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Cancer pain: Myths & facts

Dr Kok Jaan Yang, Senior Consultant in Palliative Medicine at Parkway Cancer Centre, talks about the different ways to relieve pain in cancer patients.

One of the symptoms that cancer patients may worry about on their cancer journey is pain. There are many myths, however, surrounding the relief and treatment of cancer pain. A proper understanding of cancer pain and its management can thus help cancer patients to focus better on their treatment with the aim of improving their quality of life.

Myth 1: All cancer patients will definitely suffer severe cancer pain.

Fact: Not all patients with advanced cancer experience pain.

Many people believe that all cancer patients will suffer severe cancer pain. But this is not true. Some patients with advanced cancer do not have any pain issues. In fact, in general, only a quarter of patients with advanced cancers suffer severe cancer pain, and only a small percentage experience very severe cancer pain. A quarter suffer moderate pain, a quarter have mild pain, and a quarter do not suffer any pain at all.

Myth 2: All cancer pain can only be treated by morphine or other strong opioids.

Fact: There are many other forms of medication to relieve pain.

Doctors can choose from a wide range of pain relief medications depending on the type and severity of pain.

For mild or moderate pain, for example, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and weak opioids such as tramadol, are used. If the pain is severe or cannot be controlled with the above medications, morphine or other opioids may be used.

In some cancer patients, they may also experience nerve pain, or “neuropathic pain”, which is pain resulted from a certain nerve fibre being damaged by the cancer. This type is often described as shooting pain, a sensation of pins and needles, or a burning sensation. In such cases, nerve pain medications such as pregabalin or gabapentin are prescribed.

Myth 3: Regular intake of morphine or strong opioids for cancer pain may lead to addiction.

Fact: Regular use of morphine or strong opioids in cancer pain under proper supervision does not lead to addiction.

Opioids are, in fact, used daily in medical practices, such as during and after surgery to relieve pain. Cancer patients who are prescribed morphine or strong opioids under the advice of an experienced doctor and under proper supervision, will not become addicted.

When the pain can be relieved by other means, e.g. after radiotherapy for cancer bone pain, the dosage of morphine or strong opioids can be reduced significantly or even stopped.

Myth 4: Morphine or other strong opioids have intolerable side effects.

Fact: Common side effects of strong opioids include drowsiness, nausea, vomiting and constipation. The side effects, however, can be managed easily.

Drowsiness usually starts when a patient starts taking morphine or strong opioids or when the dosage is increased.

This will normally improve after a few days. If not, the dosage can be reduced. You should discuss this with your doctor after monitoring your response to the medication.

Nausea and vomiting usually affect only one in three patients on morphine or other strong opioids. It can be addressed by anti-vomiting medicine such as metoclopramide or domperidone.

Constipation can be easily managed with more fluid intake and the taking common laxatives such as senokot and lactulose. In severe opioid-induced constipation, an opioid-naloxone combination drug may be prescribed.