Question 1

Pace yourself

Accepted Answer

• Make a list of your priorities each day, and focus on 1 or 2 each day
 • Spread out activities and make sure to rest in between – 5-10 minute breaks can go a long way
 • Schedule the most important things for the time of day you feel the best
 • Be kind to yourself and don’t worry if you don’t get through your list
Want to learn more about how to pace your activies? Watch this short video.(javascript:void(0))

Question 2

Accept help

Accepted Answer

Many people have a hard time accepting help. Letting people help you can be a gift to them. They want to show how much they care. Here are some tips:
 • 
 • Give people specific ideas and tasks they can help with, like laundry, yard work, cooking, cleaning, or errands

Question 3

Get a good night's sleep

Accepted Answer

• If pain keeps you up at night, try taking your short-acting opioid at bedtime.
 • Limit daytime sleeping to 1 or 2 short (15-30 minute) naps per day
 • Avoid caffeine and alcohol
 • Try not to watch TV or use screens for at least 30 minutes before bedtime
 • Make your bed only for sleeping. If you need to relax during the day, find another place.
 • Have a regular sleep schedule. Go to bed and wake up at the same time each day.
Want to learn more about how sleep and pain are connected? Read more here.(javascript:void(0))

Question 4

Be active

Accepted Answer

Physical activity (staying active) is one of the best ways to boost your energy. Some people can do more than others, but wherever you are is okay. Ask your care team for a safe physical activity plan. Here are some general tips:
 • Exercise does not have to be difficult. Find something you enjoy that gets your body moving. Good examples are walking, cooking, playing with children or pets.
 • Try walking 5-10 minutes, a few times per day. Slowly build up as able.  Any walking counts, even if it’s around your house.
 • Do something fun while you walk, like listening to music, or talking to a friend.
 • If activity causes you pain, don’t forget to take your short-acting opioid 30 minutes beforehand.

Question 5

Pay attention to your thoughts

Accepted Answer

Worrying can make your fatigue worse. If you’re struggling with worrying, read more about the connection between stress and pain,(javascript:void(0)) and see what has worked for other people.

Question 6

Prevention is key

Accepted Answer

Laxatives are medicines that help with constipation (such as Senna ® or Miralax ®). Start taking laxatives as soon as you are on opioids. Don’t wait until you are constipated.

Question 7

Adjust your laxatives to keep you regular

Accepted Answer

Make it a goal to have a good bowel movement every day or two. If you haven’t gone in more than 24 hours, increase the dose of your laxatives, or add another laxative. Tap to learn more about adjusting your laxatives.(javascript:void(0)) Also – if you report your constipation in this app, we will offer advice on what to do with your laxatives.

Question 8

What to do if you get diarrhea

Accepted Answer

Sometimes laxatives can work too well, and you may have loose stools or diarrhea. If this happens, stop the laxatives until your diarrhea has been gone for about a day.
 
When your diarrhea has been gone for about a day then restart your laxatives at a slightly lower dose (Tap for specific advice about how to adjust laxatives)(javascript:void(0)).
 
Don’t make the mistake of stopping your laxatives completely: this can cause the “yo-yo” problem where you become very constipated again, you need high doses of laxatives, then the yo-yo swings in the opposite direction towards diarrhea.

Question 9

Other ways to manage constipation

Accepted Answer

Without laxatives, it’s hard to get your stool moving. Here are some other things you can do in addition to laxatives that may help:
1. Drink a lot of fluids. Aim for 8 cups per day.  Any fluids (except alcohol) count! It can be water, soup, juice, milk, tea, or any drinks you like.
2. Pay attention to other medications. Some medicines can make constipation worse. These include common anti-nausea medicines like ondansetron (Zofran), palonosetron (Aloxi), and granisetron (Kytril). If you find that these medicines make your constipation worse, try increasing your laxatives on the days you need to take them. You can also talk to your care team about other anti-nausea medicines that don’t cause constipation.
3. Be active! Even walking slowly for 5-10 minutes at a time can help move things through.
4. Eat more fiber in your food. Try raw fruits and vegetables, oatmeal, or other whole grains. Some fiber-rich foods (like broccoli or cabbage) may cause gas and bloating, so listen to your body and notice what helps and what doesn’t. Tap to learn more about nutrition and constipation.(http://dfcionline.org/departments/nursingpatientcareservices/patient-family-programs/blum/teachingsheets/nutritionsheets/) 
5. Foods to avoid: Try not to eat too many foods that cause gas, like cabbage, broccoli or fizzy drinks. Also, try to limit the amount of foods you eat that cause constipation like meats, cheese, chips, fast food, or processed foods like hot dogs or some microwave dinners.
6. Avoid fiber supplements: This sounds confusing, but most fiber supplements (like Metamucil or Citrucel) can make the stool bigger and harder to pass. So - experts say when taking opioids, STAY AWAY from fiber supplements all together.

