Pain

Acute pain often starts suddenly and feels ‘sharp’. It usually lasts days or weeks. Acute pain usually stops when the cause of the pain has been treated, or tissue in the area has healed.

• an operation
• a broken bone
• an infection.

If acute pain is not relieved, it may become chronic pain.

Chronic pain lasts for longer, usually for 3 months or more. Chronic pain is sometimes called persistent pain. It may be caused by the cancer. Or it can sometimes be due to an ongoing side effect or late effect of cancer treatments. Sometimes it can be caused by something not related to the cancer or the treatment.

People who take long-acting painkillers to manage chronic pain will often also use short-acting painkillers when they need to.

You may find the pain can get worse just before your take your next dose of long-acting painkiller. This can be because the effects of the long-acting painkillers are wearing off. Your doctors may need to increase the dose of long-acting painkillers if their effect is wearing off too soon.

If you are taking regular painkillers for chronic pain, you may still feel sudden pain. This is called breakthrough pain. It is common and usually feels like the chronic pain, only worse. Or it can feel different.

Breakthrough pain may happen because:

• the effect of the regular long-acting painkillers has worn off
• the pain is worse at a certain time of day
• you make a sudden movement, or you cough.

Sometimes it is not clear what has caused the breakthrough pain.

Breakthrough pain can last for a short time, or sometimes for longer periods. It may be treated with a short-acting painkiller. It is best to take the painkiller before the pain gets severe. Waiting longer before taking the painkiller can increase the time it takes for the painkiller to work.

Cancer that has spread to the bones (secondary bone cancer) can cause pain. The pain can feel different to different people but may be a dull ache that does not go away. It is often worse when you move.

Soft tissue pain is when there is damage to, or pressure on, your organs or muscles. For example, when the liver is swollen it causes pain and discomfort in the tummy (abdomen).

Nerve pain is caused by pressure on the nerves or by nerve damage. This may be due to the cancer or cancer treatments. You may have nerve pain at some times but not others. The area may feel numb or sensitive. The pain may be:

• burning or tingling
• stabbing or shooting
• like pricking, tingling or numbness on the skin.

Your doctor can prescribe drugs and other treatments to treat nerve pain.

An injury or problem in one part of the body may sometimes cause someone to feel pain in a different part of the body. This is called referred pain. For example, someone with a swollen liver may feel pain in their right shoulder. This is because pain signals from the liver travel along the same nerves as signals from the skin of the right shoulder. The brain confuses the signals and thinks the pain is coming from a different place.

Some people may feel pain in a part of the body that has been removed. This is called phantom pain. For example, someone might feel pain after having a limb removed (amputated), or a breast removed (mastectomy). The cause of phantom pain is not always clear. It may happen because the brain remembers the part of the body that was removed and the links to the nerve signals.

Phantom pain can cause different pain sensations that are very real to the people who experience it. It can improve with time and may eventually go away. It may be complicated to treat and is usually managed by expert doctors at a pain clinic.

When you are at home, your GP can talk to you about medicines or treatments to help control pain. They can prescribe painkillers and check with you to find out how well they are working. They can increase the dose of the painkiller or change you to a different drug if needed. Your GP can also contact your cancer doctor or nurse for further advice.

Your GP can arrange for a district nurse to visit. They can also refer you to other healthcare professionals such as a specialist palliative care team or a pain team.

If you meet with your cancer doctor (oncologist) or nurse regularly, it is important to tell them about any pain you have. They can explain what is causing the pain and how to manage it. Some people may need tests to find out the cause of the pain.

Your cancer team may ask you to contact them if you have pain, or if it gets worse. It is important to follow their advice.

A community nurse can visit you at home to help you manage your pain. They may sometimes be called a district nurse. They can check that your pain medicines and treatment are working. They can advise you about:

• taking your medicines
• different ways of managing the pain
• getting equipment that helps make you more comfortable.

A physiotherapist is someone who gives advice about exercise and mobility.

They may be able to show you different ways of moving to help manage the pain. If pain is affecting how far you can walk, they can suggest ways to make getting around easier. For example, they can arrange walking aids or a wheelchair.

An occupational therapist is someone who gives information, support and aids to help people with tasks. These may include washing, dressing, or making meals. An OT can help provide equipment to make you more comfortable. For example, they may suggest special cushions or mattresses. If you have difficulty moving around, they can arrange handrails and ramps for your home to help you move more easily. They can also suggest ways to improve your energy levels and be more active.

A pharmacist can check your prescription, give you advice about your medicines and tell you how they may affect you. Tell your pharmacist if you are buying any over-the-counter medicines. They can tell you whether it is safe to take them with your prescribed painkillers and other drugs.

Specialist palliative care doctors and nurses are experts in managing symptoms such as pain. They also give emotional support. Specialist palliative care teams work in hospitals, in the community and in hospices. The team may also include:

• a physiotherapist
• an OT
• a counsellor or psychologist

Some people find it helpful to meet with a counsellor or psychologist. This is a person who gives advice about managing feelings and behaviours. They can help you find ways to:

• cope with the pain
• deal with any worries or emotions that may be making the pain worse.

Many hospitals have specialist pain teams. The team includes doctors, nurses and usually a specialist doctor called an anaesthetist. Some teams also have a psychologist.

Your GP, cancer doctor or specialist palliative care team can refer you to a pain team. This can be very useful if your pain is difficult to control or you need a nerve block or other specialist treatment. 

Sometimes it can help to spend some time in a hospice having your pain, symptoms and other problems treated. This may be for 1 to 2 weeks.

Your community specialist palliative care team or GP can arrange this for you. If you are in hospital, the palliative care team can arrange for you to go into a hospice if you need more specialist symptom control before going home.

In the hospice, the doctors and nurses can adjust your medicines to get better control of your pain. They can often do this more quickly than if you were at home. Once your pain is controlled, you can go home again. At home, your GP and community specialist palliative care team can continue to help you. Your GP will know about community palliative care and hospice services in your area.

The British Red Cross has volunteers who can help you with things like shopping, posting letters or changing library books. They may be able to help you get to hospital appointments. They also lend equipment like wheelchairs and commodes (portable toilets). Services vary in different parts of the UK..

Living Made Easy has information and advice for disabled people. They also have advisers and occupational therapists who can advise about mobility aids and equipment.

Scope has practical information and emotional support and advice for disabled people.

Some areas have schemes to help people with things like shopping, meeting other people or transport. These are often called good neighbour schemes and are usually run by social services or local community organisations. Contact your local council or look online to find out what is available in your area.