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What You Should Know About Treating Cancer Pain
Types and Causes of Cancer Pain
Talking About Your Pain
Your Pain Control Plan
Medicines To Treat Cancer Pain
Medicine Tolerance and Addiction
Other Ways To Control Pain
Your Feelings and Pain
Financial Issues
Pain Control Record
Relaxation Exercises
Before You Go to the Pharmacy - Know What You're Getting!
For More Information
Cancer Pain Can Be Managed
Pain Control: Support for People with Cancer
Having cancer doesn't mean that you'll have pain. But if you do, you can manage most of your pain with medicine and other treatments.
This section will show you how to work with your doctors, nurses, and others to find the best way to control your pain. It will discuss causes of pain, medicines, how to talk to your doctor, and other topics that may help you.
Your "health care team" can help you manage cancer pain
Your "health care team" can mean any of the professionals you see as part of your medical care. These may include your oncologist, your family doctor, nurses, physical therapists, pharmacists, oncology social workers, clergy members, and others.
This information is also available as a printable booklet or as an e-book.
What You Should Know About Treating Cancer Pain
You don't have to accept pain
People who have cancer don't always have pain. Everyone is different. But if you do have cancer pain, you should know that you don't have to accept it. Cancer pain can almost always be relieved.The key messages we want you to learn from this booklet are:
- Your pain can be managed.
- Controlling pain is part of your cancer treatment.
- Talking openly with your doctor and health care team will help them manage your pain.
- The best way to control pain is to stop it from starting or keep it from getting worse.
- There are many different medicines to control pain. Everyone's pain control plan is different.
- Keeping a record of your pain will help create the best pain control plan for you.
- People who take cancer pain medicines as prescribed rarely become addicted to them.
- Your body does not become immune to pain medicine. Stronger medicines should not be saved for "later."
Palliative care and pain specialists can help
Cancer pain can be reduced so that you can enjoy your normal routines and sleep better. It may help to talk with a palliative care or pain specialist. These may be oncologists, anesthesiologists, neurologists, surgeons, other doctors, nurses, or pharmacists. If you have a pain control team, it may also include psychologists and social workers.
Pain and palliative care specialists are experts in pain control. Palliative care specialists treat the symptoms, side effects, and emotional problems of both cancer and its treatment. They will work with you to find the best way to manage your pain. Ask your doctor or nurse to suggest someone. Or contact one of the following for help finding a specialist in your area:
- Cancer center
- Your local hospital or medical center
- Your primary care provider
- People who belong to pain support groups in your area
- The Center to Advance Palliative Care, www.getpalliativecare.org (for lists of providers in each state)
- Tired
- Depressed
- Angry
- Worried
- Lonely
- Stressed
- Enjoy being active
- Sleep better
- Enjoy family and friends
- Improve your appetite
- Enjoy sexual intimacy
- Prevent depression
Types and Causes of Cancer Pain
Cancer pain can range from mild to very severe. Some days it can be worse than others. It can be caused by the cancer itself, the treatment, or both.
You may also have pain that has nothing to do with your cancer. Some people have other health issues or headaches and muscle strains. But always check with your doctor before taking any over-the-counter medicine to relieve everyday aches and pains. This will help ensure that there will be no interactions with other drugs or safety concerns to know about.
Different types of pain
Here are the common terms used to describe different types of pain:
- Acute pain ranges from mild to severe. It comes on quickly and lasts a short time.
- Chronic pain ranges from mild to severe. It either won't go away or comes back often.
- Breakthrough pain is an intense rise in pain that occurs suddenly or is felt for a short time. It can occur by itself or in relation to a certain activity. It may happen several times a day, even when you're taking the right dose of medicine. For example, it may happen as the current dose of your medicine is wearing off.
What causes cancer pain?
Cancer and its treatment cause most cancer pain. Major causes of pain include:
- Pain from medical tests. Some methods used to diagnose cancer or see how well treatment is working are painful. Examples may be a biopsy, spinal tap, or bone marrow test. If you are told you need the procedure, don't let concerns about pain stop you from having it done. Talk with your doctor ahead of time about what will be done to lessen any pain you may have.
- Pain from a tumor. If the cancer grows bigger or spreads, it can cause pain by pressing on the tissues around it. For example, a tumor can cause pain if it presses on bones, nerves, the spinal cord, or body organs.
- Spinal cord compression. When a tumor spreads to the spine, it can press on the spinal cord and cause spinal cord compression. The first sign of this is often back or neck pain, or both. Coughing, sneezing, or other motions may make it worse.
- Pain from treatment. Chemotherapy, radiation therapy, surgery, and other treatments may cause pain for some people. Some examples of pain from treatment are:
- Neuropathic pain. This is pain that may occur if treatment damages the nerves. The pain is often burning, sharp, or shooting. The cancer itself can also cause this kind of pain.
- Phantom pain. You may still feel pain or other discomfort coming from a body part that has been removed by surgery. Doctors aren't sure why this happens, but it's real.
How much pain you feel depends on different things. These include where the cancer is in your body, what kind of damage it is causing, and how you experience the pain in your body. Everyone is different.
Call your doctors right away
Listen to your body. If you notice that everyday actions, such as coughing, sneezing, moving, walking, or standing, suddenly cause new pain or your pain to get worse, tell your doctors right away. Also let them know if you have unusual rashes or bowel or bladder changes.
Talking About Your Pain
Pain control is part of treatment. Talking openly is key."At first I tried to be brave. Now I realize that the only way to handle my pain is to be open and honest about it with my health care team. It's the only way I can stay on top of it and keep it under control." - Janie
Controlling pain is a key part of your overall cancer treatment. The most important member of the team is you. You're the only one who knows what your pain feels like. Talking about pain is important. It gives your health care team the feedback they need to help you feel better.
Some people with cancer don't want to talk about their pain. They think that they'll distract their doctors from working on ways to help treat their cancer. Or they worry that they won't be seen as "good" patients. They also worry that they won't be able to afford pain medicine. As a result, people sometimes get so used to living with their pain that they forget what it's like to live without it.
But your health care team needs to know details about your pain and whether it's getting worse. This helps them understand how the cancer and its treatment are affecting your body. And it helps them figure out how to best control the pain.
Try to talk openly about any other medical problems and fears you have. And if money worries are stopping you, be sure to read the Financial Issues section. There may be ways to help you get the medicine you need.
Tell your health care team if you're:
- Taking any medicine to treat other health problems
- Taking more or less of the pain medicine than prescribed
- Allergic to certain drugs
- Using any over-the-counter medicines, home remedies, or herbal or alternative therapies
This information could affect the pain control plan your doctor suggests for you. If you feel uneasy talking about your pain, bring a family member or friend to speak for you. Or let your loved one take notes and ask questions. Remember, open communication between you, your loved ones, and your health care team will lead to better pain control.
Talking about your pain.
The first step in getting your pain under control is talking honestly about it. Try to talk with your health care team and your loved ones about what you are feeling. This means telling them:
- Where you have pain
- What it feels like (sharp, dull, throbbing, constant, burning, or shooting)
- How strong your pain is
- How long it lasts
- What lessens your pain or makes it worse
- When it happens (what time of day, what you're doing, and what's going on)
- If it gets in the way of daily activities
Describe and rate your pain.
You will be asked to describe and rate your pain. This provides a way to assess your pain threshold and measure how well your pain control plan is working.
Your doctor may ask you to describe your pain in a number of ways. A pain scale is the most common way. The scale uses the numbers 0 to 10, where 0 is no pain, and 10 is the worst. You can also use words to describe pain, like pinching, stinging, or aching. Some doctors show their patients a series of faces and ask them to point to the face that best describes how they feel.
No matter how you or your doctor keep track of your pain, make sure that you do it the same way each time. You also need to talk about any new pain you feel.
It may help to keep a record of your pain. See Pain Control Record for an example. Some people use a pain diary or journal. Others create a list or a computer spreadsheet. Choose the way that works best for you.
Your record could list:
- When you take pain medicine
- Name and dose of the medicine you're taking
- Any side effects you have
- How much the medicine lowers the pain level
- How long the pain medicine works
- Other pain relief methods you use to control your pain
- Any activity that is affected by pain, or makes it better or worse
- Things that you can't do at all because of the pain
Share your record with your health care team. It can help them figure out how helpful your pain medicines are, or if they need to change your pain control plan.
Here are some ways your health care team may ask you to describe or rate your pain:
Share your beliefs.
Some people don't want to take medicine, even when it's prescribed by the doctor. Taking it may be against religious or cultural beliefs. Or there may be other personal reasons why someone won't take medicine. If you feel any of these ways about pain medicine, it's important to share your views with your health care team. If you prefer, ask a friend or family member to share them for you. Talking openly about your beliefs will help your health care team find a plan that works best for you.
Your Pain Control Plan"It took a few visits to my health care team to get my pain under control. But by trying different medicines and doses, I now have a pain plan that works for me." - Michelle
Make your pain control plan work for you.
