Transcutaneous electrical nerve stimulation (TENS)
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TENS machines send a weak electrical current through the skin. TENS works in two ways:
It stimulates the nerves that carry non-painful messages to the brain. As these nerves are stimulated, they override and block the messages being carried in the pain nerves. This prevents painful messages from reaching the brain.
It can also make the body release its own natural painkillers called endorphins.
TENS can help relieve cancer pain, especially if it’s in a specific part of the body. It’s common to use TENS alongside other treatments for pain.
TENS machines are usually only available for short-term loan on the NHS. Pain teams, physiotherapists and many palliative care teams can advise you on whether TENS is suitable for you and how to use it. Usually they will loan you a TENS machine so you can see how helpful it is before you decide whether to buy one. There are also many companies that sell TENS machines, but it’s always best to get specialist advice before buying and using a TENS machine.
Nerve blocks may help relieve pain by preventing pain messages from getting to the brain.
Nerves can be blocked using drugs such as local anaesthetics (sometimes given with steroids) or other chemicals such as alcohol or phenol. Local anaesthetics produce a short-lasting block. Although alcohol or phenol produce a longer-lasting block, they are less commonly used because of the side effects associated with them.
Specific nerve blocks may help specific pains. For example, pain from the pancreas may be reduced by something called a coeliac plexus block.
Occasionally epidural or intrathecal analgesia may be needed to control severe pain that is very difficult to control or if painkillers are causing unacceptable side effects. These techniques usually involve giving a continuous infusion of a painkiller (such as morphine, diamorphine or fentanyl) with or without a local anaesthetic by a fine tube that is inserted into the epidural or intrathecal space. The tube may be connected to an external pump or an internal pump, which is placed under the skin during a minor surgical procedure. The pumps are refilled with painkillers as required.
Nerve blocks are specialist techniques that are usually carried out by a pain team specialist (usually an anaesthetist) in your local hospital or at a specialist pain clinic. Your GP or hospital specialist can refer you to a pain team specialist, who usually works as part of a wider team of healthcare professionals known as a pain team.
Pain may stop you from using the part of your body that hurts. This can lead to the deterioration of muscles and joint stiffness, which in turn may make pain and disability worse. Physiotherapy can help treat the problem and lead to an improvement in pain relief. Your GP will be able to refer you to a physiotherapist, who will be able to advise you on exercises that may help.
It’s thought that acupuncture may work by stimulating the body to produce endorphins. It can be helpful for some people with cancer. A number of specialist NHS pain and palliative care teams offer acupuncture. Your GP or cancer specialist can refer you.
Learning to relax and let go of your fears and anxieties - even if only for a short time each day - can play a useful part in your overall pain control. There are two main types of relaxation exercises:
Physical exercises work on tension in your body. A technique called progressive muscle relaxation involves getting to know particular groups of muscles in the body and learning to tense and relax them. Once you can relax and contract stomach muscles, neck muscles and others individually or together, you can start using the technique during stressful periods to help reduce tension and therefore pain. When you have learned the basic techniques, you can use them to help with pain relief during more difficult times.
Mental exercises, such as imagery exercises, help relax your mind. These can be particularly helpful if you find that anxiety is making your pain worse.
Try to find a quiet, warm, dimly lit, relaxing place where you will not be disturbed, then lie or sit in a well-supported position. You will get the maximum benefit from these techniques if you practise them for 5-15 minutes each day. Using relaxation tapes can be great way to learn different exercises. You may want to just experiment until you find the best exercise for you, or you can ask your doctor if there is a healthcare professional, such as an occupational therapist or psychologist, who can help you find the technique that’s best for you.
Hypnotherapy may help relieve cancer pain, but it is rarely effective on its own. However, self-hypnosis can play a part in helping you relax, which can help reduce the effect of emotional upset on your level of pain. Your GP may have a list of local therapists who provide hypnotherapy, or you can contact the National Register of Hypnotherapists and Psychotherapists for further information.
If you’re being treated for any mental illnesses, check with your doctor before using meditation. Although meditation can be helpful - for those with anxiety and depression, for example - it can also make problems worse if not properly supervised.
There are many different types of meditation, but they are all aimed at calming your mind and becoming at peace with yourself. You can try meditation by sitting quietly and being aware of your breathing, without trying to control it. Whenever you become aware that thoughts have come up in your mind, just come back to the awareness of your breathing. If you prefer, you can put an object in front of you and pay attention to that instead.
Meditation can be very difficult at first, and you may feel initially that you are getting worse as you become aware of how busy your mind is. However, it will become easier as you practise.
It may help you let go of distressing or depressed thoughts for a period of time. It’s helpful to practise meditation once or twice a day and to have guidance from an experienced meditator. You can find details of meditation organisations in your local phone book or at your local library.
Visualisation (creating mental images) is a technique that helps you bring happy, relaxing pictures into your mind and use them to overcome some of your pain. By ‘seeing’ and ‘hearing’ images and sounds that bring you pleasure, you can, to some extent, shut out symptoms of pain and discomfort.
You may find meditation, visualisation, relaxation or a combination of these techniques helpful in relieving your pain. Methods vary but the overall aim is the same: to reduce stress and other emotional factors that may be making your pain worse. You can either go to classes to learn these techniques or buy tapes, CDs, records or books. Your GP may know of local relaxation classes, some of which are especially suited to the needs of people with cancer.
Meditation, relaxation and visualisation are explained more fully in our section on Cancer and complementary therapies.
It’s natural to feel a whole range of powerful emotions, including depression, fear and anxiety, when dealing with cancer. These emotions can make pain worse.
It’s important that you are given emotional support. It helps if you acknowledge your feelings and don’t bottle things up.
You may have anxious feelings from time to time and it may help to talk through your feelings with your partner, a close friend or relative.
If you feel anxious most of the time or you don’t feel able to talk to someone close to you (perhaps because it upsets you both too much), let your GP know. Your GP can put you in touch with a counsellor. There are many other support organisations you can contact, or you can speak to one of our cancer support specialists who may be able to give you details of local support groups.
Sometimes your GP may suggest that you take either an antidepressant or a sedative drug such as diazepam to help improve your mood or reduce anxiety.
Our section on the emotional effects of cancer discusses has more advice for ways of dealing with these emotions.
Serious illness can force people to take life more seriously, to question its meaning and to stop taking things for granted. Some people who have religious beliefs may find their faith greatly shaken by their cancer diagnosis. Even people who have never been regular worshippers may experience spiritual as well as emotional pain. People often ask questions such as, ‘Is there life after death?’ and ‘Why should the people I love suffer?’ Unanswered questions such as these, which relate to fundamental beliefs, can cause great emotional and spiritual pain that can increase the experience of physical pain.
It’s often hard to accept or understand why an illness like cancer happens to you or to those you love. People often have feelings of anger and guilt, and you may worry about how the cancer will affect your family now and in the future. Sometimes the strength of these emotions may make you feel isolated and frightened, and you may withdraw from family and friends. It can help to talk to someone about these feelings.
Some people find great comfort in religion at this time, and it may help to talk to a local minister, hospital chaplain or other religious or spiritual leader. If you don’t feel that this is the right sort of support for you, talking with family and friends, a counsellor or someone from a cancer support organisation may help. You can use our organisation search to find details of organisations that provide counselling.