Cancer pain

Cancer doesn't always cause pain, but pain is one of the more common symptoms of the disease—and it’s also a frequent side effect of the therapies used to treat many different types of cancer.

Between 20 percent to 50 percent of cancer patients experience pain, and about 80 percent of people with advanced cancer endure moderate to severe pain, according to the National Cancer Institute.

Cancer pain—like pain in general—may be debilitating. It may erode your energy, make sleeping or eating difficult and take a toll on your mental and emotional health. It may affect your work life and how you go about your daily tasks.

Cancer-related pain has a wide variety of causes—the cancer itself, tests and procedures to diagnose the cancer, or therapies to treat the cancer—and pain may appear in different forms. It may come and go and range in severity.

Regardless of the cause, type or severity of the pain, it’s crucial to discuss it with your care team. It should never be viewed as an inescapable consequence of the disease. Pain is highly treatable, and many evidence-based medical treatments and evidence-informed integrative therapies are available to help reduce it.

Pain as a side effect of cancer

When the cancer itself causes pain, it’s often due to a tumor. As a tumor grows, it may put pressure on the surrounding area. Tumors that press on nerves, bones or organs may result in pain.

Two common types of pain caused by cancerous tumors are:

• Spinal cord compression pain. This condition occurs when tumors grow near the spine and constrain spinal cord nerves, leading to pain in the back or neck that is often intense. Other symptoms may include pain, numbness or weakness in an arm or leg. Sudden movements such as coughing or sneezing may aggravate this type of pain. Spinal cord compression is a medical emergency and requires immediate treatment to shrink the tumor—often using radiation, steroids, surgery, or a combination of these therapies. Without treatment, there’s a risk of serious complications, including paralysis.
• Bone pain. When cancer develops in the bones or spreads to them, it weakens them and damages nearby nerves, causing pain. This type of pain may be alleviated with pain medications, treatments to fight the cancer, and drugs or therapies to strengthen the affected bones.

Pain as a side effect of cancer treatment

Patients may also experience pain as a side effect of the treatments and tests used to diagnose and fight the cancer. Below are some of the more common cancer treatments and the painful side effects they may cause.

Surgery

• Postoperative pain: Pain in the days or weeks following most surgeries is expected, but it may be reduced with pain medication. Ask about how much pain to expect and how long it should last. If you experience postoperative pain that’s more severe or long-lasting than expected, or if the pain medications don't seem to be working, it's crucial that you inform your care team.
• Phantom pain: Surgery that removes a body part—like an arm, leg or breast—may lead to phantom pain. Phantom pain refers to the experience of pain or other symptoms that feel like they’re coming from the body part removed during surgery. The cause of phantom pain isn’t fully understood, but treatment options for this type of pain may include pain-relief drugs, physical therapy and antidepressants.

Radiation therapy

• Radiation therapy may cause painful side effects in the areas of the body where it’s focused. For example, the skin on top of the treated area may become inflamed, burned or scarred. If radiation is aimed at the mouth, it may cause mouth sores. Radiation in the throat, intestine and bladder may also cause painful injury or irritation.

Chemotherapy

• Chemotherapy sometimes causes a type of nerve damage called peripheral neuropathy (or chemotherapy-induced peripheral neuropathy) that leads to pain, numbness, tingling or weakness in the hands and feet. Speak with your care team if you're experiencing these symptoms during chemotherapy treatment. Peripheral neuropathy often subsides after treatment, but it may cause long-term problems.
• Chemotherapy may cause painful sores to develop in the mouth, throat or other areas of the digestive tract.

Diagnostic tests and procedures

• If you need a test or procedure to diagnose your cancer or find out how advanced it is, ask if you should expect pain. Some of these tests may be painful, but your care team can make sure you’re prepared and receive pain medication as necessary.

Managing and preventing cancer pain

The right way to treat pain may depend on several factors related to your body and preferences, your cancer type, and the type and severity of your pain.

To make sure that your pain is properly managed, be open and direct with your care team and explain how you feel to the best of your ability. Your care team needs to know when you're in pain and how severe it is. Identifying when, where and why the pain started may make it easier to treat it.

Assessing cancer pain

Your care team will likely ask you to report your pain levels regularly. You may be asked to describe your pain level using a number from zero to 10. It’s helpful to keep a record listing when and how long the pain lasts, where it’s located, and if anything seems to make it better or worse, including the time of day. You may share these details with your care team.

Along with this information, your care team may also need to review your medical history, especially if you've had any experience with substance use or mental health disorders. You may need a physical exam to determine the location and source of your pain. Then, you and your care team may decide together how best to treat it.

Treating cancer pain

The methods used to curb cancer-related pain range from strong pain medications to nonmedical therapies like acupuncture. In other words, if you’re experiencing pain, there are many options to discuss with your care team.

In many cases, drugs may be used to manage cancer pain. There are several types of pain medication, and your care team will typically choose one according to the severity of your pain.

Some medications, like opioids, are typically reserved for more severe pain, while drugs like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) may be useful for mild-to-moderate pain. NSAIDs include ibuprofen, naproxen and others. They may be purchased over-the-counter or prescribed in higher doses.

While opioids must be prescribed cautiously due to their strength, side effects and potential for addiction, they’re often necessary and safe to use for many people with moderate-to-severe pain. However, other drugs like acetaminophen and NSAIDs are potent options for less severe pain or for anyone who cannot take opioids. When taken regularly, these drugs may be a highly successful pain-relief option.

Besides opioids, acetaminophen and NSAIDs, other drugs that may be used to help treat cancer pain include:

• Antidepressants
• Anticonvulsants
• Local anesthetics
• Corticosteroids
• Bisphosphonates and denosumab

If pain medication isn’t working, or it causes too many side effects, other treatments may be an option. Some include procedures such as treatments to shrink the tumor or nerve blocks (via an injection of numbing medicine) to block the pain stemming from a nerve in or near the spinal cord.

However, there are also many nonmedical treatment options for pain relief, including rehabilitation and integrative therapies. Integrative therapies that may be used to help relieve pain include:

• Acupuncture
• Talk therapy or support groups
• Hypnosis

Always ask your care team before trying any nonmedical treatments. They often need to be used alongside standard pain medication.