Cancer Pain

What is cancer pain?

Cancer pain is pain you may experience because you have cancer or receive cancer treatment, like chemotherapy, radiation, surgery or a combination of any of these treatments. Pain from cancer or cancer treatment may be sharp or dull, burning or throbbing. It can affect several areas of your body.

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.

Cancer pain can affect your quality of life. That’s why pain management is an essential part of cancer treatment. But 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.

Types of cancer pain

There are several types of cancer pain:

• Acute pain. You may have acute pain as you recover from cancer surgery and treatments. The pain may be mild or severe, but it goes away.
• Breakthrough pain. This 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.
• Chronic pain. Like acute pain, chronic pain may range from mild to severe. The difference is that chronic pain doesn’t go away. Chronic cancer pain may happen if cancer or treatment damages or affects nerves. Experts estimate 35% of all cancer survivors experience pain months and years after they complete treatment.
• Phantom pain. Some cancer treatment involves surgery to remove a part of your body that cancer affects. Phantom pain is when you feel pain in the part of your body that surgery removed.
• Referred pain. This 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.

What does cancer pain feel like?

Pain from cancer or cancer treatment may vary depending on why you’re hurting. For example, cancer in one of your organs may cause pain that feels different from cancer in your bones: For example:

• Bone pain may feel like a dull ache or throbbing pain.
• Joint pain may make you feel sore, stiff or achy.
• Nerve pain may feel like a burning sensation, shooting pain or tingling.
• Soft tissue pain (pain in an organ or muscles) may be sharp, cramping, throbbing or an ache.

Everyone experiences pain differently. That’s why it’s important to tell your cancer care team when you have pain, where it hurts and how it feels.

What are the most common causes of cancer pain?

Cancer pain happens for many reasons. Some common causes are:

• Medical tests, like a biopsy or spinal tap to diagnose cancer
• A cancerous tumor pressing on tissues, bones or nerves
• Side effects from cancer treatment — for example, you may have bone pain if you receive cancer medication that helps your body make more white blood cells

How do healthcare providers treat cancer pain?

Managing cancer pain is a very important part of treating cancer. Healthcare providers may use medication, medical procedures or surgery to ease pain from cancer or cancer treatment.

To treat cancer pain, providers take time to understand your pain. They may ask:

• How much it hurts. They may ask you to describe your pain on a scale of 0 to 10, with 10 representing extreme pain.
• What it feels like. Cancer pain may be an ache, throbbing pain or sharp pain.
• Where it hurts. Knowing what area of your body hurts the most helps providers determine what may be causing your pain.
• How it affects your quality of life. Cancer pain can disrupt your daily routine. Sharing the ways that cancer pain may affect your daily routine gives your care team important perspective.

Your care team may suggest you keep a pain record. Your team will make suggestions, but some things you may note include when you take pain medicine and how long it works. Tracking how pain affects you will help your team develop a detailed cancer care plan. Following the plan may help you feel confident that you can control pain instead of the pain controlling you.

What are common cancer pain treatments?

Cancer pain treatments target the source of pain. That’s why your cancer care team will ask you to tell them where it hurts. For example, you may have pain from a tumor pressing on your nerves. In that case, your team may recommend chemotherapy to shrink the tumor. Other treatments are pain medication and medical procedures to block pain signals or ease pain.

Medication to reduce or stop cancer pain

Your cancer care team may use several different pain medications, including nonopioids like acetaminophen or NSAIDs (nonsteroidal anti-inflammatory drugs). Cancer care providers often prescribe opioids for cancer pain, including:

• Buprenorphine buccal film (Belbuca^®)
• Buprenorphine transdermal patch (Butrans^®)
• Buprenorphine (Suboxone^®)
• Fentanyl skin patch (Duragesic^®)
• Hydrocodone (Vicodin^®)
• Hydromorphone (Dilaudid^®)
• Methadone (Dolophine^®)
• Oxycodone (Oxycontin^®, Percocet^®)
• Morphine (MS Contin^®)

Some pain medications may make you feel confused, woozy or drowsy. If that’s your situation, talk to your healthcare provider. They may recommend changing your dosage or using another type of medication.

