KEY POINTS

• Nerve blockages
• Neurological Treatments
• Cordotomy
• Palliative Care
• Radiation therapy
• External Radiation Therapy
• Radiopharmaceuticals
• Physical Medicine and Rehabilitation
• Integrative Therapies

Some cancer patients can control their pain with medications. However, some patients experience too many adverse effects or pain in certain body parts. Talk to your doctor to determine the best way to reduce your pain. Other treatment options include:

Nerve blockages

A Nerve Block is an injection that injects a local anesthetic or another drug around or into a Nerve to block the pain. The nerve block is used to control pain when other methods are ineffective. The nerve blocks can also determine the source of pain, predict how pain will react to treatment over time, and prevent pain after specific procedures.

Neurological Treatments

Surgery is performed to insert a Device which delivers drugs or stimulates nerves using mild electric current.

Cordotomy

The cordotomy procedure is less standard and is used for pain relief by cutting some spine nerves. This stops the sensations of pain and cold/hot. Patients with severe pain and nearing the end of their lives may choose this procedure.

Palliative Care

Palliative Care Services can be of great help to specific patients. Palliative-care providers are also known as support care providers. These professionals work together in teams with doctors, nurses and mental health specialists. They also include pharmacists, dietitians, chaplains and social workers. Palliative care has several goals, including:

• Enhance the quality of life of patients and their family members.
• Manage pain and non-pain symptoms.
• Support patients with higher doses of opiates, with a history of substance abuse disorder, and dealing with emotional, social, and psychological problems.

See Transitioning to End-of-Life Care in Advanced Cancer for more information.

Radiation therapy

Radiation Therapy relieves pain for patients who have skin lesions or tumors. Palliative Radiation Therapy is the term used for this type of treatment. It can be administered directly as Local Therapy to the tumor or to more significant parts of the body. Radiation therapy can help drugs and other medicines to work better by shrinking the tumors that cause pain. Radiation therapy can help patients move more freely with less pain.

Radiation therapy can be of the following types:

External Radiation Therapy

External Radiation Therapy is a treatment that uses an external machine to deliver high-energy radio waves and other types of electromagnetic radiation towards the cancerous area. External radiation therapy can relieve pain caused by cancer that has spread into the bones. Radiation can be administered in one dose or several smaller doses over time. The cost and ease of getting the treatment may influence whether or not a single dose is given. Patients who do not experience pain relief after their first radiation treatment may benefit from repeating the radiation therapy.

After receiving palliative radiotherapy for cancer that has spread into the bones, patients may experience a Pain Flare. This is a temporary worsening in pain.

Radiopharmaceuticals

Radiopharmaceuticals contain radiation that can be used to treat cancer or diagnose it. Radiopharmaceuticals can also treat cancer that has spread into the bones. One dose of radioactive agent injected into a vein can relieve pain in cases where cancer has spread from one area of the bone to another or when external radiation therapy is not practical.

Physical Medicine and Rehabilitation

Cancer patients may experience pain and lose strength. They may also need help managing their everyday activities. Physical Therapy and Occupational Therapy can help.

Physical medicine uses physical methods such as machines and exercises to treat or prevent disease.

A physiatrist can help develop a plan that is tailored to the patient. Some physiatrists have also been trained in pain management and treatment procedures.

Integrative Therapies

Complementary or alternative therapies and standard treatments may be used to treat pain. Integrative therapies are also used to describe them. Integrative therapies have been used for pain relief.

Treating Cancer Pain in Older Patients

KEY POINTS

• Cancer pain treatment for older adults is affected by certain factors.
• Patients over 65 years old may receive more than one medication.
• Doses start at lower levels.
• Older patients are more susceptible to side effects.
• In older patients, there is a risk that they will not receive enough treatment.

Cancer pain treatment for older adults is affected by certain factors.

Patients 65 and older are more susceptible to specific problems. The following are essential considerations for caregivers who care for these patients:

Patients over 65 years old may receive more than one medication.

Patients over 65 may suffer from more than one chronic condition and be taking several medications for different needs. This can increase the likelihood of interactions with drugs. Drugs can interact with each other and affect chronic disease.

Doses start at lower levels.

