How to Talk about Pain with Your Doctor

By Jennifer Castoro,

Wednesday, May 13, 2015

An older man in a checkered shirt smiles at his doctor, who has his hand on the man’s shoulder.

Pain is a common side effect of cancer treatment, but patients aren’t doomed to live with it. Doctors can provide many forms of relief, including medications and physical therapy. The crucial first step is reporting your symptoms.

  • Pain is a common side effect of cancer.
  • But many forms of relief are available.
  • The most important step is to ask for help.
  • If initial pain interventions don’t work, tell your doctor.

It’s pretty easy to recognize when you’re in pain, whether it arrives in the form of a sharp stab, a dull ache, or a twinge that comes and goes. But talking about the pain you’re feeling — and describing it to your doctor — can be less straightforward.

Unfortunately, pain is a common side effect of cancer and the therapies used to treat it. But just because you’re undergoing treatment doesn’t mean you’re doomed to suffer. The pain and palliative care specialists at Memorial Sloan Kettering are experts in all ways to ease patients’ pain — of which there are many — and are always available to help patients get some relief.

MSK physician Natalie Moryl, a Palliative Medicine attending physician, says the first crucial step in pain relief is one that patients often don’t take: speaking up. She emphasizes the importance of communicating your pain to your doctor and clarifies the most important things to highlight when sharing your symptoms.

Why is it important for patients to report pain to their doctor?

First, pain may indicate the need for tests or examinations that can help locate a problem that could be helped or fixed. Pain also has significant impact on quality of life — for both the patient and for family members. It’s not uncommon for the patient to be very stoic, but because of pain, his or her ability to participate in family life is limited. We often hear complaints from family members about a patient being in pain and not being able to be “with them” fully. And that causes a lot of grief for all involved.

And finally, some patients feel that they’re bothering doctors, that there are too many complaints, too many issues to report. But in fact, nurses and doctors are required to ask about and document pain, so having an open and frank discussion helps speed the process. Talking about pain openly and freely will help your team, not burden them.

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Do people assume that pain is normal and that’s why they don’t speak up?

It really varies, but some patients do feel that if they have cancer, they’re almost doomed to have pain, that it’s part of the picture and they should not be complaining. But that isolates the person a lot, and it’s really unnecessary. We have medications to make pain a lot better, if not disappear completely. We can help decrease how pain interferes with quality of life, or at least explain what is happening.

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What do people typically tell you about pain? What can they say that’s helpful?

In addition to where the pain is located and what makes it better and worse, a nurse or a doctor may ask you to describe it. Is it burning? Is it stabbing? Does your skin feel very sensitive? Some people have very odd descriptions, like, “I feel like water is running down my leg constantly,” or “I feel ants are crawling on my foot.”

Sometimes people feel embarrassed to report these unusual sensations, but actually those kind of strange descriptions help identify the problem very quickly. Something as simple as disc herniation in the lower lumbar spine can cause a sensation of ants crawling on the top of your foot. Patients may not want to describe it, but if I heard that, it would really help me understand what’s happening and where to look to investigate further.

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What do you typically prescribe to treat pain?

In the case of complex pain management, we use multiple methods. Medication is the main approach. We try to give the lowest but most effective doses possible. There’s also physical therapy, rehab, and psychological support. If there are interventions that can fix the pain permanently, such as surgery, radiation therapy, or nerve blocks, we try to seek those. We refer the patients to subspecialists who can help manage these aspects.

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Are patients hesitant to take more medications?

Yes. One of the reasons we get referrals from oncologists is when patients are very apprehensive about taking opioids or other non-narcotic pain medications. And then we discuss the risks, the benefits, the way they’re monitored, and we look at the goals of care for that person. Cancer patients rarely become addicted to medications prescribed for cancer-related pain. If the patient takes the medication exactly as prescribed and follows the physician’s directions, we see very little reason to be concerned.

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What signs can people look for to know that it’s time to report pain symptoms to their doctor?

If people feel new pain or uncontrolled pain, they should ask their doctor or nurse and try to understand where it’s coming from. The nurse or doctor may explain that this is peripheral neuropathy from chemotherapy, and that within six months after stopping chemotherapy, it’s going to be a lot better. You may decide to take medication for that or not, but at least you will not be as fearful. Understanding where things are coming from helps a lot of people to just cope with it.

Something that comes up often in my practice is that patients don’t want to disappoint their doctor. If they get pain medication and the doctor asks if it helps, the patient will say yes. But then when you continue asking, it actually doesn’t help. People don’t want to give negative feedback to their treating team.

Our patients are extremely loyal, an amazing group of people. They try to be “good patients” and not complain. But they need to at least give us accurate information — with the purpose of seeing if it could be helped. So if whatever you’re getting for pain is not working, please speak up. Maybe we could do better.

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