Your pain control plan will be designed for you and your body. Everyone has a different pain control plan. Even if you have the same type of cancer as someone else, your plan may be different.
Take your pain medicine dose on schedule to keep the pain from starting or getting worse. This is one of the best ways to stay on top of your pain. Don't skip doses. Once you feel pain, it's harder to control and may take longer to get better.
Here are some other things you can do:
- Bring your list of medicines to each visit.
- If you are seeing more than one doctor, make sure each one sees your list of medicines, especially if he or she is going to change or prescribe medicine.
- Never take someone else's medicine. What helped a friend or relative may not help you. Do not get medicine from other countries or the Internet without telling your doctor.
- Don't wait for the pain to get worse.
- Ask your doctor to change your pain control plan if it isn't working.
The best way to control pain is to stop it before it starts or prevent it from getting worse.
Don't wait until the pain gets bad or unbearable before taking your medicine. Pain is easier to control when it's mild. And you need to take pain medicine often enough to stay ahead of your pain. Follow the dose schedule your doctor gives you. Don't try to "hold off" between doses. If you wait:
- Your pain could get worse.
- It may take longer for the pain to get better or go away.
- You may need larger doses to bring the pain under control.
Keep a list of all your medicines.
Make a list of all the medicines you are taking. If you need to, ask a member of your family or health care team to help you. Bring this list of medicines to each visit. You can take most pain medicines with other prescription drugs. But your health care team needs to know what you take and when. Tell them each drug you are taking, no matter how harmless you think it might be. Even over-the-counter medicines, herbs, and supplements can interfere with cancer treatment. Or they could cause serious side effects or reactions.
How to tell when you need a new pain control planHere are a few things to watch out for and tell your health care team about:
- Your pain isn't getting better or going away.
- Your pain medicine doesn't work as fast as your doctor said it would.
- You have breakthrough pain.
- You have side effects that don't go away.
- Pain interferes with things like eating, sleeping, or working.
- The schedule or the way you take the medicine doesn't work for you.
Don't give up hope. Your pain can be managed.
If you are still having pain that is hard to control, you may want to talk with your health care team about seeing a pain or palliative care specialist (see Pain specialists can help). Whatever you do, don't give up. If one medicine doesn't work, there is almost always another one to try. Also, new medicines are created all the time. And unlike other medicines, there is no "right" dose for many pain medicines. Your dose may be more or less than someone else's. The right dose is the one that relieves your pain and makes you feel better.
Medicines To Treat Cancer Pain
There is more than one way to treat pain.
Your doctor prescribes medicine based on the kind of pain you have and how severe it is. In studies, these medicines have been shown to help control cancer pain. Doctors use three main groups of drugs for pain: nonopioids, opioids, and other types. You may also hear the term analgesics used for these pain relievers. Some are stronger than others. It helps to know the different kinds of medicines, why and how they're used, how you take them, and what side effects you might expect.
Nonopioids - for mild to moderate pain
Nonopioids are drugs used to treat mild to moderate pain, fever, and swelling. On a scale of 0 to 10, a nonopioid may be used if you rate your pain from 1 to 4. These medicines are stronger than most people realize. In many cases, they are all you'll need to relieve your pain. You just need to be sure to take them regularly.
You can buy most nonopioids without a prescription. But you still need to talk with your doctor before taking them. Some of them may have things added to them that you need to know about. And they do have side effects. Common ones, such as nausea, itching, or drowsiness, usually go away after a few days. Do not take more than the label says unless your doctor tells you to do so.
Nonopioids include:
- Acetaminophen, which you may know as Tylenol®
Acetaminophen reduces pain. It is not helpful with inflammation. Most of the time, people don't have side effects from a normal dose of acetaminophen. But taking large doses of this medicine every day for a long time can damage your liver. Drinking alcohol with the typical dose can also damage the liver.
Make sure you tell the doctor that you're taking acetaminophen. Sometimes it is used in other pain medicines, so you may not realize that you're taking more than you should. Also, your doctor may not want you to take acetaminophen too often if you're getting chemotherapy. The medicine can cover up a fever, hiding the fact that you might have an infection.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (which you may know as Advil® or Motrin®) and aspirin
NSAIDs help control pain and inflammation. With NSAIDs, the most common side effect is stomach upset or indigestion, especially in older people. Eating food or drinking milk when you take these drugs may stop this from happening.
NSAIDs may also keep blood from clotting the way it should. This means that it's harder to stop bleeding after you've hurt yourself. NSAIDs can also sometimes cause bleeding in the stomach.
Tell your doctor if:
- Your stools become darker than normal
- You notice bleeding from your rectum
- You have an upset stomach
- You have heartburn symptoms
- You cough up blood
|Acetaminophen and NSAIDs at a Glance
|Other Names
|Side Effects
|Reduces pain and fever
|Large doses can damage the liver.
May cause liver damage if you drink three or more alcoholic drinks a day.
Lowers fever. Talk to your doctor if your body temperature is above normal (98.6°) and you are taking this medicine.
|NSAIDs (aspirin, ibuprofen, naproxen)
|Reduces pain, inflammation (swelling), and fever
|Can upset the stomach.
Can cause bleeding of the stomach lining, especially if you drink alcohol (wine, beer, etc.).
Can cause kidney problems, especially in the elderly or those with existing kidney problems.
Can cause heart problems, especially in those who already have heart disease. However, aspirin does not cause heart problems.
Avoid these medicines if you are on anticancer drugs that may cause bleeding.
Lowers fever. Talk to your doctor if your body temperature is above normal (98.6°) and you are taking this medicine.
What to avoid when taking NSAIDs
Some people have conditions that NSAIDs can make worse. In general, you should avoid these drugs if you:
- Are allergic to aspirin
- Are getting chemotherapy
- Are on steroid medicines
- Have stomach ulcers or a history of ulcers, gout, or bleeding disorders
- Are taking prescription medicines for arthritis
- Have kidney problems
- Have heart problems
- Are planning surgery within a week
- Are taking blood-thinning medicine (such as heparin or Coumadin®)
Opioids - for moderate to severe pain
If you're having moderate to severe pain, your doctor may recommend that you take stronger drugs called opioids. Opioids are sometimes called narcotics. You must have a doctor's prescription to take them. They are often taken with aspirin, ibuprofen, and acetaminophen.
Common opioids include:
- Codeine
- Fentanyl
- Hydromorphone (e.g. Dilaudid®)
- Levorphanol
- Meperidine (e.g. Demerol®)
- Methadone
- Morphine
- Oxycodone (e.g. OxyContin®)
- Oxymorphone
Getting relief with opioids
Over time, people who take opioids for pain sometimes find that they need to take larger doses to get relief. This is caused by more pain, the cancer getting worse, or medicine tolerance (see Medicine Tolerance and Addiction). When a medicine doesn't give you enough pain relief, your doctor may increase the dose and how often you take it. He or she can also prescribe a stronger drug. Both methods are safe and effective under your doctor's care. Do not increase the dose of medicine on your own.
Managing and preventing side effects
Some pain medicines may cause:
- Constipation (trouble passing stools)
- Drowsiness (feeling sleepy)
- Nausea (upset stomach)
- Vomiting (throwing up)
Side effects vary with each person. It's important to talk to your doctor often about any side effects you're having. If needed, he or she can change your medicines or the doses you're taking. They can also add other medicines to your pain control plan to help your side effects.
Keep in mind that constipation will only go away if it's treated. But don't let any side effects stop you from getting your pain controlled. Your health care team can talk with you about other ways to relieve them. There are solutions to getting your pain under control.
Other less common side effects include:
- Dizziness
- Confusion
- Breathing problems
- Itching
- Trouble urinating
Almost everyone taking opioids has some constipation. This happens because opioids cause the stool to move more slowly through your system, so your body takes more time to absorb water from the stool. The stool then becomes hard.
You can control or prevent constipation by taking these steps:
- Ask your doctor about giving you laxatives and stool softeners when you first start taking opioids. Taking these right when you start taking pain medicine may prevent the problem.
- Drink plenty of liquids. Drinking 8 to 10 glasses of liquid each day will help keep stools soft.
- Eat foods high in fiber, including raw fruits with the skin left on, vegetables, and whole grain breads and cereals.
- Exercise as much as you are able. Any movement, such as light walking, will help.
- Call your doctor if you have not had a bowel movement in 2 days or more.
Some opioids cause drowsiness. Or, if your pain has kept you from sleeping, you may sleep more at first when you begin taking opioids. The drowsiness could go away after a few days.
If you are tired or drowsy:
- Don't walk up and down stairs alone.
- Don't do anything where you need to be alert - driving, using machines or equipment, or anything else that requires focus.
Call your doctor if the drowsiness is severe or doesn't go away after a few days.
- You may have to take a smaller dose more often or change medicines.