Question 10

Ask for help

Accepted Answer

Cancer doctors and nurses take constipation seriously. Here are some reasons to call your care team:
 • If you haven’t had a stool in 4 days or more
 • If you haven’t passed gas from your bottom in more than a day
 • If you have constipation and symptoms like sharp belly pain or vomiting

Question 11

Thoughts about pain that make pain worse

Accepted Answer

• “My cancer must be growing if it hurts this much.”
 • “This pain won’t ever get better.”
 • “This pain will be the end of me.”

Question 12

Things you expect from pain that make pain worse

Accepted Answer

• “Nothing will work.”
 • “Nothing makes the pain better.”
 • “I always have pain when I try to do ________.”
 • “I can’t do any of the things I want to because of my pain.”

Question 13

Thoughts about pain that make pain better

Accepted Answer

• “There are things I can do to manage this pain.”
 • “This pain doesn’t define who I am.”
 • “I’m working with my doctors to learn better ways I can manage my pain at home.”

Question 14

Things you expect from pain that make pain better

Accepted Answer

• “My pain isn’t always bad. There are times it feels better.”
 • “I’m getting the help I need to learn about ways to make my pain better.”
 • “I’m not alone in this. I have people to support me, and a care team to help me manage my pain.”

Question 15

Social factors that can make pain worse

Accepted Answer

• Missing social events because of pain
 • Missing work or working too much
 • Wanting to isolate when pain is worse

Question 16

Social factors that can improve pain

Accepted Answer

• Spending time with people you care about
 • Attending social or cultural events that are meaningful to you
 • Attending Church, Synagogue, Mosque or other religious services
 • Going to community events like sporting events
 • Getting help from loved ones
 • Sharing your feelings about pain with a trusted friend, and knowing you’re not alone in managing your pain

Question 17

Start with a goal you know you can accomplish

Accepted Answer

Try to pick something you used to do enjoy doing but find an easier way to do it. Watching sports with friends instead of playing them. Walking around the park instead of running. Get creative. Talk to trusted friends to help come up with something that makes sense for you.

Question 18

Pick a shorter amount of time to do the activity

Accepted Answer

Time can be a helpful tool to stay within your limits and to not overdue it. Use time limits to set realistic goals You can slowly increase the time to improve your endurance when you feel ready. If it doesn’t start to feel easier, reduce the time or intensity, or pick something easier. Read more about pacing your activities here.(javascript:void(0))

Question 19

Do the activity less often

Accepted Answer

Try the activity once a week for a while, increase it after a few weeks when you feel comfortable.

Question 20

Stick to things that matter to you

Accepted Answer

If for a while you enjoyed an activity, keep that going. If you start to notice that the goal is less meaningful to you, pick something else.

Question 21

Pick and activity goal

Accepted Answer

Start by choosing an activity that is meaningful to you. It should be something important to you, something you enjoy, and something realistic.  People often choose something that fits into their everyday life like light housework or home repairs, cooking, gardening, or walking. Or they chose an activity that has a social aspect to it – like going out to dinner with friends, shopping, or going to a sporting event.

Question 22

Try it for a short time

Accepted Answer

Whatever the activity, start with baby steps.  If your goal involves walking, start with a distance or amount of time you know that you can do comfortably.  People try to start with what they used to before they were sick. This usually isn’t a good idea. Try to start with something more realistic. Overdoing it at the beginning can make your pain flare up, discourage you, and get you stuck back in the pain cycle.

Question 23

Slowly work your way up

Accepted Answer

Once the activity feels comfortable, stick to that same routine for a few days. This helps build your endurance. Then - increase the time you spend doing that activity by a few minutes. Or make the activity a little bit more difficult (like walking faster).
 
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Question 24

Pay attention to how you feel

Accepted Answer

Check in with yourself often and notice how your energy and pain are doing. You will start to learn your body’s signals that you’re pushing too hard, or that you’re ready to step up your activity level.

