What is pain management?

Cancer and some of the treatments for it can cause pain. But having cancer does not mean that you have to live with pain. Medicines and other treatments can reduce or stop your pain completely. Getting your pain under control is an important part of cancer treatment. It can help you eat and sleep better, have more energy for your usual activities, and enjoy time with your family and friends.

Pain control starts with finding the cause of the pain. As soon as your doctor knows what is causing your pain, the doctor can recommend the best treatment for your type of pain.

Medicines are often used to treat pain. You and your doctor may need to adjust your medicine to help you get the best possible pain control with the fewest side effects. Your doctor may suggest different medicines, combinations of medicines, or higher doses. You do not need to "tough it out" or wait until your pain is bad before you take medicine. Pain medicine may work better if you use it when you first notice pain, before it becomes bad.

You are the only person who can say how much pain you have, or if a certain pain medicine is working for you. It is important to tell your doctor what your pain feels like and what works and does not work. The more specific you can be about your pain, the better your doctor will be able to treat it.

Besides pain medicine, there also are many other ways to control cancer pain, including things you can do at home. Some people find acupuncture, massage, and aromatherapy helpful. Or you may want to use relaxation exercises, biofeedback, or guided imagery to help you cope better with the pain. Emotional support from your family and friends can also help.

Treatment for pain from an SCI depends on the type of pain you have. Treatments may include:

Complementary therapies.

These may help reduce pain. They may also help you cope with stress and improve your emotional and physical well-being. These therapies include:

• Acupuncture. This involves putting very thin needles into the skin at certain points on the body.
• Biofeedback. This is a method of consciously controlling something that is normally controlled automatically by the body, such as skin temperature.
• Guided imagery. This is a series of thoughts and suggestions that direct a person's imagination toward a relaxed, focused state.
• Hypnosis. This is a state of focused concentration. In hypnosis, a person becomes less aware of their surroundings. Some people learn to manage pain by concentrating in this way.
• Yoga. This uses meditation and exercise. Yoga helps you improve your breathing, be more flexible, reduce stress, and stay healthy.

Transcutaneous electrical nerve stimulation (TENS).

This treatment applies brief pulses of electricity to nerve endings in the skin. It can relieve chronic pain.

Counseling (such as cognitive-behavioral therapy).

This focuses on your mental health and conditions such as stress and depression. These can happen along with chronic pain and can make it worse. To recover from your chronic pain, it's important to take care of your emotional health and your physical health.

Medicines for neuropathic pain.

These include anticonvulsants (such as gabapentin) and tricyclic antidepressants (such as amitriptyline).

Anesthetic medicine or surgery.

Segmental pain may be treated by injecting an anesthetic medicine into the space between the wall of the spinal canal and the covering of the spinal cord. This is called an epidural block. Or surgical procedures that cut nerve roots may be used for this type of pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen.

These may be used to treat secondary overuse pain. Limiting or taking breaks from the activity that causes pain may also help.

Antispasmodics such as baclofen and tizanidine (Zanaflex).

These are used to treat muscle spasm pain.

If you have pain, don't ignore it. Talk to your doctor. Pain can be a sign of a more serious problem.

Chronic pain often requires both counseling and medical treatment, because it can have a wearing effect on both the body and the mind. At a pain management clinic, you can get multidisciplinary treatment from a team of specialists, including:

Physiatrists.

These medical doctors specialize in physical medicine and rehabilitation. They often coordinate a chronic pain treatment team.

Psychologists or counselors.

They teach cognitive-behavioral skills for managing pain, anxiety, and depression.

Physical therapists.

They teach exercises for improving and maintaining strength, function, and mobility.

Doctors who prescribe pain medicine and are skilled in pain management devices and procedures.

These doctors include neurologists, anesthesiologists, physiatrists or physical medicine specialists, internists, and family medicine doctors.

Doctors who prescribe medicine for supporting mental health.

These doctors include psychiatrists and family medicine doctors.

Nurses or social workers.

These professionals help support and coordinate patient care.

Other specialists, such as complementary medicine providers, may also be available in a chronic pain management clinic. These specialists meet to share information and make sure that care is coordinated.

Some chronic pain clinics have a stronger emphasis on invasive treatment, such as injections and surgical procedures, than others. Look for a clinic that offers you a choice of noninvasive treatments, including cognitive-behavioral therapy. Before having an invasive pain treatment, ask your doctor about his or her experience with that treatment. Also, ask about research that shows how well it works for your condition.

You may feel some pain during your stay in the hospital. A certain amount of pain from an injury or surgery is common and normal.

Pain is your body's way of letting you know that something is wrong. Your body's nerve endings send pain signals to your brain. Everyone feels pain differently. It can be dull or sharp. It can throb or burn. It can move from one part of your body to another.

No matter how much or why or for how long it hurts, pain can make it hard to move, sleep, and recover. Your care team will work with you to help manage your pain.

Controlling your pain can help you to:

• Be active.
• Sleep.
• Cope better with your treatment for a health problem.
• Enjoy family and friends.
• Eat with pleasure.
• Heal faster after an injury or surgery.

Long-term pain that isn't controlled can take the joy from your life. You may not be able to work. Physical activity may be too painful or exhausting. You may have a hard time sleeping at night, which can make you tired and cranky. Your outlook on life may change and strain your relationships with family and friends. You may become depressed and anxious.

Controlling pain can help with all these things.

Your doctor will explain how much pain you should expect and how long it may last. This will depend on what is causing your pain.

Controlling pain doesn't always mean that you will feel no pain at all. You and your doctor can work together to find ways to limit your pain as you recover so you can feel better and do more for yourself.

Your feelings about how you want your pain to be managed are important. Some things that might shape what you prefer include:

• How you've dealt with pain in the past.
• Your feelings about side effects of medicine.
• Your past health.
• Your age.

Your doctor will talk with you about what options are available in your case. Your choices for pain control might include more than one medicine. In the hospital, you might get intravenous (I.V.) medicines through a tube in a vein in your arm or hand. You may also use a type of pump that lets you give yourself a certain amount of pain medicine if you need it. And some pain control medicines might be in pill form.

Some conditions can make pain control more complex. If this is true in your case, you might be referred to a pain specialist.