PAIN is scary. Really scary.
I've had two kids, I know what childbirth feels like.
That was always my barometer – and then I was diagnosed with bowel cancer and pain took on a new meaning.
When you have a baby, there's a pay off, a happy ending. When you have stage 4 cancer there's very little happy about it.
I've had operations to remove tumours, chemo, radiotherapy and various different drug combos – all of which hurt in different ways.
Stabbing pain in my chest
But recently, I've experience new pains – ones that I didn't see coming. I've been in pain on and off for the last few months.
Rightly, wrongly or maybe understandably I now associate pain with cancer – and so my immediate thought is, I'm about to die.
Every new twinge is a new tumour, or so I think.
These new pains started after my last round of CyberKnife (a fancy targeted radiotherapy), I started getting a stabbing pain below my chest.
My mind immediately decided it was a heart attack, or maybe my liver was packing it in.
I called the hospital but my symptoms didn't appear to worry anyone but me, which did comfort me in some ways.
Stretching helped, but it didn't feel like a pulled muscle. I convinced myself it was new tumours.
A scan eventually revealed it wasn't, instead it was inflammation caused by my treatment.
Then back pain floored me
Then came my next bout of pain – and this time I really thought it was serious.
I started running again post-CyberKnife, it's good for my mental health and reminds me that as long as I can run I'm alive.
But after two weekends and two 10ks in a row – albeit slow ones – I collapsed in a heap and could barely walk.
Obviously, in my head it wasn't just a case of overdoing it, or putting my back out (spoiler alert).
No, I convinced myself yet again it was cancer rearing its ugly head and trying to kill me, with a renewed fervour.
For three weeks I cried through the night, unable to sleep with a searing pain in my back.
Chronic pain is an invisible agony like no other
I've been through operations and cancer, but this was different. This was chronic pain.
The kind of pain that wears you down, that infects your brain and leaves you pacing up and down the house at 3am, bending over, rocking, begging for all the painkillers.
My back pain was relentless. There wasn't a moment in the day when I wasn't aware of it, throbbing, piercing and invading my very core
I've heard people talk about it, and always thought to myself, 'it's no childbirth or cancer'.
But the reality is, it is just as bad – like nothing I've ever been through.
It's relentless. There wasn't a moment in the day when I wasn't aware of it, throbbing, piercing and invading my very core. I began to forget what life felt like before the pain.
It knocked my mental health as much as my physical. I spiralled into a depression, questioning if I would ever sleep again.
I assumed the worst, that I wasn't responding to my new drugs and that cancer was growing inside me – and fast.
A few scans later, and lots of talking with my very patient team at The Royal Marsden and I was beyond relieved to learn it wasn't new tumours.
Relief it wasn't more cancer
I had actually screwed my back up, like a normal person, a cancer-free person.
Just knowing it wasn't cancer made me feel better.
But, once that relief had worn off, I still had to work out how to deal with the pain.
I'm lucky, my first step was asking for some help – next step see my pain specialist at the Marsden, Dr Matt Brown.
But, rather than keep his wisdom to myself, I figured I would share his expertise.
I have a new insight into millions of people plagued by back pain, an invisible agony that really hacks away at you. My advice, don't suffer in silence, go and speak to the experts.
An expert's view with Dr Matt Brown, consultant in pain medicine at The Royal Marsden
Pain is the most feared symptom in cancer patients and is really common, affecting – depending on the stage of disease – between one-third and two-thirds of patients.
It can arise for a number of reasons, these include the disease itself (for example when a tumour presses on a nerve), chemotherapy (which can cause damage to the tiny nerves in the skin), radiotherapy and surgery.
Patients who have had cancer for a long time are often find even normal activities painful.
Often, unfortunately, patients may have more than one cause of their pain which commonly results in it being severe and challenging to treat.
Pain is a big problem in cancer patients for a number of reasons, firstly it impacts on quality of life, reducing mobility and activity levels and can often be distressing both for patients and their loved ones.
Pain doesn’t sit in isolation – it’s a bit like a pebble dropped in a pond with the ripples spreading outwards… it impacts on every area of a patient’s life
Secondly, pain may have a negative impact on patients’ treatment, for example chemotherapy doses might be reduced if serious nerve damage occurs.
Finally, being in severe pain for long periods can lead to the development of anxiety and depression developing (which ironically can make the pain feel even worse)!
So what can be done about the pain?
Well pain doesn’t sit in isolation – it’s a bit like a pebble dropped in a pond with the ripples spreading outwards.
Pain impacts on every area of a patient’s life, and the best way to tackle it is to use a structured approach – focusing on the biological (i.e. the physical causes), psychological and social aspects of the pain.
This bio-psycho-social approach means that all areas are covered and no problems are missed.
When I see a cancer pain patient in my clinic I start by taking a history so that I can fully understand their cancer journey, the type of pain they are experiencing and how it is affecting them.
I normally accompany this with a physical examination focused on the painful area and a review of any relevant scans.
Education and explanation is really important in managing pain successfully – if someone understands why they are experiencing pain, the symptoms are often less distressing and I spend a lot of time chatting with my patients, explaining my findings and coming up with a management plan.
A combination of approaches can be used to treat pain, often these address not only the physical effects of the pain but also the psychological and social effects.
Approaches can include pain-killing medications ranging from simple drugs like paracetamol through to stronger agents like morphine and anti-nerve pain medicines, injections to block nerves, psychological approaches like relaxation techniques, physiotherapy and complementary therapies like acupuncture.
Combining a number of different treatments often leads to a better result.
Because pain and cancer are so closely intertwined, and pain often changes rapidly over the course of the disease, regular review and support is important.
The UK has a well-established speciality of pain medicine and most hospitals have pain medicine departments, if you feel your pain is not adequately controlled I would recommend asking your cancer doctor to consider referring you to your local pain specialist.
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