Other medications

Healthcare providers may prescribe additional medications that may help with cancer pain or reduce side effects of cancer pain medications. These may include:

• Anticonvulsants. Medications like gabapentin (Neurontin^®) and pregabalin (Lyrica^®) may help ease nerve damage pain.
• Corticosteroids. These medications may reduce inflammation and bone pain. Examples are dexamethasone and prednisone help with inflammation and bone pain.
• Depression medications. Medications like duloxetine (Cymbalta^®) and venlafaxine (Effexor^®) may ease nerve damage pain.
• Laxatives. Opioids may cause constipation. Taking laxatives may keep constipation under control.
• Neurostimulants. Amphetamines and other non-amphetamine options may help with opioid side effects like drowsiness.

Medication can ease cancer pain. But you may wonder if taking pain medication will make you feel out of control or confused. If you take prescription opioids for pain, you may worry that you’ll develop opioid use disorder. You may be concerned you’ll become dependent on other cancer pain medications.

Your cancer care team will understand those concerns. They’ll help you manage pain while reducing any risk of addiction or dependency. Talk to them about how to use your pain medication safely.

Medical procedures that block pain signals

Several medical procedures block pain. These include:

• Nerve block. This treatment involves injecting medication close to a specific nerve or group of nerves. It treats pain in your back, legs, arms, butt, neck and face.
• Pain pumps (intrathecal catheters). The pumps deliver pain medication to your spinal fluid through an implant that a surgeon places in your lower spine.
• Peripheral nerve stimulators (PNS). Cancer surgery may cause nerve pain that you feel when your peripheral nerves send messages to your brain that it interprets as pain. Stimulators work by blocking those messages. A stimulator is a small electrode that’s placed on your peripheral nerve. The electrode carries an electrical current around your nerve, or spinal cord.
• Radiofrequency ablation. This involves radio waves that heat a section of the nerve that sends pain signals to your brain.

What are the possible complications or risks of not treating cancer pain?

Cancer pain may have a major impact on your quality of life. It can make it hard to sleep. It can affect your appetite. Coping with pain may make you feel weak, so you can’t work or manage your daily routine. Without cancer pain treatment, you may develop anxiety or depression.

But it’s not unusual for people to be reluctant about asking for cancer pain treatment, particularly if treatment involves opioid medication. Fear of opioid use disorder or becoming dependent on medication is a common concern. There are other reasons why someone may not ask for cancer pain support, like:

• They think asking for help with cancer pain treatment may distract their care team from cancer treatment.
• They rely on their care team to determine the appropriate type and amount of cancer pain care treatment.
• They have cancer pain that’s getting worse and are afraid that means cancer is getting worse.

Cancer care providers understand why you may have these questions or concerns. It’s important to remember that treating cancer pain is part of cancer treatment. Don’t hesitate to tell your care team if you have pain that’s more severe than you expect or that’s getting worse.

When should cancer pain be treated by a doctor or healthcare provider?

You should contact your cancer care team if you:

• Have breakthrough pain. This is sudden, severe pain that your prescription pain medication can’t manage.
• Can’t “stay ahead” of the pain. This can happen if something makes your pain worse. For example, a tumor that starts to press on a nerve may cause pain that your current medication doesn’t ease.
• Have issues with medication side effects. Cancer pain medication may be stronger than you expect.

What cancer causes the most pain?

That’s hard to say. Pain is very personal. One person’s mild pain may be moderate pain for someone else. That said, one analysis indicates that pancreatic cancer causes the most pain. Data shows that 83% of people with pancreatic cancer experience moderate to severe pain.

Are there alternative or complementary cancer pain treatments

According to the National Center for Complementary and Integrative Health, treatments such as acupuncture and hypnosis may ease some types of cancer pain or painful cancer treatment side effects.

These treatments aren’t substitutes for medical cancer pain treatment. If you have cancer, talk to your healthcare providers before starting any type of alternative or complementary treatment for cancer pain.

What can I do at home to treat cancer pain?

Taking your pain medication as prescribed is one of the most important things you can do at home to manage cancer pain. That means you should take your full dose as scheduled. Here are other suggestions:

• Warm packs and heating pads. Packs and pads may stop muscle spasms, encourage circulation and make you feel more comfortable. You can apply heat for 10 or 20 minutes at a time. But you shouldn’t apply heat to areas where you have tumors or where you had radiation treatment.
• Cold packs. Ice or cold packs wrapped in cloth may help with inflammation and nerve pain. Like heat, you can apply cold packs for 10 to 20 minutes at a time.