How to Manage Pain
This guide is for adults who have pain before, during or after cancer treatment, and for their family, friends or caregivers. It does not replace advice from your health-care team.
What is cancer pain?
When you have cancer pain, it:
- Can be described as hurting or suffering
- May come and go or be with you all the time
Only you know how much pain you feel and how it affects you. You do not have to accept pain as a normal part of living with cancer. You may have one or more of the different types of cancer pain:
Bone pain can be deep, throbbing or pulsing and may feel sharp at times. Bone pain may get worse when you are moving.
Nerve (neuropathic) pain may feel like burning, shooting, piercing, stabbing, stinging, tingling or like an electric current. Nerve pain may hurt when things like clothing, water or wind touch your skin.
Soft tissue (visceral) pain is pain in the tissues that surround the organs inside your body, such as tendons, ligaments and some muscles. It might feel like a dull, deep squeezing pain.
Causes of cancer pain
Talk to your health-care team about what may be causing pain for you. Some examples of things that can cause cancer pain include:
- A tumour (growth) pressing against organs, nerves or body parts, such as bones
- Symptoms or side effects of cancer and treatment, like constipation and mouth sores
- Medical tests and procedures, such as biopsies (a physician takes a small piece of tumour to examine it)
Tell your health-care team (physician or nurse) right away if you have any of these symptoms:
- Pain that is not going away or is getting worse
- A new pain that you haven’t had before
- Pain when you take a deep breath
- Sudden leg weakness, especially if you have back pain
Managing cancer pain
When your pain is well controlled, you can:
- Sleep and eat better
- Enjoy time with family and friends
- Do your work and hobbies
Things you can do to manage your cancer pain include:
- Take pain medicine(s)
- Move your body
- Try mindfulness and other complementary therapies
- Other treatments as recommended by your health-care team
Your health-care team may choose a palliative approach to managing your pain. Palliative care focuses on relieving your symptoms and helping you feel comfortable. It can help people at all stages of cancer and treatment, not only those at the end of life.
Pain medicine
To control your pain as much as possible, your health-care team will carefully plan:
- The type and amount of pain medicine you take
- How often you take your medicine
Contact your health-care team as soon as you can if you are still in pain while taking pain medicine.
You may need to take a combination of prescription and over-the-counter medicines for your pain.
Prescription pain medicines may come in pills, creams or other forms. Prescription pain medicine may include:
- Opioids, which are strong pain medicines such as morphine
- Medicine to treat nerve pain
- Steroids to lessen inflammation (swelling) or slow down the immune system
Over-the-counter medicines can be purchased from a pharmacy or store without a prescription. Talk to your health-care team before taking any of these medicines to make sure they are safe for you. Over-the-counter pain medicine may include:
- Acetaminophen (Tylenol™)
- Ibuprofen (Advil™ or Motrin™)
- Muscle relaxants (such as Robaxacet™) and rubs (such as Voltaren™)
Pain medicine usually works best when taken on a schedule. It is easier to prevent pain than to stop it once it has started. Your health-care team will work with you to make sure you are as comfortable as possible at all times. Do not save your pain medicine in case the pain gets worse later.
Breakthrough pain is any type of pain that starts between your regular doses of pain medicine. It may happen suddenly or when you do not expect it. Having breakthrough pain does not mean that your cancer is getting worse or that you have a new problem.
To prevent breakthrough pain, take your pain medicine on time even if you do not feel pain.
Important things to know when taking opioid pain medicines
Opioid pain medicines cause constipation. Your health-care team may have you take a daily laxative to help you have a bowel movement (poo) while taking these medicines.
Worries about addiction and dependence are normal. Addiction to opioid medicine is not common for people with cancer, but it can happen even when opioids are used as prescribed. Dependency is not addiction. Dependence is when your body gets used to a drug after taking it regularly. Unpleasant symptoms can happen if you stop taking the drug too quickly. Your health-care team will help you make a plan to stop taking your pain medicine slowly.
What to do if pain medicine stops controlling your pain
At times, your pain may be worse or harder to control. Your health-care team may need to change the amount or type of pain medicine that you take. Your health-care team can help if you:
- Have trouble remembering to take your pills
- Need help making a schedule to take your pills at the right time
- Miss a dose of medication
- Feel like your pain medicine isn’t working as well as it should
- Have side effects from your pain medicine
Cannabis (marijuana) for pain
Many people with cancer would like to try different forms of cannabis to help treat symptoms and side effects. Talk to your health-care team about whether cannabis may help your pain.