- It may be that the medicine isn't relieving your pain, and the pain is keeping you awake at night.
- Your other medicines may be causing the drowsiness.
- Your doctor may decide to add a new drug that will help you stay awake.
Nausea and vomiting
Nausea and vomiting could go away after a few days of taking opioids. However, if your nausea and vomiting prevents you from taking your medicine, call your doctor right away. You should also call if any breathing problems develop.
These tips may help:
- Stay in bed for an hour or so after taking your medicine if you feel sick when walking around. This kind of nausea is like feeling seasick. Some over-the-counter drugs may help, too. But be sure to check with your doctor before taking any other medicines.
- Your doctor may want to change or add medicines, or prescribe antinausea drugs.
- Ask your doctor if something else could be making you feel sick. It might be related to your cancer or another medicine you're taking. Constipation can also add to nausea.
Starting a new pain medicine
Some pain medicines can make you feel sleepy when you first take them. This usually goes away within a few days. Also, some people get dizzy or feel confused. Tell your doctor if any of these symptoms persist. Changing your dose or the type of medicine can usually solve the problem.
What to watch out for when taking pain medicine
All drugs must be taken carefully. Here are a few things to remember when you are taking opioids:
- Take your medicines as directed. Also, don't split, chew, or crush them, unless suggested by your doctor.
- Doctors will adjust the pain medicine dose so that you get the right amount for your body. That's why it's important that only one doctor prescribes your opioids. Make sure that you bring your list of medicines to each visit. That way, your health care team is aware of your pain control plan.
- Combining pain medicine with alcohol or tranquilizers can be dangerous. You could have trouble breathing or feel confused, anxious, or dizzy.
Tell your doctor how much and how often you:
- Drink alcohol
- Take tranquilizers, sleeping pills, or antidepressants
- Take any other medicines that make you sleepy
How to stop taking opioids
You may be able to take less medicine when the pain gets better. You may even be able to stop taking opioids. But it's important to stop taking opioids slowly, with your doctor's advice. When pain medicines are taken for long periods of time, your body gets used to them. If the medicines are stopped or suddenly reduced, a condition called withdrawal may occur. This is why the doses should be lowered slowly. This has no relation to being addicted (see Medicine Tolerance and Addiction).
Stopping your pain medicines slowly prevents withdrawal symptoms. But if you stop taking opioids suddenly, you may start feeling like you have the flu. You may sweat and have diarrhea or other symptoms. If this happens, tell your doctor or nurse. He or she can treat these symptoms, which usually resolve quickly.
Other types of pain medicine
Doctors also prescribe other types of medicine to relieve cancer pain. They can be used along with nonopioids and opioids. Some include:
- Antidepressants. Some drugs can be used for more than one purpose. For example, antidepressants are used to treat depression, but they may also help relieve tingling and burning pain. Nerve damage from radiation, surgery, or chemotherapy can cause this type of pain.
- Antiseizure medicines (anticonvulsants). Like antidepressants, anticonvulsants or antiseizure drugs can also be used to help control tingling or burning from nerve injury.
- Steroids. Steroids are mainly used to treat pain caused by swelling.
How medicine is given
To relieve cancer pain, doctors often prescribe pills or liquids. But there are also other ways to take medicines, such as:
- Mouth: Some pain medicine can be put inside the cheek or under the tongue.
- Injections (shots): There are two different kinds of shots:
- Under the skin: Medicine is placed just under the skin using a small needle. These are called subcutaneous injections.
- In the vein: Medicine goes directly into the vein through a needle. These are called intravenous (IV) injections. Patient-controlled analgesia (PCA) pumps are often used with these kinds of injections. PCA pumps let you push a button to give yourself a dose of pain medicine.
- Skin patches: These bandage-like patches go on the skin. They slowly but steadily, release medicine.
- Rectal suppositories: These are capsules or pills that you put inside your rectum. The medicine dissolves and is absorbed by the body.
- In or around the spinal cord: Medicine is placed between the wall of the spinal canal and the covering of the spinal cord.
Questions to ask your health care team about your pain medicine:
How much medicine should I take?
How often?
If my pain doesn't go away, can I take more medicine?
How much should I increase the dose?
Should I call you before taking more medicine?
How long does the medicine last?
What if I forget to take my medicine or take it later than I was supposed to?
Should I take my medicine with food?
How much liquid should I drink with the medicine?
How long does it take for the medicine to start working?
Is it safe to drink alcohol (wine, beer, etc.), drive, or run machinery after I've taken the medicine?
What other medicines can I take with the pain medicine?
What are the side effects? How can I prevent them?
What should I call you about right away?
Other ways to relieve pain
Medicine doesn't always relieve pain in some people. In these cases, doctors use other treatments to reduce pain:
- Radiation therapy. Different forms of radiation energy are used to shrink the tumor and reduce pain. Often one treatment is enough to help with the pain. But sometimes several treatments are needed.
- Neurosurgery. A surgeon cuts the nerves that carry pain messages to your brain.
- Nerve blocks. Anesthesiologists inject pain medicine into or around the nerve or into the spine to relieve pain.
- Surgery. A surgeon removes all or part of a tumor to relieve pain. This is especially helpful when a tumor presses on nerves or other parts of the body.
- Chemotherapy. Anticancer drugs are used to reduce the size of a tumor, which may help with the pain.
- Transcutaneous Electric Nerve Stimulation (TENS). TENS uses a gentle electric current to relieve pain. The current comes from a small power pack that you can hold or attach to yourself.
Medicine Tolerance and Addiction
When treating cancer pain, addiction is rarely a problem.
Addiction is when people can't control their seeking or craving for something. They continue to take medicine, or perform a certain action, even when it causes them harm. Often people take medicines when they don't have pain. They take it for psychological reasons, not physical. But people with cancer need strong medicine to help control their pain. Yet some people are so afraid of becoming addicted to pain medicine that they won't take it. Family members may also worry that their loved ones will get addicted to pain medicine. Therefore, they sometimes encourage loved ones to "hold off" between doses But even if they mean well, it's best to take your medicine as prescribed.
People in pain get the most relief when they take their medicines on schedule. And don't be afraid to ask for larger doses if you need them. As mentioned in Opioids - for moderate to severe pain, developing a tolerance to pain medicine is common. But taking cancer pain medicine is not likely to cause addiction. If you're not a drug addict, you won't become one. Even if you have had an addiction problem before, you still deserve good pain management. Talk with your doctor or nurse about your concerns.
Tolerance to pain medicine sometimes happens.
Some people think that they have to save stronger medicines for later. They're afraid that their bodies will get used to the medicine and that it won't work anymore. But medicine doesn't stop working - it just doesn't work as well as it once did. As you keep taking a medicine over time, you may need a change in your pain control plan to get the same amount of pain relief.
This is called tolerance. Tolerance is a common issue in cancer pain treatment.
Medicine tolerance is not the same as addiction.
As mentioned, medicine tolerance happens when your body gets used to the medicine you're taking. The result is that the dose no longer works as well. Each person's body is different. Many people don't develop a tolerance to opioids. But if tolerance happens to you, don't worry.
Under your doctor's care, you can:
- Increase your dose
- Add a new kind of medicine
- Change the kind of medicine that you're taking for pain
The goal is to relieve your pain. Increasing the dose to overcome tolerance does not lead to addiction.
Taking pain medicine will not cause you to "get high."
Most people do not "get high" or lose control when they take cancer pain medicines as prescribed by the doctor. Some pain medicines can cause you to feel sleepy when you first take them This feeling usually goes away within a few days. On occasion, people get dizzy or feel confused when they take pain medicines. Tell your doctor or nurse if this happens to you. Changing your dose or type of medicine can usually solve this problem.
Other Ways To Control Pain
Along with your pain medicine, your health care team may suggest you try other methods to control your pain. However, unlike pain medicine, some of these methods have not been tested in cancer pain studies. But they may help improve your quality of life by helping you with your pain, as well as stress, anxiety, and coping with cancer. Some of these methods are called complementary or integrative.
These treatments include everything from cold packs, massage, acupuncture, hypnosis, and imagery to biofeedback, meditation, and therapeutic touch. Once you learn how, you can do some of them by yourself. For others, you may have to see a specialist to receive these treatments. If you do, ask if they are licensed experts.
Acupuncture is a form of Chinese medicine. It involves inserting very thin, metal needles into the skin at certain points of the body. (Applying pressure to these points with just the thumbs or fingertips is called acupressure.) The goal is to change the body's energy flow so it can heal itself.
When receiving this treatment, you may have a slight ache, dull pain, tingling, or electrical-feeling sensation for a few seconds after the needles are inserted. Once the needles are in place, though, you shouldn't feel any discomfort. They remain in place for 15 to 30 minutes. However, it may be more or less, depending on what the practitioner suggests.
