Cancer Pain

Pain is one of the most common symptoms people with cancer face, affecting nearly half of all patients and even more of those with advanced disease. Yet with proper pain management, most people can find relief and maintain a better quality of life throughout their cancer journey.

Table of contents

• What is Cancer Pain?
• What Causes Cancer Pain?
• Types of Cancer Pain
• How Common is Cancer Pain?
• Impact on Quality of Life
• How Healthcare Providers Assess Pain
• Treatment Options for Cancer Pain
• Pain Medications
• Non-Medical Approaches to Pain Relief
• Overcoming Barriers to Pain Management

What is Cancer Pain

Cancer pain is pain you may experience because you have cancer or receive cancer treatment. The pain can come from cancer itself, treatments like chemotherapy (drugs that kill cancer cells), radiation, surgery, or a combination of these. Pain from cancer or cancer treatment may be sharp or dull, burning or throbbing, and it can affect several areas of your body^[2].

Pain is usually a sign that something is wrong in the body. When there is damage to any part of your body, your nervous system sends a message along nerves to your brain. When your brain receives these messages, you feel pain^[7].

What Causes Cancer Pain?

Cancer pain happens for many reasons. The tumor itself may press on and irritate nerves, bones, or organs in the body, resulting in pain in the affected area. As a tumor grows, it can press on nerves, bones, or organs, and the tumor can also release chemicals that can cause pain^[2].

Some common causes of cancer pain include medical tests like a biopsy or spinal tap to diagnose cancer, a cancerous tumor pressing on tissues, bones or nerves, and side effects from cancer treatment^[2]. For example, you may have bone pain if you receive cancer medication that helps your body make more white blood cells^[2].

Different cancer treatments may cause specific types of pain. Surgery can result in persistent pain, and postoperative pain (pain after surgery) is common. Chemotherapy can cause spasms, stinging, and itching, as well as mucositis (inflammation of the mucous membranes). Radiation therapy can cause pain from lying in the same position during treatment, mucositis in areas that were treated with radiation, and skin inflammation^[3].

Sometimes pain can be completely unrelated to your cancer. It’s possible to have everyday aches and pains from conditions like arthritis, headaches, constipation, or digestive problems^[7].

Types of Cancer Pain

There are several types of cancer pain that people may experience. Understanding the type of pain you have helps healthcare providers choose the right treatment.

Acute pain is pain that may be mild or severe but goes away. You may have acute pain as you recover from cancer surgery and treatments^[2].

Chronic pain is pain that doesn’t go away. It may range from mild to severe and can be due to changes to the nerves caused by cancer pressing on nerves or from chemicals produced by a tumor. It can also be caused by nerve changes from cancer treatment. Chronic pain can continue long after the injury or treatment is over and can range from mild to severe. Experts estimate that 35% of all cancer survivors experience pain months and years after they complete treatment^[2].

Breakthrough pain is severe pain that comes on very quickly. It may happen even if you’re taking pain medication as prescribed. Breakthrough pain may start if your pain medication is wearing off^[2].

Phantom pain occurs when you feel pain in a part of the body that has been removed. For example, you might feel pain in the breast area after removal of the breast or pain where you may have had an arm or leg removed due to a bone tumor. This pain is very real and can sometimes be described as unbearable^[4].

Referred pain is pain in one area of your body that happens because you have cancer in another area. For example, liver cancer may make your liver swell and press on nerves that cause right shoulder pain^[2].

Cancer pain can also be classified by how it feels. Nerve pain (also called neuropathic pain) is caused by pressure on nerves or the spinal cord, or by damage to the nerves. People often describe nerve pain as burning, shooting, tingling, or a feeling of crawling under their skin^[4]. Bone pain occurs when cancer spreads into the bone and damages the bone tissue. This is often described as aching, dull, or throbbing^[4]. Soft tissue pain (also called visceral pain) means pain from a body organ or muscle. People often describe this pain as sharp, cramping, aching, or throbbing^[4].

How Common is Cancer Pain?

Pain is one of the most common symptoms that people with cancer have. Not everyone who has cancer has pain, but research shows nearly half of people with cancer are likely to experience it^[2].

Research shows that 64% of patients with advanced or metastatic cancer (cancer that has spread to other parts of the body) report pain. Among those currently receiving treatment to fight the cancer, 59% report pain. Even one-third of patients have pain after completing treatment meant to cure the cancer^[14].

