What is pancreatic cancer?
Pancreatic cancer occurs when cells in the pancreas, a vital organ behind the stomach, begin to multiply out of control. The pancreas produces important enzymes which help the body digest foods. It also produces important hormones which help the body control glucose.
Pancreatic cancer is rarely diagnosed in the early stages. This is because, in most cases, symptoms don’t appear until much later in the disease.
Pain can be a major problem and shouldn’t be ignored. Identifying patterns of pain can help your doctor diagnose the possibility of pancreatic cancer and whether it’s spread. Controlling pain can also help improve your quality of life. In addition, a study published by the National Center for Biotechnical Information suggests that reducing pain levels may increase the lifespan of those with pancreatic cancer.
Pain from pancreatic cancer may come from different areas. Early pancreatic cancer rarely causes any symptoms. By the time it does cause symptoms, it’s often already spread outside the pancreas.
Pain in the stomach (abdomen or belly) is quite common. This may be for different reasons. A common cause is fewer digestive enzymes and a buildup of undigested foods. Foods may also back up into the stomach area if the cancer is blocking its passage out of the stomach.
A common cause of abdominal pain is the growth of a tumor which then presses on nerves or nearby organs.
A new pain after eating should be brought to your doctor’s attention. You should also tell your doctor about any pain that tends to be worse after eating.
Back pain — especially when it seems to be coming from the stomach area — is also common. This may come from changes to the abdomen area, or it may stem from changes to the liver. The liver is often enlarged in pancreatic cancer. This can lead to pain when the enlarged liver presses on nerves and tissues in surrounding areas.
Constipation can cause pain in multiple sites, including the abdomen and the back.
Other pancreatic cancer signs and symptoms may include:
- jaundice (yellowing of the skin and eyes)
- dark urine
- light-colored or greasy bowel movements
- very dry, itchy skin
- enlarged liver
- weight loss and/or loss of appetite
- nausea and vomiting
- blood clots
It’s important to know that these symptoms may not be from pancreatic cancer in your case. Other causes may be responsible. It’s critical to see your doctor so the causes of your symptoms may be found and treated as soon as possible.
Pain from pancreatic cancer is a worrisome symptom. Fortunately, there are many pain treatments. For most people, pain can be controlled.
For mild pain, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil are often recommended. Acetaminophen (such as Tylenol) is another option. Disadvantages of these drugs are they can only provide a certain amount of pain relief. In larger amounts or if taken over a period of time, these medications may also cause stomach bleeding, kidney problems, or liver problems.
Overall, these medications are typically used as an add-on to other medications (described below). This is done to help reduce the amount needed of other more powerful medications.
NSAIDs are available without a prescription. But you should never take any medication for pancreatic cancer pain without your doctor’s advice.
A weak opioid, such as codeine or tramadol, may be useful for moderate pain. These medications are useful for those who don’t respond fully to NSAIDs, but may not need something for severe pain. Weak opioids are only able to manage pain up to a certain degree. They are often combined with medications (such as NSAIDs) given for mild pain.
Side effects tend to be similar to those that occur when using medications for moderate to severe pain. These may not be quite as noticeable, but you should always tell your doctor about any unwanted effects to any medication.
Moderate to severe pain
The most common medications used for advanced pancreatic cancer pain are stronger opioids. These include, among others, morphine, hydromorphone, fentanyl, and methadone.
Like other categories of pain treatment and dosing, finding the right combination involves trial and error. Your doctor may start you at a lower dose and then increase the dose until your pain is controlled. Additionally, other drugs or therapies may be added to help control pain and reduce the amount of strong opioid needed for pain control.
As with all treatments, be sure to tell your doctor if your pain is not being controlled, even with stronger medications. They’ll likely change the dose, or the treatment, so you are more comfortable.
One thing to watch for is called breakthrough pain. As the name implies, this situation occurs when your pain is controlled most of the time but you experience periods of pain before your next scheduled dose of pain medication. In some cases, this means a higher overall dose is needed. There may also be other ways to help manage breakthrough pain.
People are often concerned about addiction with stronger opioids. In fact, if dosing is done properly, addiction rarely occurs. An important approach is to treat pain before it becomes severe. One way to do this is to take pain treatments at regular times, not just when the pain occurs. Pain is easier to control if it’s prevented as much as possible. And preventative pain management may lower the overall daily amount of medication needed.
Side effects that may occur with stronger opioids include:
- mood changes
In general, people taking opioids should avoid alcohol as it can add to the feeling of drowsiness. You should also avoid driving a car or performing other activities that require alertness until you know how you respond to these medications.
Sometimes non-pain drugs are used in addition to pain medications. Laxatives and anti-nausea drugs are used to manage the side effects of pain medications. Steroids may be used to help increase pain control. Antidepressants can help control fear and anxiety. And anti-seizure medications can help nerve pain. Any of these medications may be used at any point in pain management.
Your doctor may also recommend the following treatments, depending on the cause of your pain:
- alcohol nerve block (to stop a nerve from causing pain)
- celiac plexus block (helps stop pain in the upper stomach area)
- chemotherapy or radiotherapy (if the cancer has spread to other organs)
Non-drug pain treatment
The following approaches may be combined with pain medications and other treatments. They’re not necessarily effective by themselves, but they can help reduce pain and therefore the amount of pain medication needed.
- relaxation therapy
- guided imagery
- ice and heat
- cognitive behavioral therapy
- physical therapy
- coping skills training
What’s the outlook for this pain?
Pancreatic cancer is one of the most aggressive cancers there is. It can be associated with a great deal of pain. Fortunately, there are many ways to help control pain and to improve your quality of life. In addition, there are a number of new treatments being studied, suggesting that pain from pancreatic cancer will become even easier to control in the near future.