Acupuncture has been shown to help with nausea and vomiting related to cancer treatment. And some studies have shown it may help with cancer pain. Before getting acupuncture, talk with your health care team to make sure it's safe for your type of cancer. If it is, your health care team can suggest a licensed acupuncturist. Many hospitals and cancer centers have one on staff.
Biofeedback uses machines to teach you how to control certain body functions, such as heart rate, breathing, and muscle tension. You probably never think of these body functions because they happen on their own. But learning how to control them may help you relax and cope with pain. Biofeedback is often used with other pain relief methods. If you're interested in trying this method, you must see a licensed biofeedback technician.
Distraction is simply turning your focus to something other than the pain. It may be used alone to manage mild pain, or used with medicines to help with acute pain, such as pain related to procedures or tests. Or you may try it while waiting for your pain medicine to start working.
More than likely, you've done this method without realizing it. For example, watching television and listening to music are good ways to distract your mind. In fact, any activity that can focus your attention can be used for distraction. You can count, sing, or pray. You could try slow rhythmic breathing or repeat certain phrases over and over again, such as "I can cope."
You could do certain activities that take your mind from the pain. Some of these may be crafts or hobbies, reading, going to a movie, or visiting friends.
Heat and Cold
Heat may relieve sore muscles, while cold may numb the pain. However, ask your doctor if it is safe to use either during treatment. Do not use them for more than 10 minutes at a time. And do not use heat or cold over any area where circulation is poor.
For cold, try plastic gel packs that remain soft even when frozen. You can find them in drug and medical-supply stores. Of course, you always can use ice cubes wrapped in a towel or frozen water in a paper cup.
For heat, you can use a heating pad. But you also can try gel packs heated in hot water, hot-water bottles, a hot, moist towel, and hot baths and showers. Be careful not to leave heat on too long to avoid burns.
Hypnosis is a trance-like state of relaxed and focused attention. People describe it as a lot like the way they feel when they first wake up in the morning. Their eyes are closed, but they're aware of what's going on around them. In this relaxed state, people's minds are usually more receptive or open to suggestion. As a result, hypnosis can be used to block the awareness of pain or to help you change the sensation of pain to a more pleasant one.
You'll need to see a person who is trained in hypnosis, often a psychologist or psychiatrist. He or she may also be able to teach you how to place yourself in a trance-like state, by making positive suggestions to yourself.
Imagery is like a daydream. You close your eyes and create images in your mind to help you relax, feel less anxious, and sleep. You daydream using all of your senses - sight, touch, hearing, smell, and taste. For example, you may want to think of a place or activity that made you happy in the past. You could explore this scene, which could help reduce your pain both during and after you try it.
If you have to stay in bed or can't leave the house, imagery may help. It may lessen the closed-in feelings you have after being indoors for a long time. See How to Use Imagery for an exercise on how to use imagery.
Massage may help reduce pain and anxiety. It may also help with fatigue and stress. It is pressing, rubbing, and kneading parts of the body with hands or special tools. For pain, a steady, circular motion near the pain site may work best. Massage may also help relieve tension and increase blood flow. Deep or intense pressure should not be used with cancer patients unless their healthcare team says it's okay to do so.
Meditation is a form of mind-body medicine used to help relax the body and quiet the mind. It may help with pain, as well as with worry, stress, or depression.
People who are meditating use certain techniques such as focusing attention on something, like a word or phrase, an object, or the breath. They may sit, lie down, walk, or be in any other position that makes them feel comfortable. A goal while meditating is to try to have an open attitude toward distracting thoughts or emotions. When they occur, attention is gently brought back to breathing or the silent repeating of phrases."I began meditating as a way to help relieve my pain and calm myself. I can't avoid medicine, but I feel like I don't have to take as much." - Anna
Relaxation reduces pain or keeps it from getting worse by getting rid of tension in your muscles. It may help you sleep and give you more energy. Relaxation may also reduce anxiety and help you cope with stress.
The most common methods of relaxation are:
- Visual concentration. When you stare at an object.
- Breathing and muscle tensing. This is breathing in and tensing the muscles, then breathing out while letting your muscles go. See Relaxation Exercises for an exercise on how to use breathing and muscle tensing.
- Slow rhythmic breathing. To do this, you breathe slowly in and out while concentrating on an object. You can add imagery to slow rhythmic breathing or listen to music too. See Relaxation Exercises for an exercise on how to use slow rhythmic breathing.
Sometimes, relaxation is hard if you're in severe pain. You could try using some of the methods that are quick and easy. These may be rhythmic massage or breathing and muscle tensing. Some people use music or other types of art therapy to help them relax.
Sometimes breathing too deeply can cause shortness of breath. If this happens, take shallow breaths or breathe more slowly. Also, as you start to relax, you may fall asleep. If you don't want to sleep, sit in a hard chair or set a timer or alarm before you start the exercise.
Other Methods
Here are some other ways people have tried to find relief from cancer pain.
- Physical Therapy. Exercises or methods used to help restore strength, increase movement to muscles, and relieve pain.
- Reiki. A form of energy medicine in which the provider places his or her hands on or near the patient. The intent is to transmit what is believed to be a life force energy called qi (or chi).
- Tai Chi. A mind-body practice that is a series of slow, gentle movements with a focus on breathing and concentration. The thought is that it helps what is believed to be a life force energy (called qi) flow through the body.
- Yoga. Systems of stretches and poses with special focus given to breathing. It is meant to calm the nervous system and balance the body, mind, and spirit. There are different types of yoga, so ask about which ones would be best for you.
To learn more about complementary treatments for pain:
- Talk with your doctor, nurse, or oncology social worker.
- See the NCI booklet Thinking About Complementary & Alternative Medicine: A Guide for People With Cancer. See Resources on how to order.
- Contact the National Center for Complementary and Alternative Medicine at 1-888-644-6226 or online at http://nccam.nih.gov.
- See the web site for the NCI Office of Cancer Complementary and Alternative Medicine at www.cancer.gov/cam.
Your Feelings and Pain
Having pain and cancer affects every part of your life. It can affect not only your body, but your thoughts and feelings as well. Whether you have a lot of pain or a little, if it's constant, you may feel like you aren't able to focus on anything else. It may keep you from doing things and seeing people that you normally do. This can be upsetting and may feel like a cycle that never seems to end.
Sometimes things that people used to take for granted aren't as easy anymore. These may include cooking, getting dressed, or just moving around. Some people can't work because of the pain or have to cut back on their hours. They may worry about money. Limits on work and everyday life may also make people less social, wanting to see others less often.
Research shows that people in pain may feel sad or anxious and may get depressed more often. At other times they may feel irritable or angry and frustrated. And they can feel lonely, even if they have others around them.
A common result of having cancer and being in pain is fear. For many, pain and fear together feel like suffering. People get upset worrying about the future. They focus their thoughts on things that may or may not happen. You may feel fear about many things, such as fear of:
- The cancer getting worse
- The pain being too much to handle
- Your job or daily tasks becoming too hard to do
- Not being able to attend special trips or events
- Loss of control
This rollercoaster of feelings often makes people look for the meaning that cancer and pain have in their life. Some question why this could happen to them. They wonder what they did to deserve it. Others may turn to religion or explore their spirituality more, asking for guidance and strength.
Don't lose hope.
If you have feelings like these, know that you're not alone. Many people with cancer pain have had these kinds of feelings. Having negative thoughts is normal. And some people have positive thoughts, too, finding benefits in facing cancer. But if your negative thoughts overwhelm you, don't ignore your feelings. Help is there for you if you're distressed or unsure about your future.
Finding support
There are many people who can help you. You can talk with oncology social workers, health psychologists, or other mental health experts at your hospital or clinic. Your health care team can help you find a counselor who is trained to help people with long-term illnesses. These people can help you talk about what you are going through and find answers to your concerns. They may suggest medicine that will help you feel better if you need it.
Many people say that they regain a sense of control and well-being after talking with people in their spiritual or religious community. A leader from one of these groups may be able to offer support, too. Many are trained to help people cope with illness. Also, many hospitals have a staff chaplain who can counsel people of all faiths.
You can also talk with friends or others in your community. Some join a support group. Cancer support groups are made up of people who share their feelings about coping with cancer. They can meet in person, by phone, or over the Internet. They may help you gain new insights and ideas on how to cope. To find a support group for you, talk with your doctor, nurse, or oncology social worker.
How your pain affects your loved ones
Chronic or severe pain affects everyone who loves and takes care of you. It can be hard for family members and friends to watch someone close to them be in pain.
Like you, your loved ones may feel angry, anxious, and lonely. They may feel helpless because they can't make you feel better. They may even feel guilty that you have pain while they don't. Or they may feel loss, because your pain keeps you from doing things you like to do.
It's natural for family members and friends to have these emotions. It may help if everyone understands that these emotions exist and that no one needs to face them alone.
Let your family members know it's okay for them to get help. Like you, they can talk to a counselor or join a support group. Encourage them to ask the oncology social worker about the options that are available for them.