Question 25

Take regular rest breaks

Accepted Answer

Even if you’re feeling ok, it is important to stop and rest after physical activity. This helps your body recover and prevents your pain from worsening.

Question 26

Take your pain medications to help

Accepted Answer

If you know that an activity always causes pain, it can help to take your short-acting opioid (your “breakthrough” pain medicine) about 30 minutes ahead of time. Over-the-counter pain medicines like ibuprofen (Advil) or acetaminophen (Tylenol) can also help, if your care team has said that these are safe for you. Using pain medicines wisely is an important part of building strength and endurance.

Question 27

If fear is holding you back, ask for help

Accepted Answer

Get affirmation from your care team about your concerns. Remember pain can trick us into thinking we should avoid movement, yet sometimes this isn’t always true. At times, pain gets better with more movement.

Question 28

Remember that setbacks and flare-ups in pain are normal

Accepted Answer

There will be days you don’t feel up to what you did yesterday. Try to do the activity even still. Maybe do it for a shorter time, or break up your normal activity time with rest breaks. Try not to avoid activity all together. It can be easy to lose the gains you’ve been working so hard for.

Question 29

Save energy for activities you value

Accepted Answer

Sometimes little tasks can take up a lot of energy. Try to ask others for help and save your energy for tasks and activities that are really important to you.

Question 30

Alternate hard tasks with easier tasks

Accepted Answer

Alternating tasks throughout the day can help you to sustain your energy throughout the day. This way, you don’t lose all your energy at once, and can rest during or between easier activities.

Question 31

Men, opioids, and sex

Accepted Answer

Opioids reduce hormones like testosterone. This affects different aspects of your sexual functioning. Changes can include:
 • Lack of desire for sex
 • Difficulty having or maintaining an erection (erectile dysfunction, or “ED”)
 • Reduced pleasure during sex
 • Problems with ejaculation
 • Pain or numbness during sex or in genitals
 • Negative feelings about sex or your body

Question 32

Women, opioids, and sex

Accepted Answer

Though the direct pathways are unclear, opioids can change nerve signals and hormones that affect sexual functioning. Changes can include:
 • Lack of desire for sex
 • Reduced pleasure during sex
 • Problems with orgasm
 • Pain or numbness during sex or in genitals
 • Vaginal dryness or tightness
 • Negative feelings about your body

Question 33

Make things move

Accepted Answer

Medicines like Senna (aka Senakot or Ex-lax), bisacodyl (Dulcolax) work by making the muscles in your gut squeeze more often to move stool through faster. At the drug store, these are often called stimulant laxatives.

Question 34

Bring in water

Accepted Answer

Medicines like polyethylene glycol (Miralax) Milk of Magnesia, Lactulose, or Magnesium Citrate work by bringing extra water into your gut. They make stool looser and easier to pass. Make sure you drink enough water with these.

Question 35

Soften the stool

Accepted Answer

Stool softeners like docusate (Colace) are weak and are rarely enough on their own. If you are sensitive to laxatives or get loose stools easily, stool softeners may be a good choice.

Question 36

A different angle

Accepted Answer

If stool sits in your body for too long, it can get very hard to pass. This is when enemas or suppositories can be helpful. Suppositories like glycerin or Dulcolax draw water into your rectum and loosen hard stool so you can pass it. Enemas (like Fleet’s saline, mineral oil, or phospha-soda enemas) also add fluid to flush out the stool. Enemas can be uncomfortable, but they help if you are in a bind. Before trying this option, ask your care team if enemas or suppositories are safe for you.

Question 37

Can I change my laxative doses on my own?

Accepted Answer

Many over-the-counter laxatives can be increased or decreased depending on how severe your constipation is. Senna (Senakot) and polyethylene glycol (Miralax) are most commonly used this way. My Daily Constipation Plan gives instructions on how to adjust these two laxatives to manage your constipation on a daily basis.(javascript:void(0)) 
Also – if you fill out your daily survey, we will give you suggestions about how to adjust your laxatives. If your doctor has given you specific instructions for adjusting your laxatives, use that plan. Talk to them if the plan isn’t working.

Question 38

My laxatives aren’t working well. Are there other medicines I should ask about?

