Treating Cancer Pain

MSK has experts in managing pain in people being treated for cancer, or who had cancer. 

Therapy can help with pain for most people. Sometimes we cannot relieve all the pain. But we can manage pain and other symptoms very well. This will improve your quality of life during and after cancer treatment.

Please tell your care team right away if you’re feeling pain. We can help. 

In fact, pain can make some cancer treatments not work as well. It’s very important to talk with your care team if you have any pain. 

Checking your pain level

You may not feel pain the same way as other people. That’s why your care team will assess how much pain you’re feeling. They’ll also focus on:

•    Your diagnosis
•    The stage of disease
•    Your response to pain and treatments
•    Your personal likes and dislikes
 

At MSK, you’ll have regular screenings to see if you have pain. We’ll ask about your pain level, whether you’re in the hospital or in an outpatient (not the hospital) setting. 

If you’re in the hospital, we’ll ask every 4 hours if you have pain. We also encourage you to tell your nurse or doctor if you’re in pain.

We measure your pain level on a scale of 0 to 10. No pain is rated as a 0. The worst pain you can think of is a 10. 

Palliative care

Palliative (PA-lee-uh-tiv) care helps ease your pain and other symptoms of illness.

Palliative care also is called supportive care. It’s a way of caring for you that focuses on you as a whole person, not just your illness. It includes physical, emotional, and spiritual care.

You can get palliative care at any point during an illness. Palliative care can be part of treatment, care after treatment, end-of-life care, or hospice care.

Managing your pain

Managing pain is an important part of cancer care. MSK was the first cancer center in the country to have a service just for treating pain in people with cancer. 

Our pain experts will help relieve or manage pain during treatment and after surgery. They can help while you’re still in the hospital, and after you’re home.

Research has helped us learn the best ways to treat pain. We now know more about pain receptors and how pain signals reach the brain. This research has given us better therapies for treating pain in people with cancer. 

Here are some of the methods we use at MSK.

Treating cancer to help with pain

Treating cancer with surgery, radiation, chemotherapy, targeted therapy, or immunotherapy can kill some or all of the cancer. This helps lower your pain level.

Managing pain with surgery or radiation therapy

Surgery and radiation therapy can help with pain and other symptoms. As part of palliative care, these treatments can improve your quality of life.

Surgery can help prevent or control pain caused by cancer complications (problems). Examples of complications are:

• Blocked bowels (poop) 
• Compressed (squeezed) spinal cord or peripheral (peh-RIH-feh-rul) nerves
• Compressed organs

Palliative surgery and radiation focus on comfort. Most often, we offer them to people with advanced cancer.

Pain relief medicine and opioids

Your care team will choose medicine that’s right for you, based on your level of pain. We may use medicines such as pain medications and opioids.

What are opioids?

Opioids are strong painkillers prescribed to help with moderate to severe pain. They’re also called narcotics. Opioids have some risks but can help you manage your pain. It’s important to follow your healthcare provider’s instructions when you take opioids.

Your care team may prescribe opioids if other medicines do not help, or if they affect your cancer treatment. Opioids can help you manage your pain so you can do your daily activities.

Opioids work very well as pain killers for cancer pain at any stage. Some common opioids are:

• Hydrocodone (Vicodin®)
• Oxycodone (Percocet, Oxycontin®)
• Hydromorphone (Dilaudid®)
• Morphine (Duramorph)
• Fentanyl patch (Duragesic)
• Codeine (Codeine Sulfate)
• Tramadol (Ultram®)
• Methadone (Dolophine®)

Pain levels

We describe how much pain you feel by grouping it into 3 levels.

Preventing opioid and morphine addiction

Addiction is a strong urge to use a substance, such as opioids or morphine.

Opioid misuse is when you:

• Do not take opioids the way our healthcare provider prescribed them.
• Take someone else’s opioids.
• Take opioids when you do not need them.

You can safely manage your pain with opioids by following your healthcare provider’s instructions. MSK doctors take special care to make sure you’re safely prescribed morphine and opioid medicines.

You can use higher doses of opioids for years without getting addicted or psychologically dependent on the drugs.

When you no longer need opioids for pain, we can help you manage opioid physical dependence without withdrawal symptoms. Your care team will taper the dose. That means you’ll use less each time before stopping completely. People with cancer very rarely try to use drugs except to control pain.

How do you take pain relief medicine for cancer pain?

Pain medicine is given in few ways, based on your needs and preferences. 

