Developing a Pain Control Plan

Only you know how much pain you are having. Telling your cancer care team when you’re in pain and describing it the best way you can is very important. This will help them come up with the best plan to control your pain.

Pain is different for every person with cancer. A plan to control pain needs to consider the person's diagnosis, type and stage of cancer, other health problems, medicines being taken, personal response to pain, and other personal choices.

Pain can also be an early warning sign of the side effects of your cancer treatment or some other problem. Call your cancer care team to talk about how best to treat your pain.  

What you can expect from your cancer care team and pain control plan

Your cancer care team will follow a set of steps to develop a pain control plan that works best for you. You should expect your doctor and cancer care team to develop a good pain control plan that works for you by:

• Respecting your description of pain.
• Taking a careful history of your pain (called a pain assessment) when you report it and at every appointment.
• Doing a physical exam or other tests to help figure out where the pain is and what might be causing it.
• Setting goals with you to manage your pain.
• Treating your pain based on the most recent research (called pain management).
• Checking in with you about how the pain control plan is working and making changes as needed.

Pain assessment

The first step is for your cancer care team to talk with you about any pain you may be having. This is a pain assessment. Describe your pain to your cancer care team giving them as much detail as possible.

The cancer care team will ask you questions and use certain tools to help you describe your pain. They will want to know the type of pain you are having, where it is, how bad it is, and how it may be affecting your activities and life. Talk to your family and friends about your pain. They can help you describe it to your cancer care team.  

Keep a record of your pain

It might be helpful to keep a diary or other record to keep track of details about your pain and what works to ease it. You can share this record with those caring for you. This will help them figure out what method of pain control works best for you. Your records can include:

• Words to describe the pain (like sharp, dull, throbbing, gnawing, burning, shooting, steady)
• Anything that seems to make the pain better or worse
• Any activity that you can’t do because of the pain
• The name, dose, and time you take your pain medicines
• The times you use other pain-relief methods (such as relaxation techniques, distraction, or imagery)
• The number you rate your pain at the time you use a pain-relief measure (medicine or method to reduce pain)
• Your pain rating 1 to 2 hours after using the pain-relief measure
• How long the pain medicine works
• Your pain rating throughout the day (to get an idea of your general comfort)
• How pain interferes with your normal activities, such as sleeping, eating, sex, or work
• Any side effects you have that could be caused by the medicines

Using a Daily Pain Diary might help you record details of your pain. You can download or print a Pain Diary from our website.

Use a pain rating scale

Using a pain scale might help you describe how much pain you’re feeling. For example, here is a Pain Intensity Scale that is commonly used.

To use it try to give your pain level a number from 0 to 10. If you have no pain, give it a 0. As the numbers get higher, they stand for pain that’s getting worse. A 10 means the worst pain you can imagine. For instance, you could say, “Right now, my pain is a 7 on a scale of 0 to 10.”

You can use the rating scale to describe:

• How bad your pain is at its worst
• What your pain is like most of the time
• How bad your pain is at its best
• How your pain changes with different pain treatments

Some pain rating scales use faces instead of numbers, and these may help you better describe how bad your pain is. Ask your cancer care team if they have another pain rating tool to use if you don't think numbers are the best way to describe it.

Describing your pain

Give your cancer care team, family, and friends details about your pain:

• Where you feel pain
• What it feels like (for instance, sharp, dull, throbbing, gnawing, burning, shooting, steady)
• How strong the pain is (using the 0 to 10 scale)
• How long it lasts
• What makes the pain better
• What makes the pain worse
• How the pain affects your daily life
• What medicines you’re taking for the pain and how much relief you get from them

Your cancer care team may also need to know other details, like:

• All the medicines you’re taking now, including vitamins, minerals, herbs, supplements, and non-prescription medicines (medicines you can get off the shelf or over the counter)
• The pain medicines you’ve taken in the past, including what has and has not worked for you
• Any known allergies to medicines, foods, dyes, or additives

Pain management

Your cancer care team will work with you to find ways to manage your pain.

Choosing the best pain medicine should include what medicines work best for the type of pain you have, how bad your pain is, what side effects you might get, how active you are, and what other medicines and treatments you are getting.

Here are some questions you might want to ask about the pain medicines your cancer care team suggests.

• What kind of pain medicine is this?
• How do I take it?
• Do I need a prescription for this medicine? Can it be refilled, or do I need to call you for a refill?
• What are the different names for this medicine?
• How much should I take? (What’s the dose?)
• Do I take it on a schedule or only when I need it? If only when I need it, how often can I take it?
• If my pain is not relieved, can I take more? If so, how much?
• Should I call you before I increase the dose?
• What if I forget to take it or take it too late?
• Should I take the pain medicine with food?
• How much liquid should I drink with the medicine?
• How long does it take for the medicine to start working?
• Is it safe to drink alcohol or drive after I’ve taken this pain medicine? What should my limits be while taking it?
• What other medicines can I take with the pain medicine?
• What medicines should I stop taking or not take while I’m taking the pain medicine?
• What are the side effects that might happen from the medicine? How can I prevent them? What should I do if I have them?
• Are there other safety concerns about this medicine?

Palliative care as an option

Most people with cancer can be helped by services from a palliative care team. One of the goals of palliative care is to manage pain and other symptoms. The specialists that are part of a palliative care team can help to develop a pain control plan that works for you.

A palliative care team has some of the same people as on a cancer care team, but often has others. The team might include doctors, nurses, mental health specialists, social workers, chaplains, pharmacists, and dietitians.

Making the most of your pain control plan

There are things you can do to help make sure your pain control plan works well:

• Take pain medicine when it’s time to take it even if you’re not having pain. Taking pain medicine on a regular schedule (around the clock) helps control chronic pain. .
• Do not skip doses of your scheduled medicine. The more pain you have, the harder it is to control.
• Use your short-acting breakthrough pain medicine as instructed. Don’t wait for the pain to get worse – if you do, it can be harder to control.
• Be sure only one doctor prescribes your pain medicine. If another doctor changes your medicine, the two doctors need to discuss your treatment with each other.
• Don’t run out of pain medicine. Remember that written prescriptions are needed for almost all pain medicines. They can’t be called in and drugstores don’t always have them in stock. It can take a few days to get the medicine, so give yourself time for delays. Sometimes you may need to pick up a prescription from the doctor because certain prescriptions have to be taken in person to the pharmacy.
• Keep pain medicines safely away from children, pets, and others who might take them.
• Never take someone else’s medicine. Medicines that helped a friend or relative may not be right for you.
• Do not use old pain medicine or medicine left over from other problems. Drugs that worked for you in the past may not be right for you now.