Everyone's pain journey is different, but we find that better overall well-being leads to better pain control. As such, the best way to managing your pain successfully and effectively is a multi-modal approach that tackles all aspects of your life.
MULTI-MODAL APPROACH TO PAIN MANAGEMENT
Pain is common as a result of cancer, or following cancer treatment, and can have a significant impact on all aspects of your life. This includes your day-to-day activities and your various roles (be it as a parent, at work or study). Your appetite, sleep and mood can also be affected due to your pain, and vice versa!
Whilst it is commonly understood that pain management strategies include pain medication and/or interventions, it is important to note that not all patients experience improvement solely from pain medication and/or interventions. Working towards an improvement in your overall well-being is important to achieve better pain control.
The multi-modal approach to pain management involves a multi-disciplinary team of healthcare professionals, from your pain specialist and your GP, to a physiotherapist, occupational therapist, psychologist or psychiatrist, who all work together in providing various treatments and strategies in order to help achieve the best outcome for you.
The team looking after your pain management also includes you! It is important that you take responsibility for your improvement in your well-being. Patients who are in control of their day-to-day management of pain and are able to utilise strategies and resources to manage their pain themselves are well placed to achieve better long-term pain control.
PAIN MANAGEMENT GOALS
In order for a multi-modal approach to work successfully and effectively, it is important to understand what your goals are in terms of improving and/or maintaining your function and quality of life.
What is important to you? What would you like to work towards?
By answering these questions, your pain specialist and the multi-disciplinary team will be able to tailor a management plan specific to your pain, your needs and your goals. Your pain management plan may include any or all of the following therapies: physical therapy, psychological therapy, social therapy and biological therapy.
self-education and self-assessment
You know yourself and your pain the best. For best results, we advise that you be an active role player within your pain management team. By being educated on your pain, and utilising self-assessment tools, you can take control of the day-to-day management of your pain and achieve better long-term pain control.
Our pain microsite has a brief explanation on what pain is. This is a great starting point! You may also speak to your surgeon, oncologist or your pain specialist about the nature of your specific pain, including why you are experiencing pain and how long the symptoms may last. It is important to note that there may be many reasons for ongoing pain, and conversely, there may be no direct cause for your pain. The trajectory of chronic or persistent pain differs for everyone. This is also helpful to understand; it is important to navigate your expectations about your pain.
There are also many reputable resources available on the Internet where you can learn about your pain. It is important to note that some information on the Internet may be inaccurate or misleading - always ensure you are seeking information from reliable sources such as hospital or health network websites, support organisations and/or books.
See 'Resources' below for a non-exhaustive list we recommend you check out.
A common way to assess your pain is to keep a pain diary. Record when you have pain, where it occurs on your body, how it feels to you, how long it lasts for, what triggers it, what makes it better and what makes it worse.
You can also use pain measurement tools like a numerical or verbal scale.
Finding a balance with activity and pain can be difficult. You may fall in the category of doing too much, which may aggravate and prolong your pain, which may worsen your pain and/or fatigue and cause further flare-ups of pain. Alternatively, you may choose to rest more and gain short-term relief, which may reduce your physical capacity. This is called the 'boom-bust cycle', where on a good pain day, you are on an upward slope, feel happy and positive and get more things done, whereas on a bad pain day, you are on a downward slope, remain inactive or bedridden, are fearful of aggravating your pain by moving, and have a low mood. The long-term consequences of this include increased pain sensitivity, reduced tolerance of day-to-day activities, inconsistent activity levels and emotional stress.
Instead, it may be more helpful to pace yourself with a plan:
- Plan the activities you want to do and need to do. Write it down as a list of things to do in the short-term and long-term.
- Plan when you will do these activities. Try to spread the activities out evenly over the day to weeks; do not put all the demanding activities together, instead try to balance those activities with those you find easier!
- Plan how you can do the activity. Remember that you can use frequent, short rest periods.
- Enjoy your activity!
Once you have completed an activity, or a series of activities, it may be helpful to conduct a review:
- Think about what you struggled with
- What might be some of the benefits of pacing?