Also, they can read the NCI booklets for caregivers listed in For More Information.
Talking with family members
You may want to let family members and friends know how you're feeling. For some, this can be hard or awkward. Some people say that they want to avoid upsetting those closest to them. Others say that they don't want to seem negative. But open and honest communication can help everyone. Letting others know about your pain may help them understand what you are going through. They can then look for ways to help you. Your loved ones may also feel better knowing that they're helping to make you feel more comfortable.
Family problems before your cancer
Any problems your family had before you got cancer are likely to be more intense now. Or maybe your family just doesn't communicate very well. If this is the case, you can ask a social worker to set up a family meeting for you. During these meetings, the doctor can explain treatment goals and issues. And you and your family members can state your wishes for care. These meetings can also give everyone a chance to express their feelings in the open. Remember, there are many people you can turn to at this time.
Financial Issues
When you're in pain, the last thing you want to think about is paying for your medicine. Yet money worries have stopped many people from getting the pain treatment they need. Talk with your oncology social worker if you have questions. He or she should be able to direct you to resources in your area. Here are some general tips:
When dealing with health insurance, you might want to:
- Call your insurance company and find out what treatments are covered. Sometimes insurance companies pay for only certain types of medicines. If the medicine you need isn't covered, your doctor may need to write a special appeal letter. Or your doctor may need to prescribe a different treatment.
- Ask if your insurance company can give you a case manager to help you with your coverage.
- Check to make sure that your plan will cover any specialists your doctor refers you to. If it does not, check with your insurance company to see which doctors are included in your plan. Ask your doctor to refer you to someone on your plan's list.
- Find out whether you have to pay copayments up front and how much they cost.
- Find out how you should pay your balance. For example, do you file a claim? Does the insurance company pay first? Or do you pay and get reimbursed?
- Tell the insurance company if you believe you've received an incorrect bill. You should also tell your doctor or the hospital or clinic that sent the bill. Don't be afraid to ask questions.
Government health insurance
Medicare is health insurance for people age 65 or older. However, people under 65 who are on kidney dialysis or have certain disabilities may also qualify.
Medicare Part B only pays for outpatient medicine given by a pump or by vein. It doesn't pay for pills, patches, or liquids.
Medicare Part D is a benefit that covers outpatient prescription medicines. It comes from private insurance plans that have a contract with Medicare. These plans vary in what they cost and the medicines they cover. Find out which medicines a plan covers before you join to make sure that it meets your needs. You should also know how much your copays and deductible will be.
Medicaid gives health benefits to low income people and their families. Some may have no health insurance or not enough, and therefore need this help.
If you have Medicaid, you should know that it pays for medicine given by mouth (orally) or by vein (intravenous). Each state has its own rules about who is eligible for Medicaid.
Other adviceDon't be embarrassed to tell your health care team if you're having trouble paying for your medicine. They may be able to prescribe other medicine that better fits your budget.
If you feel that you're overwhelmed, the stress may seem like too much to handle. You might try getting help with financial planning. Talk with the business office where you get treatment. There are many free consumer credit counseling agencies and groups. Talk with your oncology social worker about your choices.
You can also contact the NCI's Cancer Information Service (CIS) and ask for help. They have a database, National Organizations that Offer Cancer-Related Services that may help you. You can also access it online yourself. See Resources for ways to contact NCI.
Tips for saving money on pain medicine
If the cost of pain medicine is an issue for you, consider the following tips:
- Ask your doctor if there are generic brands of your medicine available. These usually cost less than brandname medicines.
- Ask your doctor for medicine samples before paying for a prescription. You can't get samples of opioids. But you can ask your doctor to write only part of the prescription. This way you can make sure that the medicine works for you before buying the rest of it. This will only help if you pay by the amount you buy. For some insurance plans, you pay the same amount for part of or the whole prescription. Find out what will work best for you.
- Ask about drug companies that have special programs to give free drugs to patients in financial need. Your doctor should know about these programs.
- Remember that pills may cost less than other forms of medicine.
- Use a bulk-order mail pharmacy. But first make sure that the medicine works for you. Also, be aware that you can't order opioids in bulk or through the mail. Ask your oncology social worker or pharmacist about bulk-order mail pharmacies.
- Contact NeedyMeds.
They are a nonprofit organization that helps people who cannot afford medicine or health care costs. Go to www.needymeds.com, or ask someone to do it for you.
You can get information about cancer from many sources. Some are listed here. You may also want to check for more information from support groups in your community.
For More Resources:Go to the NCI resource National Organizations That Offer Services to People With Cancer and Their Families to search for organizations that provide cancer patients and their families with financial and emotional support and advocacy.
Federal Resources
- National Cancer Institute (NCI)
Has current information on cancer prevention, screening, diagnosis, treatment, genetics, and supportive care. NCI's web site (www.cancer.gov) lists clinical trials and specific cancer topics in NCI's Physician Data Query (PDQ®) database.
NCI's Cancer Information Service
Gives clear, up-to-date information on cancer to patients, families, health professionals, and the general public. It translates the latest scientific information into plain language in English, in Spanish, or on TTY equipment.Toll-free:1-800-4-CANCER (1-800-422-6237)Online:Chat online:
- Centers for Medicare & Medicaid Services (CMS)
Has information about patient rights, prescription drugs, and health insurance issues, including Medicare and Medicaid.Toll-free:1-800-MEDICARE (1-800-633-4227)Online:www.medicare.gov (for Medicare information) or
www.cms.hhs.gov (for other information)
- National Center for Complementary and Alternative Medicine (NCCAM)
Part of the National Institutes of Health. It funds and studies medical practices that are not commonly used as standard care. It rates how well these different practices work and shares this information with the public.Toll-free:1-888-644-6226TTY:1-888-644-6226Online:
Nonprofit Organizations
- American Cancer Society (ACS)
Mission is to end cancer as a major health problem through prevention, saving lives, and relieving suffering. ACS works toward these goals through research, education, advocacy, and service. The organization's National Cancer Information Center answers questions 24 hours a day, 7 days a week.Toll-free:1-800-ACS-2345 (1-800-227-2345)TTY:1-866-228-4327Online:
- American Pain Foundation
Serves people with pain through information, advocacy, and support; pain and resource information, practical help and publications are available through toll-free telephone service and website.Toll-free:1-888-615-PAIN (1-888-615-7246)strong>Online:
- CancerCare
Offers free support, information, and financial and practical help to people with cancer and their loved ones.Toll-free:1-800-813-HOPE (1-800-813-4673)Online:
- Cancer Support Community
Cancer Support Community is a national organization that provides support groups, stress reduction and cancer education workshops, nutrition guidance, exercise sessions, and social events.Toll-free:1-888-793-WELL (1-888-793-9355)Online:
- Center to Advance Palliative Care
Goal is to increase the availability of quality palliative care services for people facing serious illness. Offers training and assistance to health care professionals.Phone:1-212-201-2670Online:For patients and families:
- National Coalition for Cancer Survivorship (NCCS)
Gives out information on cancer support, employment, financial and legal issues, advocacy, and related issues.Toll-free:1-877-NCCS-YES (1-877-622-7937)Online:
- National Hospice and Palliative Care Organization (NHPCO)
Has information on hospice care, local hospice programs, advance directives in different states, and finding a local health care provider. It offers education and materials on palliative and end-of-life issues through its Caring Connections program, as well as links to other organizations and resources.Toll-free:1-800-658-8898Online:
Caring ConnectionsToll-free:1-800-658-8898Online:
- NeedyMeds
Lists medicine assistance programs available from drug companies.
NOTE: Usually patients cannot apply directly to these programs. Ask your doctor, nurse, or social worker to contact them.Online:
- Patient Advocate Foundation
Offers education, legal counseling, and referrals concerning managed care, insurance, financial issues, job discrimination, and debt crisis matters.Toll-free:1-800-532-5274Online:
Pain Control Record
You can use a chart like this to keep a record of how well your medicine is working. Some people call it a pain diary. Print out the chart below for writing down your pain. Describe the amount of pain you feel in the way that works best for you. You can use words, numbers on a scale from 0 to 10, or even draw a face (see Talking About Your Pain for examples). Take the chart with you when you visit your doctor.
|Describe the pain you feel
|Level of pain
|8 a.m.
|stabbing pain in side
|all day
|dull ache in legs
Medicines you are taking now
Use this form to record all medicines - not just pain medicines - that you are taking. This information will help your doctor keep track of all your medicines.
|How often taken
|How well is it working?
|Prescribing doctor
Pain medicines you have taken in the past
Use this form to record the pain medicines you have taken in the past. It will help your doctor understand what has and hasn't worked.
|How often taken
|Side effects
|Reason for stopping
Relaxation Exercises
How to Use Imagery
Imagery usually works best with your eyes closed. To begin, create an image in your mind. For example, you may want to think of a place or activity that made you happy in the past. Explore this place or activity. Notice how calm you feel.
