Pain Management in Pancreatic Cancer
Identification, assessment and treatment of pancreatic cancer pain is vital to the
pancreatic cancer patient who has pain. Successful treatment of pain in pancreatic
cancer patients is achievable. Each person’s response to pain is unique and dependent
on different physical and psychological factors. It is important for the pancreatic cancer
patient to discuss their treatment options for pain management with their health care
Types of Pain
Pain is classified as mild, moderate or severe.
- Acute pain can range from mild to severe and is pain that comes on quickly and
lasts for a short time.
- Chronic pain can range from mild to severe and it either does not go away or
comes back frequently.
- Breakthrough pain is an intense rise in pain that occurs suddenly and is usually
felt for a short period of time. Breakthrough pain can occur several times a day
and may occur when medication is wearing off.
What Causes Pain for People with Pancreatic Cancer?
Pancreatic cancer pain can be caused by the tumor obstructing flow (of bile or pancreas
enzymes or the bowel contents) or else by invading nearby nerves or other structures.
Some pain may be relieved by fixing the obstruction such as placing a stent.
Pain can also be caused by side effects from chemotherapy, radiation, surgery or other
treatments. Make sure you discuss your pain with your health care team to determine the origin and
potential treatment options.
Pancreatic Cancer Pain Can Be Managed
The first step to the successful treatment of your pain is to talk honestly about it. You
are the only one who knows what you are feeling and how it is affecting your life. It is
important to be able to talk with your family and health care providers about what you
Do not wait until the pain is unbearable before discussing options with your health care
team. Pain is easier to control when it is mild. Stay ahead of your pain before it takes
control of your life. Do not try to hold off between doses, follow the dose schedule given
to you by your doctor.
Pain can be the primary concern of patients with advanced pancreatic cancer but it
should be noted that not all pancreatic cancer patients will have pain. However, if you
do experience pain it can be successfully managed. Often abdominal pain is the first
symptom of pancreatic cancer. This mid-abdominal pain often radiates to the back area.
When pain is not treated properly it can have significant negative effects on the patient
and can lead to anxiety and depression.
It is important for patients and families to know that there are options for the management of pain. The majority of patients can find excellent pain control with the help of their health care team. An integrated and knowledgeable approach toward pain will result in good pain control for almost all patients with advanced pancreatic cancer.
Describing Your Pain:
- Where do you feel the pain?
- When did it begin?
- What does it feel like? Sharp? Dull? Throbbing?
- Does it prevent you from doing your daily activities?
- What relieves your pain?
- Is your pain worse at different times of the day? If so when?
- Is your pain worse before or after eating?
- What have you tried for pain relief?
- Is your pain constant? How often does it occur and how long does it last?
Pain Control Options (This section written by Dr. Ian Beauprie)
Most pain associated with pancreatic cancer can be reduced with a simple formula
called the ‘World Health Organization analgesic ladder’. This is a set of steps, starting
with simple pain medicines and progressing as needed to stronger Opioid pain killers:
1-Tylenol or Ibuprofen taken on schedule around the clock
2-weak pain killers such as Codeine or Tramadol as needed
3-stronger painkillers such as Morphine as needed
4-long acting strong painkillers taken every 12hours with short acting
‘breakthrough’ doses as needed.
5-pain relieving antidepressants (Nortriptyline etc) or nerve pain medicines
(Gabapentin etc.) or steroids (Decadron, Prednisone).
Codeine is not a painkiller but is usually converted in the liver to morphine. Not
everyone converts Codeine well so it won’t work for everyone. Other painkillers
(opioids) are similar to each other but vary in strength. Hydromorphone is five times stronger than morphine, and methadone is variable but can be 10-17 times stronger. All
opioids cause drowsiness that gets better with time and constipation that does not.
Coeliac plexus block is often used for belly pain from pancreas cancer. It is a needle
placed in the midback to the nerves from the pancreas. It can be done by a pain
specialist or a radiologist. Usually step one is to see if test freezing will help and a few
days later to repeat the injection with something that kills the nerves (phenol or alcohol).
This is called a permanent nerve block but really only lasts six months. It can be
repeated if it wears off. The rare but serious risk of the procedure is accidental flow of
the medicine into the spinal cord causing paralysis, but this is very rare.
When A New Pain Control Plan Might Be Needed
These are some things to watch for and discuss with your health care team:
- Your pain is not getting better or going away
- Your pain medicine does not work as fast as it is supposed to
- Your pain medication does not last as long as it should
- You require breakthrough medication
- You have side effects that are not going away
- Pain is interfering with eating, sleeping or working
If your pain is hard to control do not give up hope. Your pain can be managed.
Pain is different for everyone. It is important to be as open and honest as possible about
what is happening and what works and does not work for you. You have the right to
receive the best pain control treatment options available. Good pain control allows you
to focus on your life and do the things you want to be able to do. Make sure that your
health care team listens to you and take your concerns seriously. If you are in pain and
your doctor has nothing more to offer, ask to see a pain specialist. If you have difficulty
locating a pain specialist or getting help contact a cancer center, hospice or oncology