Accepted Answer

If the medicines in the daily constipation plan or the constipation rescue plan don’t work for you (or don’t agree with you), talk to your care team. They might recommend some types of medicines. We have listed some of them below. Talk to your care team before using them.

Question 39

What should I do if I have diarrhea?

Accepted Answer

If your laxatives are causing diarrhea, stop taking your laxatives. Once your diarrhea has stopped and been gone for a day, restart your laxatives at a lower dose. There isn’t a right or wrong way to decrease your laxatives, but a common approach is to cut the doses in half. Your care team can give you more advice if you need it, or you can read more about adjusting laxatives here.(javascript:void(0))

Question 40

Senna (Senokot ®)

Accepted Answer

Senna usually comes in 8.6mg tablets, which are taken once or twice per day. Senna works by making the muscles in your gut squeeze more often and by drawing extra water into the stool. Tap to learn more about Senna.(javascript:void(0))

Question 41

Polyethylene glycol (Miralax®)

Accepted Answer

Miralax is a powder sold in boxes of single-dose packets, or in larger bottles. Miralax is taken by mixing the powder into liquid and drinking once or twice per day. It works by drawing extra water into your stool. Tap to learn more about Miralax.(javascript:void(0))

Question 42

Docusate (Colace®)

Accepted Answer

Docusate (also called Colace) comes in capsules, and works by softening the stool. Tap to learn more about docusate.(javascript:void(0))

Question 43

Bisacodyl (Dulcolax ® or Ex-Lax ®) tablets

Accepted Answer

Bisacodyl comes in 5 mg tablets, which are taken once or twice per day. Bisacodyl works by making the muscles in your gut squeeze more often and by drawing extra water into the stool. Tap to learn more about bisacodyl tablets.(javascript:void(0))

Question 44

Magnesium hydroxide (Milk of Magnesia)

Accepted Answer

This medicine is a chalky liquid that comes in a bottle that is taken with water. You can also find it in chewable tablets. It works by bringing extra water into your gut. Tap to learn more about Milk of Magnesia. (javascript:void(0))

Question 45

Glycerin suppository

Accepted Answer

This is a medicine that you put in your bottom. It draws water into your rectum to help loosen and pass stool. ALWAYS ask your care team if suppositories are safe for you before using them. Tap to learn more about glycerin suppositories.(javascript:void(0))

Question 46

Bisacodyl (Dulcolax ®) suppository

Accepted Answer

This is a medicine that you put in your bottom. It draws water into your rectum to help loosen and pass stool. ALWAYS ask your care team if suppositories are safe for you before using them. Tap to learn more about bisacodyl suppositories.(javascript:void(0))

Question 47

Sodium phosphate (Fleet’s ®) enema

Accepted Answer

This medicine comes in an over-the-counter kit that is used to add fluid to your bottom, to flush out stool. ALWAYS ask your care team if suppositories are safe for you before using them. Tap to learn more about sodium phosphate enemas.(javascript:void(0))

Question 48

Tap water enema

Accepted Answer

This medicine comes in an over-the-counter kit that is used to add fluid to your bottom, to flush out stool. ALWAYS ask your care team if suppositories are safe for you before using them. Tap to learn more about tap water enemas.(javascript:void(0))

Question 49

Stick to a regular sleep schedule

Accepted Answer

Go to bed and wake up at the same time, every day. This helps your body’s clock stay regular, which can also help with pain.

Question 50

Make a relaxing bedtime routine

Accepted Answer

Creating calming “bedtime rituals” can help teach the body that it’s time to relax and go to sleep. Some people do relaxing stretches, shower or take a warm bath before bed, do breathing or relaxation exercises (try one here),(javascript:void(0)) or enjoy a hot cup of sleepy time tea (caffeine free).
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Question 51

Keep your bed dedicated to sleep

Question 52

Try not to watch the clock

Question 53

If you can’t sleep, get up and try again"

Question 54

Avoid caffeine, nicotine, and alcohol"

Question 55

Avoid naps

Question 56

Exercise (but at the right time!)

Question 57

Cold and allergy medicines (antihistamines)

Question 58

Anti-anxiety medicines

Question 59

Anti-nausea medicines

Question 60

Medicines for nerve pain

Question 61

Antidepressants

Question 62

Blood pressure medicines

Question 63

What if my patch comes loose?

Question 64

How do I shower with a patch?

Pain Thoughts: Identifying and replacing thoughts that are not helpful