Cancer pain is often undertreated

Pain is the result of a physiological series of electrical and chemical events that occur in the body. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

Pain receptors are bare nerve endings that are widely distributed throughout the body in the skin and mucous membranes. When pain receptors are triggered by mechanical, chemical, or thermal stimuli, the pain signal is transmitted through the nerves to the spinal cord and then to the brain.

Pain depends on many factors such as the type of cancer the stage of the disease, and the patient’s tolerance.

Cancer pain can result from the following:

  • Blocked blood vessels causing poor circulation
  • Bone fracture from metastasis
  • Infection
  • Inflammation
  • Psychological or emotional problems
  • Side effects from cancer treatments such as chemotherapy and radiation
  • Tumor exerting pressure on a nerve

Initially, pain may produce physiological signs such as grimacing, rapid heart rate, sweating, and rapid breathing. Patients with pain lasting more than 3 months (chronic pain) often do not display physiological signs and as a result, chronic pain often is undertreated. Communication between the patient and physician is important to ensure adequate pain relief.

When possible, if cancer pain is caused by a tumor, removing or reducing the tumor that is causing it may help. When the tumor cannot be removed, the pain can be treated in other ways.

Incidence and prevalence of cancer pain

Studies have shown that 90% of patients with advanced cancer experience severe pain and pain occurs in 30% of all cancer patients, regardless of the stage of the disease. As many as 50% of patients may be undertreated for cancer pain, yet not all cancer patients experience pain. Pain usually increases as cancer progresses.

The most common cancer pain is from tumors that metastasize to the bone. Sixty to eighty percent of cancer patients with bone metastasis experience pain. The second most common cancer pain is caused by tumors infiltrating the nerve. Tumors near neural structures may cause the most severe pain. The third most common pain associated with cancer occurs as a result ofchemotherapy, radiation, or surgery.

Cancer pain may occur in different parts of the body. In one study, more than 80% of patients experienced pain in two distinct areas, and more than 30% experienced pain in three or more distinct areas.

Chronic cancer pain

Effectively treating chronic pain poses a great challenge for physicians. Pain from cancer often affects a person’s life in many ways. It can change someone’s personality, ability to function, and quality of life.

According to the American Cancer Society, chronic cancer pain may involve persistent pain and breakthrough pain. Persistent pain is continuous and may last all day. Breakthrough pain is a brief flare-up of severe pain that occurs even while the patient is regularly taking pain medication. It usually comes on quickly and may last from a few minutes to an hour. Many patients experience a number of episodes of breakthrough pain each day.

Breakthrough cancer pain can result from the cancer or cancer treatment, or it may occur during a certain activity (e.g., walking, dressing, coughing). It also can occur unexpectedly, without a preceding incident or clear cause. Breakthrough pain usually is treated with strong, short-acting pain medications that work faster than persistent pain medications.

Regardless of the type of pain you may be experiencing due to cancer, it is important to discuss it with your specialists and be persistent.  If you feel like your physicians aren’t taking your pain seriously enough, you may need to elicit help from family members and schedule a conference with your primary caregiver and your doctors to convey your level of pain.  Remember that it is not okay to suffer in silence.  Ask for help when you need it.  You will feel better and your family will rest easier knowing that their loved one is getting some relief from their pain.

Jennifer Kelly is a molecular geneticist and oncologist.

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  • Anonymous

    Pain management was the one bit of good luck my father had in his long struggle with prostate cancer. As soon as we learned it had spread, his doctor told him “you will have no pain.” And he didn’t. His doctors made sure he had the proper painkillers. I was afraid they would try a “minimum necessary” approach, but they didn’t. It took Norco, fentanyl, oxycontin, and percodan, but he never was in pain. He was able to drive, still had an appetite, and side-effects were handled. The proper approach to what would have been hideous pain was a gift to all of us. On the day he died, the county sheriff took away all the painkillers, which gave my mother some peace of mind, not worrying about having it all in the house when there are so many people hunting for painkillers and when she would also have her grandchildren in the house with all the adults distracted. Another bit of help in very hard times.

  • Trista

    “Don’t suffer in silence.” The generations are certainly changing to be more vocal about their needs and in this instance, pain. Too often, patients feel they are undermining their doctors or being disrespectful when they ask for something that has not been offered. Doctors that I have observed have done a great job of proactively combating this by communicating with patients up front and creating trust in the doctor/patient relationship. Patients and their families should take active responsibility in care by trusting their intuition and laying every thought, question and concern on the table. I commend health teams that encourage this and foster that type of relationship. It makes an ugly battle as positive as it can be. 

  • Anonymous

    We often under treat pain, because we know they are doomed to be addicts! Patients whose pain is under control can eat and sleep and move and their chances of participating in life go up dramatically. If someone has a terminal disease or is critically ill why would you withhold pain meds?

  • Anonymous

    I’ve often thought what people go through that have
    cancer pain. Its one thing to have chronic pain but cancer pain with chronic
    pain is scary. I’ve dealt with chronic pain for 24 years now and if it ever
    comes to cancer pain I know exactly how to deal with it. Actiq pops and a time
    released pain medication.

    No person in cancer pain should have to suffer, if you
    are a cancer patient with chronic pain don’t be afraid to ask for pain relief,
    you deserve it, the Actiq pops are good for flare up pain or break through pain.
    All it is ,is a round pop on a stick and you roll it on the inside of your
    cheek. Its sad to hear these stories, I had a friend that had a heart attack in
    front of me about a month ago. He went fast, he had suffered enough paralyzed
    from a car accident. I truly believe he is in a better place

    Its amazing
    you’re here on day and gone the next.

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