Pain control

You might be very worried about having cancer pain. Although pain is common in pancreatic cancer, it can nearly always be kept under control.

The sooner you have treatment for your pain, the easier it can be brought under control.

Painkillers

Painkillers are also called analgesics or analgesia. There are many different types and strengths of painkillers suitable for different types of pain.

Simple painkillers like paracetamol, are suitable if you have mild pain. If you have moderate pain, you might have weak opioid painkillers such as codeine. For ongoing or severe pain, you usually have morphine type (opioid) painkillers.

A doctor or nurse can judge which type of painkiller is best for you. The important thing is that you have the right type of painkiller for your pain and the right dose.

You might also have anti inflammatory drugs such as ibuprofen (Nurofen) alongside any of the other painkillers. Anti depressants or anti epileptic drugs help with nerve pain.

Some people may use complementary methods of pain control alongside painkillers.

Opioid painkillers

The most common type of painkillers used in cancer care are morphine based (opioid) medicines. Used properly, they do not usually have too many bad side effects.

Painkillers can be given in different ways, including:

• as a liquid or tablets every 2 to 4 hours
• as long acting tablets every 12 hours
• as injections into a muscle or a tube put into a vein
• through a drip
• as stick-on skin patches
• by a pump connected to a small needle under the skin

The skin patch Fentanyl can take up to 72 hours to get to the right levels of drug in your bloodstream. You need to carry on taking your previous painkillers during this time.

It also takes 72 hours to get the Fentanyl out of your system once you stop using it. Your doctor or nurse will advise you about any changes in your painkiller medicines or doses. 

You might take other types of medicines alongside an opioid to help reduce pain. You may have morphine and an anti inflammatory drug to take away swelling that is adding to the pressure of the cancer.

The most important thing with any painkiller is to use it as your doctor or nurse prescribes. Taking painkillers regularly keeps the pain under control.

If you are getting pain before your next dose of painkiller is due, let your doctor or nurse know so that they can adjust the dose to keep the pain under control.

Side effects of painkillers

Many painkillers have one or two common side effects. Most cause constipation so it helps to start taking regular stool softeners or laxatives. 

Morphine type painkillers (opioids) can also cause:

• dizziness
• drowsiness
• feeling or being sick

These side effects usually happen because you are not used to the drug. After a few days they lessen and disappear. Many doctors give an anti sickness drug along with opioids for the first week or so.

If you have other cancer treatments to reduce your pain, such as chemotherapy or radiotherapy, you may find that your painkillers are making you drowsy again. If this happens, tell your doctor. You may need to reduce your dose.

Many people worry that they will become addicted to these drugs or will need more and more. When you are taking it for pain, you are very unlikely to develop an addiction.

Your dose will be carefully monitored by the team looking after you.

Drugs to treat nerve pain

Many people with pancreatic cancer have nerve pain. This is because the tumour can put pressure on large groups of nerves as it grows. People often describe nerve pain as burning, tingling or shooting pain.

Drugs that might help with this sort of pain include amitriptyline and gabapentin. Amitriptyline is an anti depressant. But can also help to reduce pain that is difficult to treat with other painkillers.

Gabapentin is an anti convulsant drug. This means that it helps to control fits (seizures), but it can also relieve burning or tingling pain. Doctors may also use other anti convulsant drugs.

Nerve blocks

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.

Chemotherapy or radiotherapy

Cancer treatment can help to control pain. Your pancreatic tumour might be pressing on a nerve or another organ and causing pain.

If treatment can shrink the tumour, pressure on the nerve or organ will be eased and you will have less pain.

You may be able to cut down on your painkillers after chemotherapy or radiotherapy treatment.

Other ways of controlling pain

There are many ways you and your family can help to control your pain. Your pain may seem worse if you are anxious or worried. It can also seem worse at night when there is nothing to distract you.

Your doctor may suggest some medicine for anxiety or to help you sleep. They may also suggest anti depressants. If you are depressed, it can make it harder for you to cope with pain.

Doctors also use anti depressants to treat nerve pain in people who are not depressed. Ask your doctor if you are not sure why particular medicines have been suggested for you.

You could try:

• relaxation CD's or calming music
• breathing slowly and deeply when tense
• change your position at least every 2 hours to prevent stiffness and sore skin
• massage
• hot or cold packs (wrap them in a soft towel to prevent damaging your skin)
• Television, radio or reading

They are not magic cures but they can all help you to take some control over your pain for a time.

If you can't sleep, learning relaxation exercises can be particularly helpful. Remember not to get over tired.

Visitors are a wonderful distraction but you may find it best to see people frequently for a short time.