Pain is common among people with cancer, but not everyone with cancer has problems with pain. Pain can be caused by the cancer itself, especially if tumors press against nerves or invade the bones, or it can be a side effect of cancer treatments.
Cancer-related pain can usually be managed, and pain management is an important part of any cancer treatment plan. Discuss pain with your care team if it is severe, long-lasting or interferes with daily activities or your ability to eat or sleep.
Pain is classified into three types:
- Acute pain: Short-term pain that comes on quickly and doesn’t last long. Acute pain can be mild, severe or somewhere in between. It is generally caused by injury, tissue damage or inflammation.
- Chronic pain: Long-term pain that can last weeks, months or in some cases years. It may be constant or may come and go. It also can range from mild to severe.
- Breakthrough pain: Flare-ups of pain that happen while taking pain medication.
Pain is often caused by cancer itself, and it varies depending on where a tumor is growing. Cancer-related pain is more likely in people with advanced cancer or cancer that has spread from its original site, a process known as metastasis. Some cancer survivors continue to experience pain even after completing treatment.
If a tumor presses against nerves or the spinal cord, it can cause nerve pain, which is often accompanied by burning or tingling sensations. Cancer that spreads to the bones can cause deep, dull or throbbing pain. Cancer that affects internal organs such as the intestines or liver can cause a vague sensation that makes it hard to pinpoint exactly where the pain is stemming from; this kind of pain may also come with nausea and sweating. Some people can get referred pain, which stems from one part of the body but is felt in a different area. An example is an enlarged liver that presses on nerves that trigger pain in the shoulder.
Pain can also be caused by cancer treatment. Many people experience pain after surgery because of damage to tissues and nerves, or from scarring during the healing process. Some people who have had a limb or other body part removed experience so-called phantom pain, or a sensation that the missing part is still there and hurts.
Radiation therapy and chemotherapy can cause painful side effects including mouth sores, skin rash, joint pain, vomiting, diarrhea and constipation. Sometimes receiving drugs by infusion can result in pain and inflammation. Certain chemotherapy drugs can cause peripheral neuropathy, or nerve damage in the extremities, with symptoms such as pain, burning, tingling or numbness in the hands and feet.
Because different kinds of pain can arise from different sources, there are a variety of approaches to managing pain. Sometimes simple measures such as using ice packs or heating pads can help. In some cases, treatment can be adjusted to lessen painful side effects. For example, chemotherapy drugs may be given in smaller doses over a longer period to reduce peripheral neuropathy. Sometimes treatments that shrink tumors, such as radiation or chemotherapy, can relieve pain even if they can’t cure the cancer or prolong survival.
Many types of medication can help keep pain under control. For some people, over-the-counter medications are enough, while others will need stronger medications prescribed by a doctor. These may include non-steroidal anti-inflammatory drugs (such as ibuprofen) and opioids (drugs related to opiates like morphine). Medications may be administered in a variety of ways including pills, patches and self-controlled pumps. In severe cases, pain medications can be administered near the spinal cord.
Always take pain medications as directed—taking higher doses can be dangerous. Tell your cancer care team about any over-the-counter medications, herbal remedies or nutritional supplements you are using, as some of these can interfere with cancer drugs or prescription pain medications.
Some pain medications can cause problems of their own. Opioids can lead to dependence, and an overdose can result in respiratory depression and death. Ask your provider about laxatives or other strategies to manage constipation caused by opioids.
Different approaches for managing pain may include physical or rehabilitation therapy, psychological counseling and a variety of complementary therapies. Some people find they get relief from acupuncture, meditation, relaxation techniques, massage, hypnosis, guided imagery, distraction techniques or other approaches. Studies have shown that medical cannabis can relieve pain in cancer patients. Each of these approaches may be used alone or in combination. Often it takes time and trial and error to get pain under control.
The National Cancer Institute recommends keeping a pain diary. This can make it easier to explain your pain issues to health care providers, and details can be helpful when developing a pain-management plan. The diary should describe which parts of the body are affected, what the pain feels like (for example, sharp, dull, burning or throbbing), how severe it is, when the pain occurs and how long it lasts. Note if the pain interferes with daily activities and any strategies you use that help reduce the pain.
Medical professionals with different areas of expertise can play a role in assessing and managing pain. For example, a neurologist might be involved if you have nerve pain. Counselors or psychologists can help teach skills for coping with pain. If pain is chronic or unrelenting, it can affect the mood as well as the body, leading to depression, anxiety, anger and frustration—which in turn can make the pain seem worse. Strategies to improve mood may help keep pain under control.
Some people don’t get enough relief from standard pain medications and may need referral to a pain medicine specialist. Patients with pain that is difficult to control may be prescribed opioids. In cases of advanced cancer with a poor prognosis, a palliative care team may be brought in. This type of treatment focuses on making patients comfortable rather than trying to treat their cancer.
The good news is that pain related to cancer and its side effects can usually be managed, at all stages of disease, and doing so is an important part of overall care for people with cancer.
For more information on cancer-related pain, visit:
American Cancer Society
National Cancer Institute
American Society of Clinical Oncology
Last Reviewed: November 20, 2017