•    Oral pain medicine is medicine you take by mouth (swallow).
•    Some oral pain medicine is put under your tongue until it’s absorbed.
•    Some pain medicine is put into your rectum.
•    Intravenous (IV) pain medicine goes into a vein. 
•    Some pain medicine is injected just under your skin.
•    A patch with pain medicine is absorbed by your skin.
•    A pump delivers the medicine to the space around your spinal cord.

Most often, a nurse will administer (give you) these medicines. As well, you can give yourself the medicine and control the amount you use. You control the amount of pain medicine by pressing a button on a computerized pump. This is called patient-controlled analgesia (AN-ul-JEE-zee-uh), or PCA. 
 

Other drugs for cancer pain relief

We sometimes prescribe drugs that most often are used to treat something other than pain. These drugs are called adjuvant analgesics (A-juh-vunt AN-ul-JEE-zee-uhz). They include antidepressants, anticonvulsants, and steroids. 

These drugs work very well to manage the types of pain related to cancer.  For example, inflammation (swelling) can cause tingling and burning sensations. Adjuvant analgesics treat these symptoms.

Nerve blocks for local pain

A nerve block is when a local anesthetic is used to block a group of nerves from feeling pain. This medicine stops your nerves from sending pain messages from the local area to your brain. It often targets just 1 or 2 nerves.

Nerve blocks can offer short-term relief from pain. They help with bad pain, pain after surgery, and some chronic (long-term) pain problems. Nerve blocks work best for pain that’s only in a smaller area.

Your doctor injects a local anesthetic where you have pain. The medicine goes into or around nerves in that area, or below the skin. The anesthetic helps relieve pain for up to a few hours. 

Another procedure is called a neurolytic block. It kills the nerves that send pain messages from the area to your brain. Your doctor injects a substance, most often ethyl alcohol or phenol. It goes into a nerve or into the spinal fluid, stopping the pain for a long time or even forever.
 

Intrathecal (pain) pumps

An intrathecal (in-truh-THEE-kul) pump is a small, round device that holds pain medicine. It’s implanted (surgically placed) under your skin at the side of your abdomen (belly). The device also is called a pain pump.

Most of the medicine from the intrathecal pump goes right to the nerves in your spine. This means you need less medicine and should have fewer side effects.

This method is works better than other options. Pain medicine delivered by mouth or an IV does not go just to your nerves and spinal cord. It goes all over your body, including places that do not need pain medicine. You also must get a bigger dose. That’s because the medicine is diluted (watered down) as it travels through your body. 

If an intrathecal pump is right for you, you’ll have a surgery to implant your pump. The device sends pain medicine through a catheter (thin tube) right to the nerves in your spine. 

Your doctor will give you a device called a personal therapy manager (PTM). You can give yourself an extra dose of medicine from the pump, if you need it. Your doctor will set the amount of medicine in this dose.

Neurosurgery to control cancer pain

Pain medicine does a good job of managing most pain related to cancer. There are other options if drug therapy does not relieve pain enough, or has side effects.

Neurosurgery is one option. The most common procedure is called a cordotomy (kor-DAH-toh-mee). This surgery cuts some nerves in the spinal cord that send pain signals to the brain. Neurosurgery procedures also are used to implant devices that deliver pain medicine, or stimulate nerve fibers to prevent pain.
 

Psychological and mental health methods

Psychological care is an important part of managing pain. MSK offers short-term psychotherapy, structured support, and cognitive behavioral therapy. These methods help you learn skills to cope with pain.

MSK’s mental health experts were among the first to use psychiatry to care for people with cancer and their families. A psychiatrist (sy-KY-uh-trist) is a doctor with special training in mental, emotional, and behavioral health. They can prescribe medicine.

Our experts can evaluate and manage the psychiatric and mental health complications (problems) related to cancer and its treatment. We also have counseling services to support you during and after cancer treatment.

Integrative medicine for cancer pain

Integrative medicine can help with cancer pain relief during any stage of treatment. These methods are used along with other ways of controlling pain.

Integrative medicine, also known as complementary medicine, uses many methods to help relieve strong pain. It can help during procedures, with pain after procedures, and with some types of chronic (long-term) pain. Methods include:

• Relaxation
• Meditation
• Movement therapies
• Acupuncture
• Massage therapy

MSK’s Integrative Medicine Service offers individual therapy and group classes to people with cancer. If you’re a hospital patient at MSK, you can arrange for services by calling 646-888-0888.