Exercise or move your body to relieve pain
Small, simple movements or exercises may help with your pain. Talk to your health-care team to make sure the activities you choose are right for you. You could try:
- Getting up to get your own glass of water or snack
- Sitting up instead of lying down
- Walking to the end of your driveway or up and down your hallway
- Gentle stretching
If you are already active, talk to your health-care team about how to safely continue your exercise routine. They may suggest you speak to a(n):
- Physical therapist
- Occupational therapist
- Registered massage therapist
Take care of your mind and body
Your mind, body and feelings are very connected. Coping with pain can be upsetting and stressful, and these feelings can make your pain feel worse. It may help to:
- Talk to someone you trust about how your pain makes you feel
- Talk to your health-care team or a counsellor
- Talk to your spiritual or religious leader if this is something that gives you comfort
- Join a special self-help or pain self-management group to learn how to manage your pain
- Ask your health-care team about programs in your community
The activities below may help you relax or keep your mind off your pain:
- Deep breathing exercises or meditation
- Activities you enjoy, such as puzzles, crafts, hobbies or watching TV
- Walking outside, gardening, enjoying nature, reading or listening to music
If your pain is making you sad, nervous or worried, talk with your health-care team about these feelings.
Cancer treatments
Radiation therapy may help control pain, especially for people with cancer that has spread to their bones. Chemotherapy treatments can also help with pain for some people.
Using heat and/or ice
Applying heat or ice to the body may help for mild cancer pain. Heat can ease sore muscles and ice can help numb an area.
Heat and ice may not be safe if you are getting radiation therapy, chemotherapy or if you have numbness from nerve damage. Check with your health-care team before you try these.
Complementary therapies
Complementary therapies are treatments you can try along with your regular cancer treatments to help you manage your pain. Talk to your health-care team before trying any complementary therapies to make sure they are safe for you. You may try:
- Massage therapy
- Aromatherapy
- Music therapy
- Reflexology
- Acupuncture
- Transcutaneous electrical nerve stimulation (TENS machine)
- Reiki
- Hypnotherapy
For more information about these therapies, visit the Canadian Cancer Society’s website.
Talking to your health-care team about pain
Do not be afraid to tell your health-care team that you are in pain.
Describe your pain to your health-care team. They need to know details about your pain so they can help you feel better. Think about the following questions to help you describe your pain to your health-care team:
- What does your pain feel like?
- Is it burning, aching, stabbing, piercing, throbbing, etc.?
- Would you describe your pain as mild, medium or severe?
- What makes your pain better? What makes it worse?
- Does your pain go away or get better when you take your medicine?
- Is your pain getting in the way of doing your daily activities and taking care of yourself?
- Is your pain causing you stress?
Use a pain diary to keep track of your pain
A pain diary is a place to record details about your pain. It can help you see how your pain changes over time and what makes it better or worse. Here is a sample pain diary* you could use to write down information about your pain.
For each entry, record the following:
- Date
- Time
- Rate the pain on a scale of 0 to 10 (0 is no pain and 10 is the worst possible pain)
- Where do you feel pain?
- What does the pain feel like (e.g., tingling feeling)?
- What were you doing when you started to feel pain?
- Name of medicine and amount taken
- Non-medication techniques you tried (e.g., exercise, acupuncture)
- How long did the pain last?
- Any other notes
*Pain diary from the American Cancer Society
Key points
- You do not need to live in pain
- Cancer pain can be treated to help you live comfortably
- Taking pain medicine and doing other treatments together will likely work best to treat your pain
- Talk to your health-care team about your pain often and let them know about any changes you feel
Where to get more information
Visit the websites below for more information and support.
Websites
Support services
For more information on this symptom, or for guides to help manage other symptoms, visit Managing Symptoms, Side Effects & Well-Being.
If you need this information in an accessible format, contact 1-877-280-8538, TTY: 1-800-855-0511 or [email protected].
The recommendations in this guide are based on published evidence and expert consensus.
This patient guide was created by Ontario Health (Cancer Care Ontario) in collaboration with clinical experts and patients to provide information about pain. It should be used for information only and does not replace medical advice. This guide does not include all information available about managing pain. Always ask your health-care team if you have questions or concerns. The information in this guide does not create a physician-patient relationship between Ontario Health (Cancer Care Ontario) and you.