Fran Hurnen – Clinical Psychologist, Hurnen, Psych, Health & Rehab Ltd
Cancer pain can arise from a number of areas, the cancer itself and some treatments for cancer; it may be worsened from the effects of other diseases. It does not always follow a predictable course so it is not always possible to determine where, when and at what intensity the pain may arise. One thing for sure, though, is that pain is best relieved when treated early and appropriately. In this way it is important for those in pain to be able to evaluate how effective pain management medication is and how tolerable the side-effects are and communicate this clearly to their doctor or team.
While pain medications are extremely important in the management of acute and short-term pain, persistent pain can carry with it additional complications. Persistent pain can change the ability to function, personality and quality of life. It has long been recognised that a person’s mood can impact on their pain and vice versa. Persistent pain may interfere with normal routines, degrade the quality of life, and rob one of rest, creativity, joy, and peace. Such pain also increases anxiety and stress to its sufferers, their friends, and family.
When pain is not well controlled a person may become more tired, depressed, angry, worried, stressed and lonely. Because pain is regulated by the nervous system, the brain is a key player in how we perceive it. To put it simply, your brain’s ability to filter these pain signals can be negatively or positively affected by factors such as mood and this can influence what gets through.
Ongoing stress, anger, anxiety and depression can negatively impact on the mind, body and nervous system and can even increase pain. In addition, negative emotion can, in turn, lead to greater attention and focus on pain, thereby increasing pain intensity again. This process can easily turn into a vicious cycle that can further increase the sensitivity in the nervous system and contribute to increasing pain.
There is good news though, in that the nervous system can also work in the opposite direction. Increasing positive attitudes and positive mood, can also positively enhance coping, well-being, decrease pain and contribute to gaining the most out of life. This is why modern approaches to chronic or persistent pain management look wider than medications alone.
For many people with cancer, pain may be a part of their every day. However, it doesn’t have to control life. Below are a number of suggestions that people have found helpful in managing pain and gaining the most out of life. These pain management strategies can help draw attention away from the pain, improve mood, and reduce the impact that pain can have on everyday activities and well-being.
- Support – For a lot of people, talking about issues with friends, family, healthcare professionals, local cancer support groups etc. can help in reducing the impact of stress and suffering. Pain can generate a large range of emotions and talking with others can help lessen, even change, those emotions for the better. Sharing the load or gathering information can be vitally important for coping and emotional well-being.
- Distraction – is another useful approach. Engaging in meaningful, rewarding or important tasks can help distract, but also help with feeling that one is engaging with life. Examples of meaningful distraction activities could be doing an enjoyable task, visiting a friend, watching a favourite TV show or going for a walk.
- Massage, pressure, vibration, heat, cold have long been a part of pain management (please consult your doctor, as with certain treatments like chemotherapy and radiotherapy this may not be appropriate).
- Hypnosis – is a trance-like stance of high concentration where the person is awake, generally relaxed, and the brain is more open to suggestions that could be helpful – such as generating relief, being able to relax or even generating better mood.
- Exercise – where possible engage in exercise. It assists with general health, but also assists in cleaning out some negative effects of stress and pain.
- Imagery – using your imagination to create absorbing mental pictures or situations can harness both distraction and relaxation to assist with pain and related issues.
- Mindfulness – is a meditative process that involves learning how to quieten and observe the body and the mind.
- Biofeedback – uses special sensors and computer-based software to measure changes in certain body functions such as heart rate, temperature and muscle tension in response to certain techniques or coaching to better control these. This can assist with stress/tension reduction, relaxation and better coping.
- Psychology/Counselling – There are also a range of psychological approaches that help with thoughts, feelings and getting on with getting the most out life.
It is important to remember to experiment with what works for you and remember that certain combinations may work better than others. Always keep your doctor or medical professional informed as there may be some treatment or medical reasons why a certain approach may not be suitable at that time. Remember that the successful management of persistent pain usually includes a wide range of strategies.
For more information see the Cancer Society’s information sheet on managing cancer pain: https://wellington.cancernz.org.nz/assets/Information-Sheets/IS-Managing-cancer-pain-H.pdf