Pain Control for People With Lung Cancer

Causes of Cancer Pain and Methods for Managment

Doctor talking to patient about pain control for cancer
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Pain management for people with lung cancer has come a long way, but concerns about pain remain frightening to nearly everyone diagnosed with the disease. It's true that most people will have pain at some time during their journey with lung cancer. There are a number of ways in which cancer can cause pain, and these different types of pain may respond to different treatments. While pain is subjective, there are a number of pain scales that can help people better describe what they are experiencing. There are many options for pain control in addition to medications, including interventional pain control techniques such as nerve blocks, radiation therapy, bone modifying drugs, and more. In addition, some complementary and alternative therapies may help people cope with pain (though they are used in addition to conventional pain treatments).

Unfortunately, studies have found that many people with cancer are undertreated for pain, and there are many reasons for this, such as fear of addiction, fear of side effects, and the fear that medications will no longer work in time. In 1986, the World Health Organization published guidelines for managing cancer pain. Using this approach, as well as newer techniques, the vast majority of people can experience good pain control throughout their lung cancer treatment.

Frequency of Pain

Pain is very common with lung cancer, and 51 percent of people living with lung cancer experience some form of pain during their treatment. With advanced lung cancer, nearly everyone will require some type of treatment to relieve pain. In addition, it's thought that one in three people with cancer ends up coping with neuropathic pain - one of the more difficult types of pain to treat.

Causes

Lung cancer can result in pain in several ways. Some of these include:

  • Pain from the tumor pressing on nerves, bones, or the pleura (lung lining.)
  • Pain from lung cancer symptoms, such as coughing.
  • Side effects of treatment for lung cancer, such as mouth sores during chemotherapy, or incision pain following surgery.
  • Chronic pain after lung cancer surgery referred to as postpneumonectomy syndrome or post-thoracotomy syndrome.
  • Other diseases that are present along with lung cancer, such as arthritis or headaches
  • Peripheral neuropathy related to chemotherapy medications.

Importance

Cancer pain can interfere with your quality of life by disrupting your sleeping, eating and exercise habits, and can even lead to depression.

Proper treatment of pain can improve your ability to cope as you go through cancer treatment, and help you take part in normal activities that you enjoy. Adequate pain control is essential physically as well, and is associated with a better response to treatment, such as improved healing after surgery.

Describing Pain to Your Doctor

Your doctor will ask you to describe the nature of your pain. Is it sharp or dull, constant or does it come and go? What makes it better and what makes it worse? He will also ask you how severe your pain is. Doctors use several types of “pain scales” to help you describe the intensity of pain you are experiencing. The most common method is to ask you to describe your pain on a scale from 1 to 10, with 1 being barely noticeable pain, and 10 being the worst pain you can imagine.

Barriers

Studies suggest that pain is undertreated with lung cancer. Several factors can contribute to inadequate pain control, including:

  • Fear of addiction: People who take medications for cancer pain rarely become addicted.
  • Fear that pain medications will no longer work, and there will be nothing left to control pain if it gets worse: If you do develop a tolerance to pain medicines, there are many options that remain.
  • Fear of side effects from pain medications: Pain medications can have side effects, but many of these are fairly easy to control.
  • Inability to afford pain medications: If you cannot afford your pain medication, your oncologist may be able to change your prescription to one that is less expensive, or direct you to a program where you can receive financial help.

Treatments

Lung cancer can cause significant pain, and the majority of people will need medications to control pain at some point during their treatment. If pain becomes very severe, procedures such as nerve blocks can provide further relief. Some non-medication therapies may also help to control your pain.

Medications for Cancer Pain

Medications to control cancer pain fall into 3 main categories:

  • Over-the-counter medications: Over the counter medicines such as Advil (ibuprofen) or Tylenol (acetaminophen) can help with very mild pain.
  • Opioids: Opioids such as codeine and morphine are usually needed for moderate pain.
  • Other medications: Medications such as anti-depressants and anti-seizure drugs are sometimes used for burning/tingling pain, and steroids can be helpful with pain caused by swelling.

Interventional Pain Control Treatments

A problem with medications for cancer pain control, is that the doses needed to adequately control pain often come with side effects. Interventional pain control techniques are those that have been devised to help solve this problem, and address the pain at its source (the nerves.) Some of these methods include:

  • Nerve blocks - A procedure in which medication is injected around a nerve or into the spine fluid (intrathecal delivery), which can help with severe pain.
  • Spinal cord stimulation.
  • Neurosurgery which severs the nerves that send pain signals to your brain.

Pain Control for Bone Metastases

When lung cancer spreads to bone it can cause significant pain. The treatment for bone metastases may include several types of therapies that can be very effective. Radiation therapy can sometimes drastically reduce pain, and does so fairly rapidly. This can be used along with opioid pain medications. There are now bone modifying drugs for bone metastases that not only reduce pain, but have anti-cancer effects as well. By changing the microenvironment of the bone, they can reduce the chance that cancer cells that travel to bones will "stick" and begin to grow.

Vitamin D and Cancer Pain

While vitamin D may not be the answer to all of your pain, talking to your doctor about a supplement is very worthwhile. We've learned in recent years that the majority of people have a vitamin D deficiency, and having a deficiency is correlated with lower cancer survival. A recent study in Sweden provided even more impetus to test levels, however, as it may play a role in pain. Researchers in Sweden found that using a vitamin D supplement for people with cancer was associated with a lower need for narcotic pain medications, better pain control, and a better quality of life. Since your vitamin D level can be checked with a simple blood test, talk to your doctor if you haven't yet had this tested.

Alternative Approaches to Pain Control

Many cancer centers now offer complementary/alternative approaches to help with pain control. These are not a substitute for other pain treatments, but some have been shown to reduce the need for pain medications. Some of the methods that appear promising include acupuncture, massage, and qigong.

Medical Marijuana

With many states having now legalized the use of medical marijuana, some people with cancer are using this as an adjunct in addition to other types of pain control. According to the National Cancer Institute, there are now several studies that have found cannabis to be effective in reducing cancer pain, including difficult-to-treat neuropathic pain.

Coping

The most important thing you can do is talk openly with your oncologist and your loved ones about any pain you are experiencing. Everyone experiences pain differently. None of us can read minds, and it is important to share how you are feeling so your health care team can take action to help. If you have fears about becoming addicted, or that the medicines will stop working, express those fears. If you are concerned about the cost of pain medications, tell your oncologist. If you feel you are burdening your loved ones talking about your pain, know that it is important for them to understand what you are going through. Your loved ones will be able to support you the best if they understand you aren’t feeling well – and can encourage you to seek out the pain relief you deserve.

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