If you have severe pain, you may imagine yourself as a person without pain. In your image, cut the wires that send pain signals from one part of your body to another. Or you may want to imagine a ball of healing energy. Others have found this exercise to be very helpful:
- Close your eyes and breathe slowly. As you breathe in, say silently and slowly to yourself, "In, one, two," and as you breathe out, say "Out, one, two." Do this for a few minutes.
- Imagine a ball of healing energy forming in your lungs or on your chest. Imagine it forming and taking shape.
- When you're ready, imagine that the air you breathe in blows this ball of energy to the area where you feel pain. Once there, the ball heals and relaxes you. You may imagine that the ball gets bigger and bigger as it takes away more of your discomfort.
- When you breathe out, imagine the air blowing the ball away from your body. As it goes, all your pain goes with it.
- Repeat the last two steps each time you breathe in and out.
- To end the imagery, count slowly to three, breathe in deeply, open your eyes, and say silently to yourself, "I feel alert and relaxed."
Breathing Exercises
You may relax either sitting up or lying down, preferably in a quiet place. Make sure you're comfortable. Don't cross your arms or legs because you could cut off circulation. If you're lying down, you may want to put a small pillow under your neck and knees.
Once you're comfortable and your eyes are closed, you could try any of the following relaxation methods:
Breathing and muscle tensing
- Breathe in deeply.
- At the same time, tense your muscles or group of muscles. For example, you can squeeze your eyes shut, frown, or clench your teeth. Or, you could make a fist, stiffen your arms and legs, or draw your legs and arms up into a ball and hold as tightly as you can.
- Hold your breath and keep your muscles tense for a second or two.
- Let go. Breathe out and let your body go limp.
Slow rhythmic breathing
- Stare at an object or shut your eyes and think of a peaceful scene. Take a slow, deep breath.
- As you breathe in, tense your muscles. As you breathe out, relax your muscles and feel the tension leaving.
- Remain relaxed and begin breathing slowly and comfortably, taking about nine or 12 breaths a minute. To maintain a slow, even rhythm, you can silently say to yourself, "in, one, two; out, one, two."
- If you ever feel out of breath, take a deep breath, and continue the slow breathing.
- Each time you breathe out, feel yourself relaxing and going limp. Continue the slow, rhythmic breathing for up to 10 minutes, if you need it.
- To end the session, count silently and slowly from one to three. Open your eyes. Say to yourself, "I feel alert and relaxed." Begin moving slowly.
If you decide to use slow rhythmic breathing as a way to relax and reduce pain, you may want to try these tips. They can add to the experience.
- Listen to slow, familiar music through earphones.
- Once you're breathing slowly, slowly relax different parts of your body, one after the other. Start with your feet and work up to your head.
- Each time you breathe out, you can focus on a particular area of the body and feel it relaxing. Try to imagine the tension draining from the area.
- Consider using relaxation recordings, such as CDs, DVDs, or podcasts. They often include each step on how to relax.
Before You Go to the Pharmacy - Know What You're Getting!
Sometimes people get new prescriptions and are confused about how to take them and when. If your doctor prescribes a new medicine, it's important for you to understand what you will be taking.
Before you leave your visit, ask your health care team:
- How do you spell the name of the drug?
- What does the medicine look like? If there is a generic version, does it look the same?
- How many pills (or how much liquid) are in each dose?
- How many times a day do I take the dose?
- Should I take this medicine with food?
- Can I take it with my other medicine or supplements?
Be sure to read the printed information that comes with your medicine. If you have trouble reading it, ask a friend or family member to read it for you. For other questions about your medicines, see Questions to ask your health care team about your pain medicine.
For More Information
This information is also available as a printable booklet or as an e-book.
NCI has other printable booklets for people with cancer. Here are some others you and your loved ones may find useful:
- Chemotherapy and You
- Coping With Advanced Cancer
- Eating Hints for Cancer Patients
- Taking Part in Cancer Treatment Research Studies
- Radiation Therapy and You
- Taking Time
- Thinking About Complementary and Alternative Medicine
- When Cancer Returns
- When Someone You Love Is Being Treated for Cancer
- When Someone You Love Has Advanced Cancer
- When Your Parent Has Cancer
NCI is a Federal agency that is part of the National Institutes of Health. For questions, call 1-800-4-CANCER (1-800-422-6237) or visit www.cancer.gov. (See Resources for more resources.)
For information about your specific type of cancer, see NCI's Physican Data Query (PDQ®) database.


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Smaller spaces can have that big picture, too. BenQ is making it easy to add a projector into small- and medium-sized rooms, with the newly announced MW519.
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Home automation system helps wounded war veteran live more comfortably.
Check out our recommendations for the season's best new TVs for home theater, living room or anywhere.

subset: commoncrawl


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As the sun catches the golden temples that rise from bottle-green rice paddies, you'll be left speechless at the grandeur of the world's largest Buddhist temple complex that slumbers peacefully in rural Java.
In serene Ubud, trek through aromatic coffee, clove and cacao plantations that surround mountainous Munduk village; refresh your senses at a remote jungle waterfall; bask in the vibrant greens of the terraced rice fields in Jatiluwih; pay your respects at a holy temple on the southern slope of Batukaru Mountain; and visit Bayad village for an eco walk where you'll learn about the healing powers of native plants. In Yogyakarta, you'll explore the 9th century Hindu temples at Prambana; encounter the world's largest complex of Buddhist monuments that rise from a patchwork of bottle-green rice paddies; and visit impressive Keraton Palace in the heart of the old city. In the island paradise of Lombok, you'll cruise turquoise waters en route to the peaceful villages of Tetebatu and Loyok where you'll trek through local forests filled with wild black monkeys, soaring mahogany trees, aromatic clove plantations and village temples.
From the rich art of Ubud and the lush rice paddies of Yogyakarta, to the ancient temples of Prambanan and the pristine pink-hued beaches of idyllic Lombok island, this trip combines a decadent cultural experience with Indonesia's most breath-taking natural wonders. Of course, your knowledgeable team of local guides and private drivers will be at your side to ensure you get the most from every experience, and you'll have ample opportunity to indulge your senses at a range of luxury spa resorts, charming colonial villas and boutique beach hotels.
Enjoy a personalized vacation that best suits your needs, developed by one of our experienced destination experts. Relax during your trip with our 24/7 support and expert local guidance.
Meet your driver for an airport transfer with a private vehicle and English speaking guide.
Depart in the morning from your hotel and transfer to the Munduk village. Upon arrival, enjoy a beautiful trekking experience through coffee plants, cloves, cacao, and other exotic tropical plantations around the village. Your guide will give you the insight to mountain farming life and the importance of the plantations that once attracted the arrival of Europeans to the archipelago. Visit the waterfall with its refreshing breezes - a great photo opportunity. After, enjoy a short refreshment, carry on to Jatiluwih where you can enjoy a pleasant walk to discover the beautiful terrace rice fields of Jatiluwih, a UNESCO World Heritage Site. After visiting Jatiluwih, stop for lunch at the G Terrace Restaurant while enjoying the lovely views over the paddy (beverages are not included). Afterwards, continue your visit to the holy site of Batukaru Temple, located on the southern slope of Batukaru Mountain.
In the morning, visit the Bayad Village and join your local Balinese guide for the eco walk through the jungle. Explore the wealth of healing plants with your guide. Start with coffee or tea and refreshments while having a short introduction on the venture. Continue with a light hike through the spice and herbal garden where you will be introduced to the plants that are used for first aid emergencies up to the treatment of chronic illnesses. Continue the walk down to a cave and return through the underground labyrinth to the finish point at Petanu Restaurant where your Indonesian lunch will be served. After, you'll be driven back to your hotel.
Fly from Bali to Yogyakarta. Flight time is approximately 1 hour.
This morning, you will be picked up from your hotel and driven to Prambanan village to visit the Prambanan Temple. The hindu temple complex was erected in the 9th century while Java was ruled by the Hindu Sanjayas Old Mataram in the north. The complex consists of 3 major temples/shrines such as Candi Shiva Mahadeva, Candi Brahma, and Candi Vishnu. Enough time will be given to walk around and observe the beautiful carvings and the neighborhood shrines such as the Candi Palosan and the Candi Sewu. The Ramayana story is carved into the walls of the temples.
Start your day with a cultural tour through the city. Your guide will bring you to the Kraton Sultan Palace walking over the remains of the past centuries, enabling you to understand the history of this artistic city. It was built in 1970 by Sri Sultan Hamengkubowono I., which is also a model of traditional Javanese palace architecture and it lies in the center of the municipality. Up to now, Kraton still serves as the Sultan Palace. Over 25,000 people live within the greater Kraton compound named Taman Sari, which consist of its own market, shops, batik, and silver cottage industries, schools, and mosques. You'll also get to do a tour to the Water Castle. Afterwards, continue to Kota Gede which has been famed as the hub of Yogyakarta's silver industry since the 1930's. But this quite old town, which is now a suburb of Yogyakarta, was the first capital of the Mataram Kingdom, found by Panembahan Senopati in 1582. You will visit the busy silver workshops to watch the process.
