There are many different ways of controlling pain if you have advanced gallbladder cancer.
The pain may be in other parts of the body if the cancer has spread. This could be the spine or abdomen. The main way of controlling pain is using painkillers.
Pain can usually be very well controlled. It should be possible for you to be pain free at least when you are resting, if not all the time. The most important thing with any painkiller is to take it regularly.
If your pain relief isn’t working, or you are getting pain before the next dose tell your doctor or nurse. They can work out if you need different painkillers or to increase the dose.
If your treatment team can't control your pain you can ask them to refer you to a pain control team or symptom control team.
There are many different painkillers. Some are available over the counter from your chemist, such as paracetamol. These drugs can be very useful for mild pain, but they don’t control more severe pain. Talk to your doctor or specialist nurse if you’ve been taking a mild painkiller and you are still in pain.
You might need to have a stronger painkiller such as codeine or dihydrocodeine (DF118), perhaps with an anti inflammatory drug, such as ibuprofen (Nurofen) or diclofenac (Voltarol).
If the pain is still not controlled you might need a stronger morphine-type painkiller.
You might need a strong painkiller, such as morphine. It is a strong opioid and a very effective painkiller. There are other types of strong painkiller.
When you have them in the right doses and at the right times, they can control pain well. They might cause side effects at first but these usually wear off after a day or so.
You can have strong painkillers in different ways, such as:
- a liquid or tablet every 2 to 4 hours
- slow release tablets, taken every 12 hours
- through a drip
- through a pump connected to a small needle under the skin
- as suppositories
- skin patches
Side effects of strong painkillers
Most strong painkillers have side effects. They cause constipation and so it helps to start taking regular stool softeners or laxatives as soon as you begin regular painkillers. Ask your nurse or doctor to prescribe them.
You might feel dizzy, light headed and drowsy but this usually wears off after a couple of days.
Painkillers sometimes make you feel sick at first so you might have anti sickness medicines for the first week or so.
Chemotherapy or radiotherapy to control pain - gallbladder
Cancer treatments such as chemotherapy and radiotherapy can help to control pain. They can shrink a tumour that is pressing on a nerve or another organ and causing pain. You might be able to cut down on your painkillers after having treatment.
If you have pain that is very difficult to treat, your doctor may suggest a nerve block. This is a way of killing or deadening a nerve to stop it causing pain.
A nerve block is named after the nerves that it blocks.
The coeliac plexus is a complicated web of nerves at the back of the tummy (abdomen). A coeliac plexus block stops signals that can cause you to feel pain in your upper abdomen.
Types of nerve block
Different nerves can be blocked by:
- injecting local anaesthetic and alcohol into the nerves
- using radio waves (radio frequency ablation) or a laser to destroy the nerves
Your doctor will explain what type of nerve block they want to do and why.
Side effects of nerve blocks
There are not usually many side effects to nerve blocks. You might get low blood pressure for days or weeks afterwards. This can make you light headed if you stand up too quickly. This problem usually rights itself in time. After a coeliac nerve block, you may have diarrhoea for a few days afterwards.
How long the nerve block lasts for varies in different people. It may last between a few days to a few months. Although nerve blocks can be helpful for many people, they don't work for everyone.
Other ways of controlling pain
There are many ways you can help to control pain. Your pain may seem worse if you are anxious or worried. It can often seem worse at night when you can't sleep and there is nothing else to distract you. You may like to try:
- relaxation - listen to some calming music and think of somewhere nice you would like to be
- breathing slowly and deeply when you are tense
- changing your position at least every two hours to prevent stiffness and sore skin
- massage - ask your family or friends to gently massage your back, hands or feet
- hot or cold packs (wrap them in a soft towel so you don't damage your skin)
- watching TV, reading or chatting to take your mind off any pain
These aren’t cures but they can help you to take some control over your pain. It can make it seem better for a while.
If you can't sleep, learning relaxation exercises can be very helpful. Don’t get over tired as this will keep you awake.
Visitors are a good distraction but it may be better to see people more frequently for a short time if possible.