- What are some different ways you can pace these activities? Could you break up a task? Could you change a particular task? Could you change your positioning whilst doing that task?
- What are some unhelpful thoughts or beliefs you had or that you should watch out for that might prevent you from doing these activities?
By pacing your activities, you can gradually build up your overall activity level over time and seek a healthy balance between activity and rest.
You may read this fact sheet for examples on pacing.
Flare-ups - where your pain fluctuates beyond usual levels - can occur regardless of pain management strategies and medications. It is important to note that flare-ups are normal, in some cases they may be common, and there are ways to manage them. Our recommendation is to have a flare-up plan.
A flare-up plan consists of two components:
- How to avoid flare-ups
- How to manage flare-ups when they happen
By preparing a flare-up plan before you increase your activity (you may write this down and leave it somewhere readily accessible), you are giving yourself the best chance to implement successful strategies to manage your pain without having to think about it during your pain flare-up.
How To Avoid Flare-Ups
What are some potential triggers of your pain? What are some potential situations that can cause a flare-up? How could you avoid these triggers and situations, or work around them?
What are some other strategies you can use to avoid flare-ups in general? Have a look at some of the Pain Management Therapies below!
How To Manage Flare-Ups When They Happen
Don't panic!
Consider some strategies you can utilise to decrease the intensity of your pain. Think of what you can do within the broad categories of medication, physical activity, rest, relaxation, family/work/school.
For example, you could consider dropping back your activity, but not stopping completely. You could try some stretching exercises or self-massage. You could try to implement rest breaks (ideally less than 30 minutes). You could try a hot shower. You could try visualisation or deep breathing techniques. You could try asking for support from a friend or co-worker.
Monitor your improvement throughout the flare-up. Remember to practice self-compassion.
You may use this worksheet to help you set up your flare-up plan.
Physiotherapy & Exercise Physiology
Physiotherapists and Exercise Physiologists provide a comprehensive assessment and prescribe a variety of modalities including specific exercises (including group exercise), exercise and walking aids, balance and mobility training and stretching programs. They also provide guidance on increasing your physical activity and advice on self-management of pain and fatigue. They also liaise and consult with external providers for ongoing care and rehabilitation.
You can request a referral to Physiotherapy or Exercise Physiology from your doctor at Peter Mac, or alternatively, Medicare or your private health fund may provide some limited cover to these professionals in the community.
You can listen to our Exercise Physiologists talk about exercise here: Let's Talk Exercise - YouTube
For more information about Physiotherapy and Exercise Physiology services at Peter Mac, you can visit their website at: Physiotherapy and Exercise Physiology
Exercise is an important component of your care and can be a useful tool in the management of your pain. However, before taking part in any exercise program, either during or after your treatment, it is important to talk with your doctor at Peter Mac or your GP about any precautions you should take.
Occupational Therapy
Occupational Therapists provide a comprehensive assessment of your pain’s impact on your quality of life and desired activities and prescribe adaptive strategies such as implementing therapy and interventions that support participation in desired activities and increasing function, as well as alternatives or modifications in performing desired activities. They also provide guidance and advice on developing skills and customisations to enable you to live and function productively. They also liaise and consult with external providers for ongoing care and rehabilitation.
You can request a referral to Occupational Therapy from your doctor at Peter Mac, or alternatively, Medicare or your private health fund may provide some limited cover to these professionals in the community.
For more information about Occupational Therapy services at Peter Mac, you can visit their website at: Occupational Therapy
Transcutaneous Nerve Stimulation (TENS)
Transcutaneous nerve stimulation is a process in which tiny electrical impulses are emitted through your skin, which then target the nerves underneath the skin and interrupt their ability to send pain messages to the brain.
Whilst not extensively studied to gauge effectiveness, it is sometimes recommended (either by your pain specialist or your physiotherapist) as a means to manage pain. Continued use may provide some benefit.
A TENS machine may be purchased by yourself - it is usually a portable, battery-operated machine with pads that you can place on the area of skin you wish to target; these pads then deliver the electrical impulses.
