Cancer and Pain Management: You Don't Have to Suffer

Pain is one of the most feared aspects of cancer. Yet in Pakistan, cancer pain is frequently undertreated due to stigma around opioid medicines, limited awareness among patients and families, and limited access to palliative care services.

Does cancer always cause pain? No. Many cancers, especially in early stages, are painless. Pain becomes more common in advanced disease. But when cancer pain occurs, it is almost always treatable.

Types of cancer pain:

• Acute pain: Often from procedures, surgery, or acute complications
• Chronic pain: From the tumour pressing on nerves, bones, or organs
• Neuropathic pain: A burning or shooting pain from nerve damage (common after chemotherapy)

The WHO Pain Ladder — a simple, effective approach:

1. Step 1: Non-opioid medicines (Paracetamol, NSAIDs like Ibuprofen)
2. Step 2: Mild opioids (Codeine, Tramadol)
3. Step 3: Strong opioids (Morphine, Oxycodone)

Morphine is on the WHO Essential Medicines List and is available in Pakistan, though access can be inconsistent.

Common misconceptions in Pakistan:

• "Taking morphine means I am dying" — False. Morphine is a medicine for pain, not an end-of-life drug
• "Opioids are addictive in cancer patients" — Addiction is rare when opioids are used for genuine pain
• "I should tolerate pain" — Never. Uncontrolled pain worsens quality of life and can have an adverse effect on outcome

What can patients and families do?

• Be honest with your doctor about pain levels (use a scale of 0–10)
• Ask specifically about pain management options
• Request a referral to palliative care services where available (SKMCH, Aga Khan Hospital)

Key message: Cancer pain can and should be treated. Speak openly to your healthcare team. You have a right to be comfortable.