The good news: Your ovarian cancer healthcare team will be very familiar with anything you face. And, in most cases, there are pain management techniques that can be tailor-made to deal with most, if not all, situations.
Where Does Ovarian Cancer Cause Pain?
In its earliest stages, ovarian cancer may cause no symptoms or only mild ones. These symptoms include bloating, pelvic or abdominal pain, trouble eating or feeling full quickly, and urinary urgency, according to the National Ovarian Cancer Coalition. Ovarian cancer pain may also extend into the back, cause pain during sex, and, in advanced stages, cause leg pain. RELATED: 6 Ways to Ease Painful Sex During and After Menopause
Is Ovarian Cancer Pain Constant, or Does It Come and Go?
Ovarian cancer pain can be tough to identify initially. “Women often report that they feel vague pelvic pain that feels like a little pressure. This pressure [generally] comes and goes,” says Marilyn Huang, MD, MS, co-director of translational gynecologic oncology research at the University of Miami Sylvester Comprehensive Cancer Center. “The ovary moves based on our movement and relaxes when we aren’t as active, and so sometimes women feel better when they slow down,” she says. As such, discomfort waxes and wanes, which also makes seeking doctor care more complicated — it’s easy to convince yourself that it’s nothing or, if you don’t have “stabbing” or intense pain, that it’s no big deal at all.
What Does Ovarian Cancer Pain Feel Like?
Women may experience different types of pain due to ovarian cancer: vague feelings of discomfort, sharp or shooting pains, a sensation of bloating, or dull and constant aches in the bones. Some women may not have any pain at all until their cancer is in a more advanced stage, says Carmel Cohen, MD, professor emeritus of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai in New York. Advanced ovarian cancer can lead to issues that create pain because the tumor has grown. “The pain has to do either with invasion of bone, or intestinal obstruction and bowel dysfunction related to the expansion of the disease, which produces a blocked or kinked bowel,” says Cohen. “That’s usually a very late event in the course of ovarian cancer. It’s controlled with pain medication the same way that one would receive pain medication for any other significant amount of pain.” RELATED: Ovarian Cancer: What Are the Signs and Symptoms of Ovarian Cancer?
Are There Treatment and Medication Options to Help Manage Pain?
When ovarian cancer is diagnosed, treatment of the disease is the first course of action to fight the cancer and try to alleviate pain. But disease management also includes pain medication to keep the pain under control. The pain management strategy will depend on the symptoms. “A lot of patients do not have sharp, intense pain, so most do not require narcotics,” says Huang. Cohen strongly recommends that women talk about pain management with their healthcare providers early and often. If pain becomes considerable, they should not try to self-medicate, he says. “They should consult a physician,” says Cohen, so that their doctor can determine the most appropriate way to treat and manage it. In one study published in the March/April issue of Cancer Nursing, patients reported using 5 different physical and emotional coping strategies, including actively managing and planning for the pain, relaxation, and distraction. The authors conclude that women should try a range of strategies to cope with the pain in order to find what works for them.
What If the Treatment Is Causing Pain?
At times, the treatments for ovarian cancer can seem worse than the disease. Surgery, chemotherapy, radiation therapy — each of these carries with it a set of possible side effects and complications, not the least of which can be pain. Pain management depends on the cause of pain, says Huang. For instance, if you had surgery to remove one or both ovaries (called an oophorectomy) or a hysterectomy, which involves removal of the uterus, then management includes treating post-operative pain, such as incisional pain. “This may include a combination of NSAIDs (nonsteroidal anti-inflammatory drugs) and small doses of narcotics as needed,” says Huang. Women with advanced disease may also need neoadjuvant therapies (therapies given before surgery), says Huang. This is done to reduce the size of the tumor and make it smaller and easier to remove. Chemotherapy may also be used after surgery to prevent its spread. However, chemotherapy can also cause neuropathic (nerve) pain. In one study, 51 percent of women who received chemotherapy reported “a little” or “very much” peripheral neuropathy (tingling in hands and feet or numbness in fingers and toes) up to 12 years after treatment versus 27 percent of women who didn’t get chemo, per Gynecologic Oncology in December 2014. Neuropathic pain can be managed with medications like gabapentin, Lyrica (pregabalin), and Irenka (duloxetine), says Huang.