This tour will bring you to the world's biggest Buddhist monument complex, Borobudur. Looming out of a patchwork of bottle-green paddies and swaying palm tops, this colossal Buddhist relic is one of the continent's marvels. Built around 800 A.D. after the decline of Buddhism and the shift of power to East Java, the monument was abandoned soon after its completion. For centuries the complex lay forgotten, buried under layers of volcanic ash. Climb up to the top and enjoy a wonderful view on the Menoreh mountains. Enough time is given to stroll around the complex and to discover its beauty. Afterwards, continue to visit the nearby temples such as Pawon and Mendut Temple.
Fly from Yogyakarta to Lombok via Jakarta.
Visit the village of Tetebatu and Loyok, popularly known as a peaceful and tranquil village. You will do some soft trekking to the local forest inhabited by the wild black monkeys (pitu), mahogony trees, and clove plantations while enjoying the simple and natural way of life of the locals. You will also visit Lingsar temple, which symbolizes the harmony of Muslim and Hindu and Taman Narmada, a kingly garden which is also the replica of Lake Segara Anak in Mount Rinjani. Lunch will be provided along the way.
Enjoy time at leisure to explore at your own pace, or relax at your hotel.
Fly from Lombok to Bali. Flight time is approximately 30 minutes.
Etched into a hillside overlooking the Tjampuhan ridge, Pita Maha Resort & Spa encompasses private pool villas in a style reminiscent of a Balinese village. Located just 5 minutes from central Ubud, this boutique hotel is an elegant retreat steeped in local tradition. Named after the artistic association that nurtured creative talent during the 1930's, Pita Maha Resort & Spa is an elegant hotel in Ubud where travelers can experience the true charm of Bali. Pita Maha means 'great shining' and this boutique resort honors the island's artistic legacy.
This historic colonial style hotel has been fully renovated. The hotel offers the facilities and comfort of a modern hotel while maintaining the traditions of the past. All 144 rooms, including 10 suites, offer private balconies and are furnished in a modern style with local touches. The Paprika restaurant specializes in Asian fusion cooking. The 1918s terrace bar overlooks an open-air courtyard and the trendy Vino Wine Bar features nightly entertainment.
Qunci Villas Hotel is 'The Boutique Hotel of Lombok', comprised of 20 units on a beautifully landscaped beachfront property with many of the units boasting an ocean view under swaying palm trees. It's a tasteful mixture of modern architecture combined with the architectural style of Lombok and Bali. The complex itself is specifically designed to take full advantage of stunning views across exotic gardens out across the sparkling blue waters of the Lombok Straits.
Olive Ramchand ,
June 03, 2014
"I have to admit, this was the BEST vacation I ever had. The tour was nothing less than Fantastic! The hotels were great, the guides were great, the transportation was great, the places were great, the people were great, the food was great and last but not least China, itself was out of this world. I'm so glad I booked this tour and would recommend this to anyone. Thanks so much for all your help, your interest and your recommendations. Steve in China was so attentive, he called constantly to make sure everything was fine. We really had a fabulous time and even my jaded husband who normally only seems to care about where the nearest golf course is, was impressed and had a wonderful time.
Thanks again, and unto the next vacation (although I don't know how we would top this one!!)
Jeanne Tarvin ,
April 21, 2014
"The tour was absolutely fabulous. It all started with the planning. Kathryn graciously accommodated our tight schedule and multiple needs, including a mid-trip change in plans. The tour guides and drivers were all great and extremely knowledgeable. The accommodations and meals were fantastic. I was apprehensive about going to China not knowing the language but it worked out great!"
Karen ,
January 15, 2014
"We just returned on Monday from our wonderful trip to South Korea, Bangkok and Phuket. I wanted to thank you for all of your hard work in planning our tours and adventures. Everything was spot on, from our arrivals at the airports, to the guides and the tours. I would not hesitate to recommend you and your company. It was truly a wonderful vacation. Thank you again.
Bob Feldman ,
November 19, 2013
"I wanted to let you know that our trip to China was great! Everybody enjoyed themselves. When planning a trip I am always concerned about the itinerary, the vehicles and the guides. All 3 of these were great. The guides were particularly good and in this case really made the trip a pleasure. Overall a great trip. Thanks for all you did."
Gloria DeWeese ,
October 10, 2013
"A wonderful trip and everything went like clockwork. Thank you so very much for all your assistance. I hope I will have a chance to work with you again."
Wayne Gavioli ,
September 04, 2013
"We just returned from our thailand/cambodia trip. It was fantastic. You did a great job. The guides were excellent as was the drivers. We loved the Victoria Hotel you selected in Siem. Wish we had more time. Thailand met our expectations but our expectations for Cambodia were low and they exceeded them. Loved the places selected for the included lunches. Certainly would use Kensington again"
Santo Filice ,
August 30, 2013
"Thank you for arranging our guided trip to Thailand - Vietnam. It was a memorable, and pleasant trip - a 1st for us with Kensington tours and a most enjoyable one. We found that we were able to maximize our visit of the the area without the concern of booking hotels, airline, finding parking and understanding the local language. "
Tim Mesarch ,
August 02, 2013
"Alexis helped us fit in all of the sites we wanted to see on our trip to Thailand and Cambodia, and suggested some more. It was valuable talking with someone who had been there and done that. The planning went pretty smoothly, and so did the trip. The local guides were all top-notch! "
ClotildeTamers ,
July 25, 2013
"I highly recommend Kesington Tours. The planning of our trip to Cambodia was outstanding. Our advisor Alexis Mayer was unbelievably patient, knowledgeable and responsive. We planned the trip in every possible detail and Alexis was extraordinary during the whole process. Once we were in Cambodia, we had a tiny issue with the car. I was able to get in contact with Alexis right away and the problem was instantly solved. The trip itself was fantastic. Everything was very well planned and perfectly organized. The local guides and drivers were great. The hotels were very well chosen.
Great trip. I would definitely travel again with Kensington Tours."
Pennie Quintana ,
August 07, 2013
"Thank you so much for the amazing trip we enjoyed!! All our guides were fantasy. Joseph in Jakarta, July in Jojakarta and Deon in Borneo!! Wow!! Bless you for all your attention to detail and the outstanding communication to all my questions. You made me feel so taken care of and tended too!! "
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This knitting sock pattern from Bernat Yarns provides sizes for adult men and women, and children 4-6 and 8-10. Create these warm socks for every member of the family with ease. You need a set of double pointed needles in size 8 (5 mm). Use your prefered colors of yarn.
Contrast A (08994 Black)
With smaller needles and MC, cast on 28 (32-36-40) sts loosely. Divide st on 3 needles as follows: 10 (10-12-12) sts on first and third needles, 8 (12-12-16) sts on second needle. Join in rnd. Mark first st to indicate beg of rnd.
Make heel:
Shape heel:
With RS facing and MC, pick up and knit 7 (8-9-10) sts along left side of heel. With 2nd needle knit across 14 (16-18-20) sts from instep. With 3rd needle pick up and knit 7 (8-9-10) sts along right side of heel. K4 (5-6-7) sts from heel onto end of 3rd needle. Slip rem 4 (5-6-7) sts from heel onto beg of 1st needle. 36 (42-48-54) sts are now divided as follows: 11 (13-15-17) sts on 1st and 3rd needles, 14 (16-18-20) sts on 2nd needle.
Work in rnds: 1st rnd: 1st needle: Knit to last 3 sts. K2tog. K1. 2nd needle: Knit. 3rd needle: K1. Sl1. K1. psso. Knit to end of needle.
Cont even until foot from pick up row measures 5 (6 1/2-7-7 1/2)" [12.5 (16-18-19) cm]. Break MC.
