Not everyone with cancer experiences pain. Pain may be caused by cancer itself as it creates pressure on or invades the nerves, bones or organs.1 Some types of cancer treatments, including radiotherapy, surgery and chemotherapy can also cause discomfort or pain. Understanding its cause will help tailor its treatment. Pain may be dull and achy, sharp or burning, or may even feel like an electric shock. In the case of brain cancer, pain may cause headaches. Pain related to cancer itself is often controlled by cancer treatments, including surgery, chemotherapy, radiotherapy and anti-inflammatory steroid medication. Pain from cancer and pain caused by treatment can also usually be effectively controlled by pain-relieving medications. If you have pain you should talk to your doctor about treatment.
Depending where the patient experiences pain, it may restrict their mobility and movement and curtail some work-related activities. Pain can also make one more tired leading to increasing fatigue. Pain medications can be very effective, but they also may cause side effects, although most side-effects either lessen with time or can be controlled. Sleepiness, nausea, and constipation are common side effects of strong pain medications such as opioids,2 and all of these problems can also affect the ability to work. Sleepiness may make it harder to concentrate at work and pose safety risks in operating machinery or driving. Steroids may cause sleeplessness and agitation. See with your patients what alternative pain medicines could be tried if they are having side-effects from their current treatment. Pain itself can also lead to irritability or feeling frustrated, especially if it persists for a long time. Individuals can function much better if they have effective pain management with appropriate medications.
What patients can do
There are many ways to manage pain effectively. These include medications of many types, but also non-pharmacological techniques such as relaxation therapy, massage, exercise3 and even supportive counselling. You can work with your patient to develop an individualized pain management plan.
- Encourage your patient to track their pain levels and activities throughout the day to determine the optimal times for pain management intervention.
- You may want to consult the Canadian Cancer Society web page on managing pain.
- You can also consult the booklet How to manage your pain (PDF) by the Princess Margaret Cancer Centre, Patient & Family Education Program.
- If your patient is taking dexamethasone for brain tumour or other kind of cancer, they may find helpful information about dexamethasone from the BC Cancer Agency.
- The Chronic Pain Association of Canada website also has resources to help manage pain. They recommend keeping a pain diary to track pain levels and intensity. This information may benefit patients who want to request changes at work based on the pattern of their pain through the day.
Overall, the main task is keeping pain under control. This means taking pain medication regularly, as prescribed and as needed. If pain is not managed or if the patient experiences new pains, these situations should be addressed by their healthcare team.
Modify work schedules:
- Request flexible hours to accommodate their capabilities.
- Request extra rest breaks.
- Change shifts to match the patient’s daily pain levels.
Modify tasks and work location:
- Identify tasks, workspaces and positions that cause the most discomfort.
- Work with the employer to develop alternatives. For example, you might want to suggest to have a desk with a standing up option or a special chair.
- Request to work from home when possible.
Reduce physical exertion:
- Request tasks that are less physically demanding.
- Use electric tools to replace manual effort.
- Reduce repetitive tasks and vary them with other duties.
- Consider a mobility aid such as a two-wheeled walker. It can take much weight off the lower extremities and fits most workspaces.
- Change positions frequently.
Modify work environments:
- Request access to a refrigerator and/or microwave for storing pain-relieving hot and cold packs.
- Maintain comfortable temperatures by using a space heater, fan, portable air conditioner, humidifiers or de-humidifiers.
- Use an anti-fatigue mat where the patient frequently stands.
- Use a headset if the patient is frequently on the telephone.
Pain can be exhausting. Workplace changes and strategies to handle fatigue will also help with pain.