Pain is more likely with advanced cancer. Research shows that 55 out of 100 people with advanced cancer have pain^[7]. Younger people are more likely to have cancer pain and pain flares than older people. People with advanced cancer have more severe pain, and many cancer survivors have pain that continues after cancer treatment ends^[3].

Having pain after successful treatment doesn’t necessarily mean that your cancer has come back. Some people get pain after cancer treatments like surgery or radiotherapy, or it might be a long-term side effect of chemotherapy. Post-treatment pain can start or get worse months or even years after treatment has finished^[7].

Impact on Quality of Life

Cancer pain can affect your quality of life. Pain can affect every part of your life, including your thoughts and feelings, as well as your body. It can cause many different emotions such as anger, fear, worry, sadness, and anxiety^[25].

Pain can keep you from doing things you want to do and spending time with loved ones and friends. If you are in constant pain, you may feel like you can’t focus on anything else^[25]. The presence and severity of pain provides prognostic information for survival. Poor communication between providers and patients regarding pain control can decrease patient satisfaction. Poor pain control is also associated with more psychological distress and decreased social activities and social support^[14].

Pain that is severe or continues after cancer treatment ends increases the risk of anxiety and depression. If you feel depressed or have anxiety, your pain may feel worse and make it harder to control. Some people are unable to work because of the pain^[3].

Pain control can improve your quality of life. Managing pain is an important part of cancer care. With good pain control, most people should be able to be free of pain when they are lying down or sitting^[7].

How Healthcare Providers Assess Pain

To treat cancer pain effectively, healthcare providers take time to understand your pain. They need enough information to correctly assess your pain and find the underlying cause. Understanding the cause of pain helps identify the best treatment options^[2].

Healthcare providers may ask you several questions about your pain. They may ask how much it hurts, asking you to describe your pain on a scale of 0 to 10, with 10 representing extreme pain. They may ask what it feels like—whether the pain is an ache, throbbing pain, or sharp pain. They will want to know where it hurts and what makes the pain better or worse^[2].

Doctors measure cancer pain so they can give you the right treatment. This can include asking questions, examining you, and rating your pain on a scale^[19]. Everyone experiences pain differently, so it’s important to tell your cancer care team when you have pain, where it hurts, and how it feels^[2].

It might be helpful to create a pain journal or diary to keep track of your pain over time. A pain journal can help your healthcare team assess your pain and see how well pain medicines are working. Your pain journal should be a daily record of your pain, including words to describe the pain, where the pain is, how bad it is at different times of the day, activities that seem to worsen or lessen the pain, and information about your pain medicines^[25].

Treatment Options for Cancer Pain

The foundation of cancer pain management is regular medication, but there are many approaches to controlling pain. Combining medications and other methods to gain maximum benefit is common^[17].

A number of treatments are available for cancer pain. Your options may depend on what’s causing your cancer pain and the intensity of the pain you’re feeling. You may need a combination of pain treatments to find the most relief^[11].

Healthcare providers may use medication, medical procedures, or surgery to ease pain from cancer or cancer treatment. Treatment of the cancer itself can help the pain—if treatments like radiation therapy, surgery, hormone therapy, and chemotherapy are successful in reducing tumor size, they may also relieve pain^[11].

Pain can be managed before, during, and after tests and procedures. Some tests and procedures are painful, so it helps to start pain control before a procedure begins. Some drugs may be used to help you feel calm or fall asleep^[3].

It is possible to relieve all pain to some extent with the right treatment. The best way of controlling pain depends on what’s causing it^[7].

Pain Medications

The foundation of cancer pain management is medication. Options include over-the-counter pain relievers, opioids (medications derived from opium), and other medications^[11].

For mild and moderate levels of pain, pain relievers that don’t require a prescription may help. Examples include aspirin, acetaminophen, and ibuprofen^[11]. Aspirin-like drugs are used for bone pain and pain caused by inflammation. Paracetamol is important in cancer pain control. It is usually well tolerated, doesn’t affect the stomach, and won’t thin the blood. It is helpful to reduce fevers and relieve bone pain, and is often used along with opioids^[17].

Opioids, such as codeine and morphine, are often needed for more severe pain. Some of the side effects may include nausea, vomiting, drowsiness, and constipation. There is no danger of addiction if taken for pain relief purposes. There are several newer opioids available, so one can usually be found to suit each person^[17].