Shape toe:
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People and Freedom News Sheet. No. 1
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Fiat Justitia ... ! THE PEOPLE and FREEDOM NEWS SHEET ISSUED BY THE PEOPLE AND FREEDOM GROUP, 35, CAMPDEN STREET, LONDON, W. 8. No. 1. EASTER. 1938. Price 1D. THE PEOPLE AND FREEDOM GROUP 1. The aim of the Group is to promote a sound grasp of political and social problems, and to further the application of Christian principles to national and international life. 2. Membership is open to those (Catholics) who agree on the following issues: (i) The primacy of morality in political life and in economic and social relations. (ii) This morality to be that founded on the Christian tradition and on respect for human personality and its rights. (iii) The necessity for civil and political liberty, with a just balance between liberty and authority, as well as between the individual and society, in every type of modern State. (iv) Permanent union and cooperation between States on a basis of morality, with the progressive formation of international law. (v) The conviction that war should no longer be recognised as a legitimate means of settling international disputes and must be replaced by a system of voluntary or compulsory arbitration or by the decisions of an international court of justice, as the case may be. COMMITTEE Chairman: Mrs. V. M. Crawford. Conrad Bonacina. Barbara Barclay Carter, Hon. Sec. and Editor. Anthony Heron, Hon. Press Sec. Anthony Mouravieff. E. Roper Power, Ph.D., Hon. Treas. Dorothy Scott Stokes. The People and Freedom Group was founded in November, 1936, as a group of study and action, and its first Committee was elected on St. George's Day a year ago. SPAIN The first problem to be faced was inevitably that of Spain. Two papers were read by Mr. Anthony Mouravieff on the political antecedents of the insurrection, and, by invitation of Dr. Fairfield, Dr. Borkenau (author of The Spanish Cockpit) gave an objective account of his recent tour of investigation. It was decided that the policy of the Group should be to refuse to be drawn into partisanship of either side, and to concentrate on working for peace and in favour of every effort to mitigate the horrors of the conflict. As the war progressed, it came to be felt that the case of the Basques was a special one, and that this Christian people, fighting for its democratic traditions and its very existence, had done nothing to forfeit the sympathy natural in such a case. In February, 1937, the Group associated itself with the appeal for pacification launched by French (Continued in next column) CATHOLICS AND DEMOCRACY Democracy is passing through a critical period in Europe, and not less in that section of democracy that is based on definitely Christian principles. It is not only that dictators have triumphed in various countries, but that even the democratic countries appear to be suffering from a phase of defeatism causing many to question whether an attitude of extreme caution, not to say of pusillanimity, may not be the most suitable under existing circumstances. It is against this that all true democrats should protest with one voice. In England, since the death of Cardinal Manning, Catholic democrats have had few opportunities of making themselves heard, whether in the social or the economic field, and more and more of recent months Catholic opinion, as expressed in the Press, has been tinged with Fascist sympathies and dazzled by totalitarian achievements. Hence the need was felt by a few Catholic democrats for a new rallying-ground, and this led to the birth last year of our PEOPLE AND FREEDOM group. Briefly, we aim at giving expression, whenever suitable, to our Catholic convictions concerning the rights of human personality, the need for civil and political liberty and the essential evils of modern warfare. Our group, however, would feel somewhat forlorn if it knew it was lifting up a voice in isolation. Our hope and our courage come from the fact that we are in close touch with similar and far larger groups on the Continent. It is true the Catholic democratic groups in Germany, in Austria, in Italy, have been ruthlessly shattered by recent events and all powers of expression denied to them, but, happily, there are still France and Holland and Belgium where Catholics on democratic lines are taking a constructive share in public life. And it is with French democrats especially that we are in constant relations. There is a tendency in England to assume that France is divided between a Conservative Right and a very "red " Left and to ignore entirely that active mass of Catholic working-men represented by the C.F.T.C. with its 500,000 members, the only effective alternative to the powerful C.G.T., as well as the Jocistes, who were able last year to collect some 50,000 ardent young Catholics for a monster three days' demonstration in Paris. Then there is that valiant little daily, the "AUBE," fighting a strenuous battle for ideals with which we are in fullest sympathy, and finally the whole group of intellectuals, led by Maritain who, like ourselves, declines to be identified with Fascist policy even when professing Catholic principles and with whose pronouncements on international questions we have been proud to associate ourselves on recent occasions. We feel, in brief, there is room for a platform for opinions on events of the day which have hitherto largely lacked opportunities of expression, and that Catholic democrats abroad warmly welcome support however small, from co-religionists in England at a time when the English Government is coming to be regarded on the Continent as without sympathy for democratic causes. VIRGINIA M. CRAWFORD. PEOPLE AND FREEDOM! (Continued from previous column) Catholics (headed by MM. Maritain, Gay, Marc Sangnier Madaule, and Madame Malaterre-Sellier, which denounced the atrocities of the war, from whatever quarter they came, protested against the system- (Continued on page 2, column 1) "People and Freedom !" was the slogan with which a week of centuries ago the cities of Italy fought for their independence and that of the Church against the Emperor. It was revived in the days of Savonarola, the first Christian Democrat. It was revived again in the last century by Christian Democracy. The People — not the modern Moloch of the State, which, like an insurance company, has "neither a body to kick nor a soul to damn," but the community of human beings, the common good of whom must be the aim of all government The People is not the mob. The dictators appeal to the passions of the mob, by their parades and sham plebiscites, but government by the People for the People means free and responsible citizens, free because they are responsible, responsible because they are free. In a democracy each individual is free to denounce injustice and uphold right, and it is his duty in conscience so to do. Our age is an age of propaganda, which enslaves. Not only in the dictatorship countries, where the whole system rests on propaganda and suppression of the wholesome breath of truth, but in the democracies, where wealth gains a hearing denied to holy poverty. "The truth shall make you free" holds good not only in religious matters but in all things. Truth is the foundation without which nothing can be built and stand. All society rests on the principle that a man's word must be his bond, on the sanctity of the pledged word—marriage, contracts, the whole temporal and spiritual order. It is the kernel of half the fairy-tales. It is recognised in the pre-Christian adage: Pacts must be kept. Subversives of the Left would deprive society of its supernatural basis. Subversives of the Right would deprive it of its basis in (Continued in next column) They do not know how great a grace is this of liberty. SAVONAROLA. Verily, daughter, I never intended (God being my good lord) to pin my soul at another man's back, not even the best man that I know this day living: for I know not whither he may hap to carry it. There is no man living, of whom while he liveth I may make myself sure. ST. THOMAS MORE. The Church imposes on the faithful, as everyone knows, the dogmatic and moral truths which Our Lord Jesus Christ her Founder entrusted to her. Outside this domain, she leaves her children a wise and just freedom. . . Hence in the Church the diverse schools, multiple institutions, very varied currents of thought and action. Taken together, all these movements proclaim the love of a wise freedom and thus favour true progress. CARDINAL VERDIER. No Catholic can regard with indifference a state of affairs in which work is considered as a commodity and the worker merely as a ''hand," and not, as he primarily is, an immortal soul. He must want those conditions to be changed into something Christian and he must do what he can to bring about the change. He must not apathetically acquiesce in them. The position of Catholics in this country, few in numbers and weak in influence, makes for discouragement and may tend to create this apathy. But we must remember that God often chooses "the weak things of this world to confound the strong"; and in any case there is nothing to prevent us from setting our own house in order. CARDINAL HINSLEY. (Advent Pastoral 1937). (Continued from previous column) natural justice, which, says Dante, God created when He created Adam, and which Christianity came to crown and complete. Such are those who look indulgently on treaty-breaking, on hypocritical conformism enforced by law, on injustice from which they look for "good," on mendacious propaganda if it be emitted by the side they favour. Truth is the basis of justice and the basis of freedom, and conversely, freedom opens the gates to truth and justice. Like all precious things, they are not easily come by. In the freest political system, freedom must be a personal conquest; it cannot coexist with apathy and the blind acceptance of the mass mind, and like all virtues, it can be preserved only by being continually rewon. In this country, where freedom is attainable for those who will (a freedom not unqualified, a threatened freedom even now, to be jealously defended if it is to live), the voice of truth is none the less a still, small voice. We are pledged to seek to hear it and to make it heard. BARBARA BARCLAY CARTER.
Object Description
|Archive collection
|Archives of the Trades Union Congress
|Archive folder
|Spanish Rebellion: Fund 1938
|Document reference
|Document title
|People and freedom news sheet. No. 1
|Issuing organisation
|People and Freedom Group
|Document date
|Easter 1938
|Copyright status
|Current copyright holder unknown.
|Image number


text: Simba, this is one of most salient problems involving women the world today. These women aren't organized enough to get their voices out to the media and no large political or government power is willing to take up their cause. Journalism such as this is a groundbreaking step in uncovering the suffering of disenfranchised domestic workers. It is an engaging and accessible piece. The "Maid for Sale" is a powerful visual aide to your story.


text:
A BART strike sent San Francisco Bay area commuters scrambling to find other transportation Friday. Here are just a few of the folks who were not happy about it.
(Jacques Brinon/AP)
Who's behind Christmas tree at Paris' Notre Dame?
PARIS (AP) — Notre Dame Cathedral in Paris has a Christmas tree this year thanks to an unusual patron: the Russian government. Full Story
(Alex Brandon/AP)
Thanksgiving: Turkey, parades, shopping deals
NEW YORK (AP) — Turkey, stuffing and a helium-filled Thomas the Tank Engine were on the menu as friends and families gathered across the United States to celebrate Thanksgiving. Full Story
(Photo by Owen Sweeney/Invision/AP)
Creed's Scott Stapp says he's homeless and broke
The singer's wife claims in divorce papers he also dealing with meth addiction and psychiatric issues.


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