When you experience pain, it can have a significant impact on your mental health, including your mood, thoughts, the activities you may like to do, and your social abilities. In addition to pain, you may also be trying to manage other symptoms such as fatigue, insomnia, and nausea and vomiting. In your cancer journey, you may also be grappling with issues such as fear of recurrence or progression of disease, grief and anxiety.
Stress is an emotional and physical response where there is a perceived imbalance between the demands being made on us and our ability to cope with those demands. Muscle tension is linked with stress and anxiety. Sometimes, we don’t even notice how our muscles become tense and this can be linked with pain.
You can see how the relationship between our mental health and pain is non-linear; in fact, each influences one another!
Psychotherapy
There are a variety of psychotherapies that a psychologist or psychiatrist may advocate for such as cognitive-behavioural therapy and acceptance and commitment therapy. These therapies aim to teach self-observation in order for you to understand the way you think, your beliefs and your behaviours, and subsequently teach specific skills, such as positive self-talk or visualisation, that reframe and manage them, with the overarching aim being to improve your function and quality of life.
Meditation and Mindfulness
Meditation is a repetitive practice that has been used for thousands of years, and more recently, has been shown to be effective in providing relief from stress, anxiety and pain. Meditation aims to encourage and develop self-awareness, clarity, concentration, and calm.
It is important to note that meditation is not necessarily spiritual or religious; anyone can meditate. Meditation is also not about “emptying” the mind of thoughts!
There are different types of meditation. The most common form is mindfulness - in which you combine self-awareness with attention. You can start with paying attention to your breath as it moves in and out of your body. Meditation can also be combined with movement, such as in yoga or tai chi.
You can learn more about meditation and mindfulness here:
Some smartphone apps that you may use to start your meditation practice are:
Relaxation Therapy
Relaxation therapy involves practices that are geared towards allowing your mind and body to relax. As described above, there is a close relationship between stress and your pain experience.
Relaxation therapies include meditation or mindfulness, gentle exercise such as yoga or tai chi and massage as described above. Progressive muscle relaxation, where you alternately tense and relax each muscle group, is also a technique you can use to bring your muscles into a deeper state of relaxation.
What are some other things you can think about that relax you? Listening to music, drawing, colouring or painting are other forms of relaxation therapy.
The cancer journey can be a difficult one, and your pain can sometimes be an isolating and/or challenging experience, but it does not need to be. In fact, social and emotional support has been shown to be a positive factor in improving the pain experience.
In the first instance, you may benefit from seeking support from your family and/or friends. You may also find individuals with similar experiences in a support group or an online network. You can ask your GP for a recommendation for a support group in your local area.
Find a support network here:
Sleep
We cannot underestimate the importance of sleep. Poor sleep results in poor levels of energy and concentration. It also adversely affects our mood. Sleep is also an important facet of restoring our physical health. Poor quality sleep has been shown to contribute negatively to our pain experience.
We recommend cultivating good sleep hygiene - these are habits that you can introduce to your daily life, such as avoiding specific stimuli prior to bedtime, and ensuring you have a comfortable space to sleep in. A night-time routine also lets your brain and body know that it is time to sleep. You can find out more about good sleep here:
Rest
Alongside with sleep, it is also important to rest adequately. Rest is not just about strategies that promote relaxation and recuperation (as described above), it is also about strategies that allow you to manage your energy levels.
Occupational Therapists have specific strategies that may guide you in managing your fatigue and energy levels. You can request a referral to Occupational Therapy from your doctor at Peter Mac, or alternatively, Medicare or your private health fund may provide some limited cover to these professionals in the community.
You can read more about fatigue management here. You can sign up for Peter Mac's monthly seminar on fatigue management here.
Nutrition
Your nutritional needs are determined by a variety of factors, including your specific health conditions. Your needs may also change during the course of your cancer journey. Poor nutrition or malnutrition can contribute to ill health, which can, in turn, affect your pain experience. It is therefore important to identify what your body requires to function optimally - this may include ensuring you have sufficient intake, and that you maintain a healthy muscle mass.
You can learn more about a healthful approach to food and nutrition here:
You can request a referral to a dietician from your doctor at Peter Mac, or alternatively, Medicare or your private health fund may provide some limited cover to a dietician in the community.
