Non-Drug therapies can be used with drugs and other treatments to manage pain and include several different options:
Heat (Use for muscle tightness after surgery or arthritic pain):
Cold (Use for itching, muscle spasms, nerve pain and severe pain):
- Heat includes warm-to-hot baths, heating pads or chemical packs.
- Chemical packs can be heated in the microwave or boiling water. Make sure you have a wrap around it, don’t place the pack directly on your skin and be sure it’s not too hot.
- Make your own hot pack by taking a long sock and filling it with dry rice. Tie the open end of the sock, and heat by putting it in the microwave for one to two (1-2) minutes.
- Avoid heat to the chest wall if you have had radiation.
- Avoid heat in the radiated breast if you have had treatment with anthracycline (doxorubicin)<.b> chemotherapy, as it can result in a severe skin reaction.
- Avoid heat in your arms, chest or legs if you have any numbness or tingling in the area.
- Cold includes ice massage, ice bags and gel packs. Gel packs are inexpensive, easy to use and can be used over again.
- Put on the painful area until you begin to feel relief. Avoid the shock of sudden, intense cold by using a wrap around it.
- Alternating use of heat and cold may be more effective than the use of heat or cold alone. Try alternating every 20 minutes or so.
Lotions and Creams (Products that contain menthol provide a feeling of warmth or coolness to an area and can help with pain) include Ben Gay®, Icy Hot® and Vicks® and similar home cures, which are often used to deal with sports injuries.
Mental and Physical Behaviors (Can help and increase sense of control. Try different ones and do regularly.)
- Do not use these lotions or creams with heat (such as a heating pad or heat pack or the sun) as the heat can cause a burn.
- Do not use these products if you have had radiation to the painful area or if your doctor has told you to avoid the use of aspirin products.
- You can also warm up regular lotions you use and rub them on the affected area.
- Relaxation: Simple relaxation methods such as deep breathing may be used for periods of brief pain.
- Redirecting thinking and distraction: Thinking about something other than pain or the negative feelings that come with pain may help. You can talk to yourself (for example, counting, praying, or saying things like “I can cope.”) Try doing something with others or out loud (listen to music, watch television, talk, listen to someone read, etc.). You can also learn to stop negative thoughts and replace them with more positive thoughts and images.
- Exercise and stretching: Some women find relief in performing yoga exercise stretches or gently exercising the area they have pain in. If pain worsens, do not continue to exercise. For women with arthritis, exercise may help keep their joints mobile.
- Therapeutic massage, acupuncture and chiropractic care are alternative ways that can help with pain as well. Finding a caring practitioner with experience can make a huge difference in your pain level.
When Do You Need to Seek Help?
Always talk to your doctor or health care team if the non-drug pain methods are not working.
The World Health Organization (WHO) has developed a three-step “ladder” for cancer pain relief in adults. It recommends people promptly use oral drugs, starting with nonopioids; then if the pain persists or increasing, move to mild opioids; and if the pain still continues, to use strong opiods. To calm fears and anxiety, WHO also recommends using additional drugs or “adjuvants.”
WHO also says to maintain freedom from pain, drugs should be given by the clock, or every three (3) to six (6) hours, rather than “on demand.” This three-step approach has been found to be less expensive and 80 to 90 percent effective in alleviating pain.
- Step 1: If you have mild to moderate pain, try pain medicine you can buy on your own such as aspirin, acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen. Remember some people cannot take these drugs, so check with your doctor first. Acetaminophen should be used with caution if you drink alcohol or have liver disease. All of these medicines should be taken as prescribed on their packaging or as prescribed by your doctor.
- Step 2: NSAIDs work well to relieve mild pain. They may be given with opioids for the relief of mild to severe pain. Acetaminophen also relieves pain, although it does not have the anti-inflammatory effect that aspirin and NSAIDs do.
- Step 3: If pain lasts or increases, your health care team may decide to prescribe opioids. You will need a prescription for these drugs. These drugs are very helpful for mild to severe pain. While they do not cure the reason for the pain, they act on the brain so that you don’t feel the pain as intensely.
Notes on Drug Therapies:
Some commonly used opioids are morphine, codeine, methadone, and fentanyl. The right dose is the amount of drug that controls pain with the fewest side effects. Take only the amount of drug that the doctor tells you to take. Some people worry about becoming addicted to drugs like these, however that is not common. By using these medicines as prescribed, in the lowest effective dose, you can avoid some of the problems associated with these medicines.
If pain lasts or gets worse, your doctor may increase the opioid dose. Take the medicine regularly (at scheduled times) to keep a constant level of the drug in your body. You don’t want to “chase the pain,” which can happen when you wait until the pain becomes too much to handle.
Your doctor may prescribe more doses or different classifications of drugs if you are having pain between the times when you take your medicine. Other drugs may be given at the same time as the pain medicine to help it work better and treat side effects (e.g. such Mepergan- a combination of Demerol and Phenergan). Feeling sleepy is a common result of taking pain medicines. That feeling will usually end in about three days when your body gets used to pain medicine. To combat sleepiness:
- Drink liquids with caffeine such as coffee, tea or sodas.
- Get up and move around or do some stretching when you feel yourself getting sleepy.
- Avoid doing active things like driving, cooking, climbing stairs, or working where you could hurt yourself and others. Taking pain medicines should not stop you from doing these things, but do not do them when you feel sleepy.
- Rest as much as needed. After taking one of these medicines, plan for a rest period.
- If you keep on feeling sleepy, talk to your doctor or health care team. Make sure that they know all of the medicines that you take, including prescribed and over-the-counter medicines. Chronic pain may best be treated by a pain management specialist.
When Do You Need to Seek Help?
Talk to your doctor or health care team if your pain medication isn’t working. You may need to get it adjusted.
World Health Organization/Cancer Pain Ladder for Adults:
American Cancer Society/Managing Cancer Pain:
Mayo Clinic/Cancer Pain: Relief is Possible:
M.D. Anderson/Cancer Pain Management:
Breastcancer.org/Treatments for Pain:
Breast Cancer Yoga Video:
National Lymphedema Network: