Cancer Pain

For a long time, cancer was feared not only as a killer, but as a cause of suffering.

Many things can be done to help make cancer and its treatment a more comfortable experience.

Pain that happens when someone has cancer comes from three main places:

  1. Cancer can cause pain by pushing on or harming bones, nerves, muscles and/or internal organs.
  2. Treatments, such as chemotherapy, radiation and surgery, can be uncomfortable or lead to painful conditions.
  3. Many diagnostic tests such as bone marrow biopsies and blood draws can cause pain.

Mucositis (myoo-koh-SY-tis) commonly causes pain. It happens when a patient receives some types of chemotherapy and their white blood cell count drops to zero. The lining of the mouth and digestive system breaks down and ulcers form. This can be very painful. Patients often experience diarrhea and/or vomiting, as well.

Chemotherapy used for bone marrow transplant preparation is often linked with the worst and longest episodes of mucositis. Eating and having bowel movements can be very uncomfortable, and patients often need strong pain medication to help with the discomfort. As the white blood cell count returns to normal, the ulcers heal and the pain goes away. This can take from a few days to a few weeks, depending on the situation.

There are many ways to treat cancer pain. Each patient is different, and the cancer affects each person differently. Treatments can include the following:

  • Mucositis is usually treated with opioid (OH-pee-oyd) medication (such as morphine), often with the use of a patient-controlled analgesia pump (PCA).
  • If a child can eat or drink, usually pain medicine by mouth works well.
  • If pain from nerve or bone involvement is the problem, then medications are used that specially treat those specific types of pain.
  • Sometimes interventions, like radiation, nerve blocks and/or epidurals, are needed.
  • At Cincinnati Children's Hospital Medical Center, the Palliative Pain Service is generally involved for complex pain.

Opioid medication is sometimes feared for the effect it can have on breathing, but this is rarely a problem. However, constipation is often a problem with the use of opioid medication. Patients may be given medicine to help keep the bowels moving normally. Let the doctor or nurse know if it has been more than two days since having a bowel movement. 

Other general side effects of opioid medication can include:

  • Sleepiness
  • Nausea
  • Itching
  • Dry mouth
  • Dizziness
  • Trouble urinating

Your child's doctor and/or nurse will check with you about these side effects. Please let them know if you think your child may be having a side effect from the medicines.

  • Be yourself. That's simple, but it's also difficult. Playing with children helps distract them from what is going on that is scary or unpleasant. Talking with children allows them to get things off their chest. They know they are sick, and kids as young as 4 years old have talked of dying. They are not being protected by having their questions avoided.
  • Speak up for your child. You understand your child best. Help the doctors and nurses interpret what your child is feeling, so they can help your child feel less afraid and be more comfortable.

At Cincinnati Children's, you can expect your child to be made as comfortable as possible. The hospital staff will also try to keep side effects to a minimum. Unfortunately, there are times when pain cannot be made to completely go away. Other times, there will be unavoidable side effects. The doctors and nurses will do their best to make your child's experience the best it can be.

Planning ahead helps. As your child goes through treatment, ask your child's doctor or nurse what you can expect from the next step in treatment.

At Cincinnati Children's, you can have child life specialists, social workers, chaplains and psychologists involved in your child's care. This can help take the stress off both you and your child.

Reducing stress and helping your child be relaxed and distracted can help cut down how much pain he/she experiences. Don't wait until things are falling apart. "Staying ahead" of pain makes taking care of it easier and more effective. Staying ahead of pain means giving treatment for pain before your child experiences the pain at its worst.

If your child has been on pain medicines for more than a week or two, they will need to have the medicine cut back slowly. Even though your child might not have any more pain, his/her body may have become used to the medicine, and may show signs of withdrawal if the medicine is stopped too quickly. Your child's doctor (or someone from the Palliative Pain Service at Cincinnati Children's), will guide this part of treatment, too.

  • Pain is not controlled
  • Your child is too sleepy
  • Your child is not making sense when talking
  • Your child experiences a lot of vomiting, itching, and/or has trouble urinating

Last Updated 09/2015