Pain management strategies

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 

• Why you are experiencing pain  

• How long the symptoms may last

There may be many reasons for ongoing pain. 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. You can learn about your pain from these sources. Some information on the Internet may be inaccurate or misleading. Always ensure you are seeking information from reliable sources. These include 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 in your body

• How it feels to you 

• How long it lasts for 

• What triggers it 

• What makes it better  

• What makes it worse

You can also use pain measurement tools like a numerical or verbal scale.

Finding a balance between activity and pain can be difficult. You may fall into the category of doing too much. This may aggravate and prolong your pain. This may in turn worsen your pain and/or fatigue and cause further flare-ups of pain. Or you may choose to rest more and gain short-term relief, which may reduce your physical ability. We call this the 'boom-bust cycle'. On a good ‘pain day’, you are on an upward slope, happy and positive, and get more things done. On a severe ‘pain day’, you are on a downward slope, remain inactive or bedridden. You are also 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  

• 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 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 diverse ways you can do 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 unhelpful beliefs that might prevent you from doing these activities? These can include thoughts and beliefs that you should watch out for 

By pacing your activities, you can build up your activity level over time. You can then seek a healthy balance between activity and rest. 

You may read this fact sheet for examples on pacing.

Flare-ups are where your pain fluctuates beyond usual levels. These 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 

Prepare a flare-up plan before you increase your activity. You may write this down and leave it somewhere accessible. This improves your chances of applying successful strategies to manage your pain.  And this way you don't have 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? 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 use to decrease the intensity of your pain. Think of what you can do. This can be in medication, physical activity, rest, relaxation, family, work and 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 have rest breaks (less than 30 minutes – or half an hour). 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. 

Check 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 and Exercise Physiology 

Physiotherapists and Exercise Physiologists supply a comprehensive assessment. They prescribe various modalities. These include exercises, walking aids, balance and mobility training and stretching programs. They also supply guidance on increasing your physical activity. And they supply advice on self-management of pain and fatigue. They can liaise and consult with external providers for ongoing care and rehabilitation. 

You can request a referral to Physiotherapy or Exercise Physiology from our doctors. Medicare or your private health fund may supply some cover to other professionals. 

You can:

• Listen to our Exercise Physiologists talk about exercise 

• Find out more information about our Physiotherapy and Exercise Physiology services

Exercise is a key part of your care and can be a useful tool in the management of your pain. Talk with your GP or us before taking part in any exercise program during or after your treatment. They will tell you about any precautions you should take. 

Occupational Therapy 

Occupational Therapists assess your pain’s impact on your life and activities. They prescribe adaptive strategies. These include implementing therapy and interventions that support participation in desired activities. They can also help with increasing function. They may suggest alternatives or modifications in performing desired activities. They supply guidance and advice on developing skills. And they supply customisations to how you live and function. 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. Medicare or your private health fund may supply some cover to other professionals. 

Find out more information about Occupational Therapy services with us. 

Transcutaneous Nerve Stimulation (TENS)  

Transcutaneous nerve stimulation is when we emit tiny electrical impulses through your skin. These target the nerves underneath the skin. Doing so interrupts their ability to send pain messages to the brain.  

This process is not completely studied to gauge effectiveness. Your pain specialist or your physiotherapist may recommend it to manage pain though. Continued use may supply some benefit.   

You may buy A TENS machine yourself. It is usually a portable, battery-operated machine. It has pads that you can place on the area of skin you wish to target. These pads then deliver the electrical impulses.

Find out more about Transcutaneous Electric Nerve Stimulation (TENS)

Experiencing pain can have a significant impact on your mental health. This includes:

• Your mood 

• Thoughts 

• The activities you may like to do 

• Your social abilities

You may also be trying to manage other symptoms such as fatigue, insomnia, nausea, and vomiting. In your cancer journey, you may also be grappling with various issues. These issues can include fear of recurrence or about the progression of the disease. You may also be experiencing grief and anxiety.  

Stress is an emotional and physical response. It is when there is a perceived imbalance between the demands on us and our ability to cope with those demands. We link muscle tension with stress and anxiety. Sometimes, we don’t even notice how our muscles become tense. This can relate to the 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 various psychotherapies a psychologist or psychiatrist may advocate for. These include cognitive-behavioural therapy and acceptance and commitment therapy. These therapies aim to teach self-observation for you. They help you understand the way you think, your beliefs and your behaviours. They also teach specific skills. These skills include positive self-talk or visualisation. Such skills reframe and manage your challenges. The overarching aim of these skills is to improve your function and quality of life. 

Meditation and Mindfulness 

Meditation is a repetitive practice. People have meditated for thousands of years. It has proven effective in supplying relief from stress, anxiety, and pain. Meditation aims to encourage and develop self-awareness, clarity, concentration, and calm. 

Meditation is not always spiritual or religious; anyone can meditate. Meditation is also not about “emptying” the mind of thoughts. 

There are distinct types of meditation. The most usual form is mindfulness. In mindfulness you combine self-awareness with attention. You can start by paying attention to your breath as it moves in and out of your body. You can combine meditation can with movement, such as in yoga or tai chi. 

You can learn more about meditation and mindfulness here: 

• Headspace Meditation 101  

• Monash Mindfulness for Wellbeing and Peak Performance 

Some smartphone apps that you may use to start your meditation practice are: 

• Headspace 

• Waking Up 

• Calm 

• Insight Timer 

Relaxation Therapy 

Relaxation therapy involves practices that allow your mind and body to relax. There is a close relationship between stress and your pain experience after all. 

Relaxation therapies include meditation, mindfulness, and gentle exercises. These exercises can include yoga, tai chi and massage. Progressive muscle relaxation is where you tense and then relax each muscle group. It is 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. Your pain can sometimes be an isolating and/or challenging experience, but it does not need to be. Social and emotional support is a positive factor in improving the pain experience.  

In the first instance, you may receive help seeking support from your family and/or friends. You may also find individuals with similar experiences. You can find them 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: 

• Community Support Organisations 

• Cancer Council Victoria Support Groups 

• Pain Australia Support Groups

Sleep 

We cannot underestimate the importance of sleep. Poor sleep results in poor levels of energy and concentration. It also affects our mood. Sleep is also an important side of restoring our physical health. An inadequate quality of sleep makes our pain worse.  

We recommend cultivating good sleep hygiene. These are habits that you can introduce to your daily life. They include avoiding specific stimuli before bedtime. You can also ensure 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:   

• Sleep Health Foundation - Good Sleep Habits  

• Why We Sleep - Matthew Walker 

Rest 

Alongside sleep, it is also important to rest enough. Rest is not only about strategies that promote relaxation and recuperation. It is also about strategies that allow you to manage your energy levels.  

Occupational Therapists have specific strategies. These strategies may guide you in managing your fatigue and energy levels. You can request a referral to Occupational Therapy from your doctor at Peter Mac. Medicare or your private health fund may supply some cover to other professionals. 

• Read more about fatigue management

• Sign up for our monthly seminar on fatigue management

Nutrition 

Your nutritional needs depend on a variety of factors. These factors include your specific health conditions. Your needs may also change during your cancer journey. Poor nutrition or malnutrition can contribute to ill health. Ill health can in turn affect your pain experience. It is thus important to find what your body needs to function the best. These needs may include ensuring you have enough intake, and that you keep a healthy muscle mass. 

You can learn more about a healthful approach to food and nutrition here:  

• Eat For Health 

• Nutrition and Cancer 

You can request a referral to a dietician from your doctor at Peter Mac. Medicare or your private health fund may supply limited cover to other dieticians.