In older patients, pain medicine may be started at lower doses and gradually increased to account for the differences in their pain threshold, expression of pain, and effects on physical and psychological function. Older patients may experience better pain relief, and it may last longer.

Older patients are more susceptible to the side effects of drugs.

It is essential to monitor older patients for adverse effects caused by opioids or NSAIDs. For more information, see side effects of opioids. Some NSAIDs can cause side effects.

• Acetaminophen.
• Proton Pump Inhibitors (given along with NSAIDs).
• Topical Nonsteroidal anti-inflammatory drugs
• NSAIDs with COX-2 (NSAIDs which cause fewer problems in the stomach and intestinal).

In older patients, there is a risk that they will not receive enough treatment.

The following factors can lead to undertreatment of older patients:

• Patients don't report their pain.
• Patients cannot talk about their pain.
• The doctor worries about possible side effects of pain medication or changes in the patient's behavior.

Other problems can arise from poor pain control in older patients.

• Reduced mental or physical function
• Slow recovery.
• Changes in sleep, appetite and sleep patterns.
• Need for increased care and assistance due to health problems.

Treatment of depression can help in the treatment of pain.

Find out more about cancer pain.

See the following for more information about cancer Pain from the National Cancer Institute:

• Side effects of cancer treatment and pain
• Cancer Pain Control Support for Cancer Patients
• The Opioid Epidemic & Cancer Pain Management

What This PDQ Summary Is About

About PDQ

The National Cancer Institute (NCI) has a comprehensive cancer information database called Physician Data Query. The PDQ database summarizes the most recent published information about cancer prevention, detection genetics, treatment and supportive care. The majority of summaries are available in two versions. In the health professional version, detailed information is written in technical terms. The patient versions use a simple, non-technical style. Both versions contain accurate, up-to-date cancer information. Most performances are available in Spanish.

PDQ is an NCI service. The National Institutes of Health includes the NCI. NIH is a federal Centre for biomedical research. These PDQ summaries were compiled based on a review of medical literature conducted independently. These are not official statements from the NCI or NIH.

The Purpose of This Summary

This PDQ cancer summary contains current information on the causes and treatments of pain. This is intended to help and inform patients, their families and caregivers. This document does not provide formal guidelines or recommendations to help make decisions about health care.

Reviewers and updates

The Editorial Boards are responsible for updating the PDQ cancer summaries. These Boards consist of cancer specialists and experts in other cancer-related specialities. The outlines undergo regular review and are updated when new information becomes available. Each summary will have a date ("Updated") to indicate the most recent changes.

The PDQ Supportive & Palliative Care Editorial Board regularly reviews and updates the information contained in this patient summary.

Clinical Trial Information

A clinical trial is an experiment that answers a scientific question, such as which treatment is superior. Tests are based on past studies and the knowledge gained in laboratories. Each trial answers specific scientific questions to find better and new ways to treat cancer patients. During clinical trials for treatment, information about a new treatment's effectiveness and effects is collected. A clinical trial that shows a new treatment to be superior to the one currently used may lead it to become "standard". Some patients may consider taking part in clinical trials. Some clinical trials are only open to patients who need to start treatment.

You can find clinical trials on the NCI website. Call the Cancer Information Service, NCI's Contact Center, at 1-800-4 CANCER (1,800-422-6237) for more information.

Permission to use this summary

PDQ has been registered as a trademark. The content of PDQ files can be freely used as text. The NCI PDQ cancer summary cannot be identified unless it is displayed and updated regularly. A user can write a sentence like "NCI's PDQ Cancer Information Summary about Breast Cancer Prevention states the risks: [include an excerpt from the summary].

This PDQ summary can be cited in the following way:

Editorial Board of PDQ(r). PDQ Cancer Pain. Bethesda: National Cancer Institute. Updated. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-pdq. Accessed. [PMID: 26389322]

Images used in this summary were created with the permission of the authors, artists and publishers for the PDQ summaries. You must obtain permission from the owner to use an image in a PDQ Summary but not the full summary. The National Cancer Institute cannot give it. Visuals Online contain information on how to use the photos from this summary and many others related to cancer. Visuals Online has more than 3,000 images of scientific research.