Chronic Pain

Survivors sometimes experience ongoing pain after cancer treatment. Knowing what the causes are and being able to describe your symptoms to your health care team can help you manage chronic pain.

Detailed Information

Suggestions

Additional Resources

Print this Topic

Email this Topic

Chronic Pain: Detailed Information

Many cancer survivors experienced pain during their treatment and find ways to manage it with the help of their health care teams. However, there are survivors who have pain after their treatments ahve ended. Their chronic(often called persistent) pain can be mild or very severe, and it can affect your quality of life after cancer. The good news is that htere are many ways to treat pain; these can greatly reduce of even eliminate the pain.

It’s understandable if you feel upset or overwhelmed by your pain. Be sure to tell your health care team if you are having pain. It’s important for you to tell them even if they don’t ask about it. Pain should not prevent you from going about your daily routine and doing the things in life that are important to you. Talk to members of your healthcare team and set goals for pain control. There are many ways to manage pain and lessen the effect it has your life.   You should not have to live your life in pain. Talk to your doctor or nurse to find ways to address your pain so your quality of life is not impacted.

Do all survivors experience chronic pain?

Not every survivor experiences chronic (persistent) pain, but some do and the causes vary. Chronic pain can result from treatment of cancer or because the cancer has spread to other parts of the body. Individuals who had breast, prostate, lung or colorectal cancer may have pain because their cancer has spread to their bones. Bony metastases are the most common cause of pain in advanced cancer. 

Peripheral neuropathy due to injury to nerves may result from treatment with chemotherapeutic agents and can cause pain, tingling, burning, numbness or weakness. It usually begins in the hands or feet. Most of the time the pain caused by peripheral neuropathy will go away when the treatment stops. However, if your nerves become permanently damaged, the pain will persist. 
Taxol, vincristine,Taxotere and cisplatin are chemotherapy medicines that may cause peripheral neuropathy.

If you took steroids as part of your treatment for cancer, you may be at risk for chronic bone pain during your survivorship. Steroids can cause the bones to grow weaker. This can lead to osteoporosis, which may cause chronic bone pain. Talk to your health care teamif you took steroids during your cancer treatment to find out what your risk of chronic pain is.

Radiotherapy and surgery can lead to a variety of acute and chronic pain problems. Studies have shown that unrelieved acute postoperative pain is a major risk factor for delayed recovery and the development of chronic pain problems.

What you should tell your doctor, nurse or other members of your health care team?

Be sure to tell your doctor or nurse:

• If you experience a new pain
• If your current pain medication stops working or aren't working as well as they did
• If the pain changes or feels different to you
• If you develop painful swelling in the arm or leg
• If you feel pain, numbness, tingling or a burning sensation in your hands or feet

What can be done to manage your pain?

There are things your health care team can do to help reduce or eliminate how much pain you feel. Forming a strong partnership with your health care team is essential for good pain management.

There are many medications to treat pain:

• For mild pain, medications such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDS). Some of these drugs such as ibuprofen and naproxen that .
• For moderate pain, medications that combine an opioid (sometimes called a narcotic) such as hydrocodone or oxycodone with acetaminophen or aspirin may be needed. Vicodin and Percocet are examples of these combination drugs. The dose of these combination drugs is limited by the toxicity of the acetaminophen or aspirin.
• For severe pain, medications that contain an opioid only (sometimes called a narcotic) such as morphine, oxycodone, fentanyl or methadone are usually needed.
• Adjuvant medications may be important for the treatment/management of neuropathic pain. These are medications with primary uses for other conditions, but which are effective for certain kinds of pain. Examples include the antidepressants Elavil and Cymbalta.

While pain medicine is almost always needed when pain is moderate or severe, other treatments can bring comfort and reduce the stress that can make pain worse. Heating pads, hot or cold packs, or massage can soothe the body. You may also want to explore how to use your mind and spirit to help with your pain and to help deal with your illness. Some turn to spiritual faith, others learn breathing exercises, relaxation, visualization and imagery. Sometimes laughing, talking with friends or listening to music can distract you from pain.

Your doctor may also suggest a technique called a nerve block, where medication is injected directly into or around a nerve or into or around the spine to block the nerves so that you will not feel the pain. 

Every survivor is different and every survivor may respond differently to pain management strategies. Open communication with your health care team can help you figure out together what strategies work best to manage your pain.

What are some suggestions for survivors who are trying to manage chronic pain?

• Use the Cancer Survivor’s Health Journal to prepare for your next visit with a member of your health care team.
• Talk to your health care team about any medication they prescribe for pain.
• Keep track of any medication you take for pain.
• Ask your health care team about complementary therapies.

