McGill

Pain

Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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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.

Vocational implications

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.

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.

Job accommodations

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.

Back to the list of common cancer treatment side effects

Pain can be exhausting. Workplace changes and strategies to handle fatigue will also help with pain.