you do might help you deal with having cancer.

For information about support services in your area contact your local Unit of the American Cancer Society, the Visiting Nurses Association, the Cancer Information Service at 1-800 4 CANCER (1-800-422-6237), or someone from a hospice, if one is located in your area.

If you feel that these informal ways to lessen your anxiety or depression are not helpful, you may wish to talk with a counselor, a mental health professional who is skilled at dealing with such problems. Your doctor or nurse may be able to help you find a counselor who is specially trained to help people with chronic illnesses. The social services department at your local hospital is another source of information about people who can help you deal with anxiety and depression. Another option is to ask your doctor about medication. Sometimes, medicine such as antidepressants or tranquilizers can be helpful. Some of these medicines relieve pain in addition to their antidepressant effects.

How Does Fatigue Affect My Pain?
Fatigue can make it harder for you to deal with pain. When you are tired, you may not be able to cope with the pain as well as when you are rested. Many people notice that pain seems to get worse as they get tired. Lack of sleep can increase your pain. Be sure to tell your doctor or nurse if you have not been sleeping well because of pain or worry.

What Is Phantom Limb Pain?
If you have had an arm or leg removed by surgery, you may still feel pain or other unpleasant sensations as if they were coming from the absent limb. Doctors are not sure why it occurs, but phantom limb pain is real; it is not imaginary. This also can occur if you have had a breast removed - you may have a sensation of pain in the missing breast. No single pain-relief method controls phantom limb pain in all patients all the time. Many methods have been used to treat this type of pain, including pain medicine, physical therapy, and nerve stimulation. If you are having phantom pain, ask your doctor, nurse, or pharmacist about how you might relieve it.

How Is Cancer Pain Treated?
When treating cancer pain, the doctor will usually try to treat the cause of the pain first. Surgery, chemotherapy, or radiation therapy may be used to shrink tumors. There are several ways to relieve pain:

 
• With medicine, also called “pharmacological pain relief.” You should ask your doctor, pharmacist, or nurse for advice before you take any medicine for pain. Medicines are safe when they are used properly. You can buy some effective pain relievers without a prescription. For others, a prescription from your doctor is necessary.  
• Without medicine, sometimes called “noninvasive measures.” These usually have very few side effects, and they can be combined with medicines. Methods may include skin stimulation and techniques such as distraction, relaxation, and imagery.  
• Nerve blocks, or “neurological pain relief.” Blocking the pain messages that are sent by nerves to the brain (with surgery or injection of local anesthetic into the nerve) can sometimes be used when nothing else works to relieve pain.  
• Radiation therapy is often used to relieve pain that is due to cancer that has spread to other sites in the body (metastasis).

There is no one best way to relieve pain, but something usually can be found to help every patient.

Are There Any General Guidelines for Relieving Pain?
It is important to try to prevent the pain before it starts or gets worse by using some pain-relief method on a regular schedule. If pain begins, don’t wait for it to get worse before doing something about it. Learn which methods of pain relief work best for you. Vary and combine pain relief methods. For instance, you might use a relaxation method at the same time you take medicine for the pain. Know yourself and what you can do. Often when people are rested and alert, they can use a method that demands attention and energy. When tired, they may need to use a method that requires less effort. For example, try distraction when you are rested and alert; use hot or cold packs when you are tired. Be open-minded and keep trying. You may find that some things that sound as if they could not possibly work, might be helpful. Be willing to try different methods. Keep a record of what makes you feel better and what doesn’t help. Try each method more than once. If it doesn’t work the first time, try it a few more times before you give up. Keep in mind that what doesn’t work one day may work the next. Also, you might need help in figuring out the best way to use a certain technique. But don’t get discouraged if a certain method does not work for you. People are different, and not all the methods will work for everyone. Most important, always ask yourself: Which is more bothersome - the pain or the method of making it go away? Does pain relief allow me to do what is important to me and those I care about?

What Should I Do if My Pain Is Not Relieved and My Doctor Says Nothing More Can Be Done for Me?
Cancer pain almost always can be substantially lessened or relieved. However, no one doctor can know everything about all medical problems. If you are in pain and your doctor has nothing more to offer, ask to see a pain specialist. Pain specialists may be oncologists, anesthesiologists, neurosurgeons, other doctors, nurses, or pharmacists. A pain control team may also include psychologists and social workers. If you have difficulty locating a pain program or specialist, contact a cancer center, a hospice, or the oncology department at your local hospital or a medical center.