This document was produced in collaboration with:
Peggy Flood, RN, MS, AOCN

Works Cited

American Cancer Society. A Guide to Pain Control. Atlanta: American Cancer Society, 2001.

Cherny, Nathan. “Cancer Pain: Principles of Assessment and Syndromes”. Principles & Practice of Palliative Care & Supportive Oncology 2nd Edition. Ed. Ann M. Burger, Russell K. Portenoy, David E. Weissman. Philadelphia: Lippincott Williams & Wilkins, 2002.

Dillard, J., N., The Chronic Pain Solution, Your Personal Path to Pain Relief. New York:
Bantam, 2002.

McCaffery, Margo, Pasero, Chris. Pain: Clinical Manual 2nd Edition. St. Louis: Mosby, 1999.

Rosenfeld, A., The Truth about Chronic Pain, Patients and Professionals on How to Face it, Understand It, Overcome It. New York: Basic Books, 2003.

[return to top]

CHRONIC PAIN: Suggestions

Use the Cancer Survivor’s Health Journal to prepare for your next visit with a member of your health care team:

• The Cancer Survivor’s Health Journal can be found at www.livestrong.org/cancersupport in the Download Worksheets tab.
• Use the Health Diary to record any symptoms that you notice and when they happen.
• Use the Health Care Team Appointment document to write down everything you want to ask your health care team. You can write notes and questions on the sheet between appointments.
• Use the List of Medications to keep track of your medications. Bring this list to your appointment along with all of your medication bottles. This lets the team know all the medications you are taking, including vitamins and over-the-counter medications.
• Use the Health Care Team Appointment document to take notes during the appointment and to write down your next appointment date.
• Keep all of these documents together in a binder and bring it with you to your appointments.
• Bring extra copies of all of these documents with you to give to the health care team. You can also email, fax or mail these documents in before the appointment. Having the health care team read your documents may be an easier way for you to communicate.
• You can store pamphlets, medication side effect inserts and important phone numbers in your binder so that everything is in one place.

Talk to your health care team about any medication they prescribe for pain:

Medications are commonly prescribed by physicians to help control pain. It is important to understand as much as you can about the medications you are taking.

Questions to ask your health care team about medications:

• What is the name of the medication?
• How much should I take (dosage and strength)? Do patients understand these terms?
• When should I take this medication?
• Should I eat before I take it?
• Does this medication have any side effects?

Keep track of any medication you take for pain:

Some of the things that may help you:

• Pill dispensers
• Making lists
• Asking a family member or friend to help you keep track

Ask your health care team about complementary or alternative therapies:

Complementary or alternative therapies can be used along with medications to help you manage your pain. Some complementary therapies you may want to discuss with your health care team:

• Acupuncture
• Aromatherapy
• Art
• Dance
• Diet and nutrition
• Herbs, vitamins and minerals
• Music
• Meditation
• Reflexology
• Tai Chi
• Yoga
• Massage
• Spiritual care

[return to top]

Chronic Pain: Additional Resources

The resources listed below provide more detailed information and support services to help you with chronic pain.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

Click a resource for more information:

• LIVESTRONG SurvivorCare Program
• National Cancer Institute (NCI)
• American Cancer Society
  

LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare

LIVESTRONG SurvivorCare offers assistance to all cancer survivors, including the person diagnosed, caregivers, family and friends. The program provides education, information about treatment options and new treatments in development, counseling services and assistance with financial, employment or insurance issues. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations, including CancerCare, Patient Advocate Foundation and EmergingMed.

The LIVESTRONG Survivorship Notebook is a tool that can help you organize and guide your cancer experience. The portable, three-ring binder contains a variety of information covering a full range of physical, emotional and practical survivorship topics. You may order a free LIVESTRONG Survivorship Notebook at www.livestrong.org/notebook. Shipping and handling charges will apply.

 Return to top

National Cancer Institute (NCI)
www.cancer.gov

Cancer.gov, the National Cancer Institute Web site, provides accurate, up-to-date information on many types of cancer and the challenges cancer can bring. You can also use the site to search for information by cancer type or topic, and you can access information about treatment-related issues. Information about financial and insurance matters is also included. You can learn how clinical trials work and search for a clinical trial in your area. This site has a detailed dictionary of cancer terms. Web site information and publications are available in Spanish.

 Return to top

American Cancer Society
www.cancer.org

The American Cancer Society Web site contains information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area, or you can join online groups and message boards. Some information on the Web site is available in Spanish, Chinese, Korean and Vietnamese. Information specialists can answer questions 24 hours a day by phone or email.

 Return to top

[return to top]