Many people worry about taking opioids because they are afraid to become addicted or think they should wait until they are very ill before they use these drugs. Evidence shows that it is far better to find a suitable opioid early and get your pain under control. It’s very rare for people taking painkillers for cancer pain to become addicted to them^[7].

Other medications may also help with certain types of pain. Antidepressants or other medications might be prescribed for nerve pain^[13]. Studies of drugs used to treat chemotherapy-induced peripheral neuropathy (CIPN)—a nerve problem that can cause pain, numbness, and tingling in the hands and feet—have shown that duloxetine is a drug that has been studied for this condition^[3].

Pain medications may be given in different forms. They can be taken by mouth, through the skin with patches, by injection, or through other routes depending on what works best for each person^[2].

Non-Medical Approaches to Pain Relief

In addition to medication, there are many other ways to help control cancer pain. These approaches can be used along with pain medicines to provide additional relief.

Nerve-block injections may be an option. These are placed into the painful area to block pain signals. A nerve block can help relieve cancer pain that is difficult to treat by killing or deadening the nerve to stop it causing pain^[13].

Several relaxation techniques can help manage pain. Relaxation can reduce muscle tension, which can relieve pain or keep it from getting worse. Relaxation can also give you more energy, reduce fatigue, anxiety and stress, and help with falling asleep^[25]. Helpful relaxation therapies include meditation, massage, tai chi, yoga, and hypnotherapy (using hypnosis to put you into a trance-like state where your body is deeply relaxed but your mind is active)^[17].

Other techniques that may be helpful include acupuncture (involving putting fine needles into the body at particular points), massage therapy, aromatherapy massage, reflexology (applying gentle pressure to your feet or hands), and meditation^[29]. Studies of acupuncture for chemotherapy-induced peripheral neuropathy have been reported^[3].

Electrical nerve stimulation, known as TENS (transcutaneous electrical nerve stimulation), may temporarily help pain that is in one area of the body. Small pads are stuck onto your skin and release a small electrical charge, causing a tingling feeling that blocks the nerves carrying the pain messages^[29].

There are also many ways that you and your family can help to control your pain. Changing your position regularly can prevent stiffness and areas of sore skin. Hot or cold packs can help relieve pain, but should be wrapped in a soft towel so they don’t damage your skin. Watching TV, reading, or chatting can help to take your mind off your aches and pains. Learning relaxation exercises can be very helpful if you can’t sleep^[29].

Therapies such as imagery or relaxation can also help control pain and anxiety related to treatment. To help lower your anxiety, ask about procedures or tests before they begin so you know what to expect. Have a family member or friend stay with you during procedures^[3].

Overcoming Barriers to Pain Management

Despite the availability of effective pain treatments, cancer pain is often under-treated. Even though there has been a decrease in under-treatment of cancer pain, approximately one-third of patients living with cancer still have pain that is inadequately treated^[14].

Don’t be afraid to tell your doctor or nurse that you have pain, however mild or severe it feels to you. The earlier you get treatment for pain, the easier it is to get it under control. Many people with cancer are scared that they will become addicted to painkillers, so they don’t ask for help. But it’s very rare for people taking painkillers for cancer pain to become addicted to them, and it is important that the pain is controlled^[7].

Research suggests people coping with pain from cancer may be reluctant to ask for help, specifically pain medication. If you’re experiencing cancer pain, it’s important to remember that no one expects you to “put up” with pain or try to overcome it on your own^[2].

Talking about how you are feeling may help you manage pain. It can be difficult to share feelings about pain, but talking about it and how you are feeling can often help to reduce pain. Talking about your pain can also help others understand what you are going through^[25].

If you think your provider is not able to effectively manage your pain, ask for a referral to a pain specialist. Some nurses and doctors specialize in managing pain, such as physiatrists (doctors who specialize in physical medicine and rehabilitation) and anesthesiologists (doctors who specialize in pain relief and managing pain during and after surgery)^[6].

You are not alone. There are many people who can help you. Talk about your feelings with someone you feel comfortable with, such as family, friends, a counselor, a doctor, or a nurse. You may also find it helpful to talk to someone who has had cancer and who understands what you are going through. A support group where people meet and share feelings about how they cope with cancer pain may also be helpful^[25].