Many patients with cancer fear that they will suffer pain. In fact, at some point during the course of the disease, 60 to 90 percent of patients will require a pain-relieving therapy. But not all cancers produce pain equally, and some cancers, even when advanced, may not cause pain at all. Cancers that are more typically painful include tumors of the bone (either primary or through spread) and the organs of the abdomen. Cancers of the blood system, such as leukemias or lymphomas, often never cause pain.
Pain can have a terrible effect on a cancer patient's life. It can lead to depression, loss of appetite, irritability, and withdrawal from social interaction, anger, loss of sleep and an inability to cope. If uncontrolled, pain can destroy relationships with loved ones and the will to live. Fortunately, pain can almost always be controlled. What is needed is an understanding by caregivers of the nature of the pain, of what causes it and of the appropriate treatments for the type of pain involved, as well as a commitment to relieving it. The oncologist is usually well equipped to handle most types of pain. For more unremitting pains, patients may be referred by their doctor to a specialist who will help to sort out the cause and treatments for symptoms.
Pain is a complex phenomenon. It has physical, emotional and psychological components. How each person responds to pain is also complex. The extent of disease and the nature of the discomfort contribute to a person's experience of pain. But pain is also modified by remembrances of past painful episodes, the special meaning of pain to each individual, the expectations of family and friends, religious upbringing and personal coping skills and strategies. Cultural beliefs also influence the pain experience. Certain cultures teach tolerance of pain or that the outward expression of pain is inappropriate. People from these cultures bear their pain without complaining or even expressing their needs. Externally, they may appear to have a higher threshold or tolerance to pain while in fact suffering quietly. Other cultures readily and outwardly express painful experiences, and people from those cultures may appear to have a lower threshold or tolerance.