Coping With Pain in Colorectal Cancer

Coping with colorectal cancer is not easy, and one of the most unpleasant effects of cancer is pain. The effects of pain on physical and mental health cannot be understated, as it may affect many aspects of your life. Daily routines can be disrupted, and even sleep or rest can be compromised. It is undoubtedly an uncomfortable period, which is why it is important that any pain you feel over the course of your diagnosis and treatment is well managed.

To help your team of doctors and specialists correctly and effectively alleviate any pain, being able to clearly describe how you feel is a key first step.

In this article, we’ll help you understand why you may experience pain in different ways and how your team of specialists may prescribe medication to help you cope.

Along with many other diseases and cancers, pain is an oft-accompanying and unwelcome effect. With cancer, pain can increase in frequency and intensity with advancing stages, by and large, due to tumor growth and spread.

At the same time, pain can also paradoxically occur as a side effect of cancer treatments such as chemotherapy. Studies have found a correlation between the use of life-prolonging or curative treatments and the number of colorectal cancer patients who experience prolonged, persistent pain. As many as 30–70% of patients can suffer from chemotherapy-induced peripheral pain (CIPN), and about 5–10% suffer chronic, function-impairing pain.

At present, the use of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are the mainstay ways to manage pain. However, wrong dosages or poor management can also contribute to poor physical and emotional well-being.

You might be worried that the pain you experience may not receive sufficient treatment or that a too-high dose of pain medication may lead to other problems in future. While it is difficult to predict how your treatment journey will proceed, being frank and honest with your doctors about the pain you are experiencing is something you can do. This open and continuous dialogue will allow doctors to deduce the likely causes of the pain and prescribe an appropriate medication dosage.

When you are experiencing pain, it can be difficult to convey the full extent of your discomfort to your doctors. Providing a detailed and accurate description of your pain can help your doctor determine the most effective way to move forward. Try and go into as much detail as possible. Your doctor may prompt you for more information, but the four main ways to describe your pain are:

1. Where the pain is: Be sure to describe where the pain is located in your body. Is it in one specific area, or does it spread to other parts of your body?
2. What kind of pain you feel: Try to describe the type of pain you feel. Is it a dull ache or a sharp, stabbing pain? Is it a burning sensation, or does it feel like a pressure or tightness? Don’t worry about using the “wrong” words to describe your pain. Analogies and real-life scenarios can help paint a clearer picture for your doctors.
3. How often you feel pain: How often do you experience the pain? Does it happen every day or only occasionally? Are there certain times of day when the pain is more noticeable?
4. How severe the pain is: It's important to describe how severe the pain is. This can help your healthcare provider determine the best treatment options. You can use a pain scale to rate your pain from 0 to 10, with 0 being no pain and 10 being the worst pain imaginable.

Besides pain, describing any other symptoms such as nausea, fatigue, or difficulty sleeping, can provide important information about the cause of your pain and help guide your treatment plan. The more information you provide, a better understanding the doctors will have of the probable causes of your pain.

Colorectal cancer patients may experience different types of physical pain, including nociceptive and neuropathic pain. It is possible for patients to experience mixed nociceptive-neuropathic pain.

Nociceptive pain: Pain that is caused by the stimulation of pain receptors (nociceptors) and is easily described to others.

Neuropathic pain: Pain that is characterized by sensations atypical of pain, such as a "pins and needles" sensation or a shooting, burning feeling. This can occur if parts of the nervous system are damaged or not working correctly.

A third type of pain, sometimes called psychogenic pain, is characterized by unpleasant emotional experiences without clear tissue damage. In essence, it is a pain that arises due to other factors not relating to the illness, and originates from the brain. Many experts today view ‘psychogenic pain’ as an outdated term due to historically negative connotations that suggest the pain is imaginary, leading many people to feel invalidated.

Nonetheless, it is equally important to also talk about your emotional experiences with your care team. To help manage the difficulties you face, they may also include therapy alongside medication to help you cope.

Nociceptive pain in colorectal cancer patients is caused by a wide variety of pain factors, including elevated levels of nonapeptide bradykinin, prostaglandins, cytokines and vascular endothelial growth factor in tumor cells. The first step in standard treatment for nociceptive pain involves the use of NSAIDs, which reduce pain mainly by inhibiting the production of prostaglandins, but this is usually insufficient.

Neuropathic pain that colorectal cancer patients experience often occurs as a result of chemotherapy treatment. Most commonly, colorectal cancer patients receiving chemotherapy may experience peripheral neuropathic pain, in which they feel tingling sensations or numbness in their limbs and extremities. Switching away from chemotherapy to a different treatment plan may be recommended to halt nerve damage, and anticonvulsants or antidepressants may be prescribed to treat neuropathic pain. Alternative treatments such as acupuncture or massage can also provide temporary pain relief and comfort.

The World Health Organization (WHO) analgesic ladder is the guideline used by hospitals for the management of cancer pain. This ladder is a three-step algorithm for the selection of analgesic medications.

Step 1: Non-opioid medications, such as aspirin, acetaminophen, or NSAIDs, are prescribed to control mild to moderate pain.

Step 2: Weak opioids, such as codeine or tramadol, are used in combination with non-opioids to control moderate to severe pain.

Step 3: Strong opioids such as morphine, oxycodone or fentanyl are prescribed to control severe pain that cannot be managed by non-opioids or weak opioids.

When pain medication is administered, your doctor will also closely monitor your condition for any adverse side effects such as constipation, nausea, sedation, or respiratory depression.

In some hospitals, you may also be allowed to self-administer medication within set limits through what is known as the patient-controlled analgesia (PCA) system. The PCA system allows greater autonomy for patients to administer a dose of painkiller without delay. This is done by pressing a button that controls a computerized intravenous (IV) pump, which releases the painkiller dose into an IV line inserted into your vein.

In addition to medication, non-pharmacological interventions, such as cognitive-behavioral therapy, relaxation techniques or physical therapy may also be used to help you manage pain.

Ultimately, candid and truthful communication with your doctors and care team will help ensure that you are receiving the right treatment not only to treat colorectal cancer but also to manage pain and improve your quality of life while you weather this difficult time.