Cancer Pain

What is cancer pain?

Cancer pain is pain from cancer or cancer treatment. Not everyone who has cancer has pain, but most people with cancer are likely to experience pain. Studies show pain is one of the most common and most feared symptoms of cancer.

Cancer pain may be mild, moderate or severe. It may take several forms, such as feeling like a sharp stabbing pain that comes and goes, a tingling or burning sensation or a persistent ache.

Cancer pain affects your quality of life. It can make certain cancer symptoms and treatment side effects feel worse. It may increase your risk of developing depression and anxiety. That’s why pain management is an essential part of cancer treatment.

What kind of pain could you have if you have cancer?

Pain is personal, meaning what’s painful for one person may not be painful for another person. Some pain happens when cancer affects your bones, nerves and soft tissues. Some people with cancer have what providers call “phantom pain” or “referred pain.” Types of cancer pain include:

• Bone pain: Bone pain from cancer may feel like a dull ache or throbbing pain.
• Nerve pain: Nerve pain happens if a cancerous tumor puts pressure on your nerves or spinal cord. Nerve pain may also happen if cancer treatment damages your nerves. Nerve pain may feel like a burning sensation, shooting pain or tingling. Nerve pain may be more difficult to manage than other types of cancer pain.
• Soft tissue pain: Cancer that affects your organs or soft tissues may cause sharp pain, cramping pain, throbbing pain or an ache. “Soft tissue” is a medical term for the parts of your body that help connect, support or surround your bones and internal organs. Soft tissue may include your tendons, muscles, skin and fat.
• Phantom pain: Phantom pain is pain in a part of your body that’s been surgically removed to eliminate a cancerous tumor. For example, people who have a mastectomy may feel pain where their breast used to be.
• Referred pain: You may notice pain in one area of your body that’s caused by cancer in another area of your body. For example, cancer in your liver may make it swell and press on nerves that cause right shoulder pain.

What are the most common causes of cancer pain?

Cancerous tumors that are growing or spreading in parts of your body often cause cancer pain. For example, a tumor that spreads to your bones may put pressure on your nerves, causing painful nerve damage. A tumor growing in your pancreas may stretch organ walls and cause pain. Other cancer pain causes include:

• Pain from cancer surgery: People often have post-surgical pain if they needed surgery to remove a cancerous tumor.
• Pain from cancer treatment: Cancer treatments such as chemotherapy or radiation therapy may have painful side effects. For example, someone receiving chemotherapy may have severe bouts of vomiting that can be painful. Other types of chemotherapy may cause peripheral neuropathy leading to numbness and pain in your fingers and toes.
• Breakthrough pain: Breakthrough pain is sudden severe pain that’s not controlled with the medications you’ve been prescribed.

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 of cancer pain research indicates pancreatic cancer causes the most pain. Data show 72% of people with pancreatic cancer reported cancer pain. Between 80% and 100% of people with advanced cancer reported cancer pain.

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

• Describe your pain: For example, they may ask you to think about your pain on a scale of 0 to 10, with 10 representing extreme pain. They may ask if your pain is sharp, throbbing or an ache.
• Tell them where it hurts: Knowing what area of your body hurts the most helps providers determine what may be causing your pain.
• Tell them when it hurts: For example, they may ask if specific activities bring on pain.

It’s important to remember that no one expects you to “put up” with your cancer pain. Telling your healthcare provider that you’re in pain isn’t a sign of weakness.

It’s easier to control pain when it starts rather than waiting until your pain is more severe. (Providers call this “staying ahead of pain.”)

If you have pain, don’t hesitate. Speak up when you’re hurting so your providers can help you. They’ll work with you to develop a plan that minimizes the impact pain may have on your daily life and that best manages your pain.

What are common cancer pain treatments?

That depends on the source of your pain. For example, you can have pain from a tumor pressing on nerves or an organ wall. If that’s your situation, your provider may use chemotherapy or radiation therapy to shrink the tumor. They may also do surgery to remove the tumor, eliminating the pain. Other treatments include medication to stop or reduce pain, medical procedures to block pain signals and neurological surgery techniques.

Neurological surgical techniques for cancer pain

Neurological surgery techniques may include:

• Pain pumps: A pain pump is a catheter placed in your lower spine that delivers pain medication directly to your spinal fluid. This treatment eases pain without causing some of the side effects, such as drowsiness or constipation, which may happen when you take oral or intravenous pain medication. Pain pumps may cause side effects such as itching or retaining pee (urine).
• Stimulators: Some people may have nerve pain after surgery. In this situation, healthcare providers may use a stimulator. 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. Normally you feel pain because your nerves send messages to your brain that your brain interprets as pain. If you have a stimulator in place, the current from the electrode interrupts that messaging process. Instead of feeling pain, you may notice a tingling sensation or a sense of numbness.

Medical procedures to block pain signals

• Nerve blocks: Healthcare providers inject pain medications such as lidocaine (Xylocaine®, Xylocaine MPF®) or bupivacaine (Marcaine®, Sensorcaine®, Sensorcaine MPF ®) around the nerve that’s sending pain signals. Providers typically use nerve blocks for pain in your back, legs, arms, butt, neck and face.
• Radiofrequency ablation: This procedure uses heat to destroy tissue. It treats pain by sending radio waves through a precisely placed needle to heat an area of the nerve. The heat keeps your nerve from sending pain signals to your brain.
• Epidural catheters: Similar to a pain pump, epidural catheters deliver pain medication that keeps your nerves from sensing pain. To place an epidural catheter, providers implant a very thin flexible tube into the epidural space in your spine. The catheter delivers ongoing doses of pain medication.

Medication to reduce or stop cancer pain

Healthcare providers may use several different pain medications to stop or reduce cancer pain:

Non-opioid pain medication

These medications include:

• Acetaminophen.
• Nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen.

Opioid pain medication

Opioids may include:

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

Opioid side effects

Your healthcare provider may prescribe opioids to help ease your cancer pain. You may worry about opioid use disorder or becoming dependent on other cancer pain medications. You may wonder if taking cancer pain medication will make you feel out of control or confused. These are common concerns:

• Addiction to opioids: Your provider monitors your pain and your medication, working to reduce risk of addiction while managing your pain. Ask them how to use your pain medication safely. Remember that pain is easier to treat before it becomes severe, so take your prescribed pain medication as directed.
• Pain medication side effects: 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 the side effects of cancer pain medications. These medications may include:

• Stimulants: These drugs help with opioid side effects. Amphetamines can be highly addictive, so you should avoid taking more than your prescribed dose.
• Anticonvulsants: Cancer and cancer treatments may cause nerve damage. Anticonvulsants such as gabapentin (Gabarone®) and pregabalin (Lyrica®) may help ease nerve damage pain.
• Depression medications: Like anticonvulsants, depression medications such as duloxetine (Cymbalta®, Drizalma®, Irenka®) and venlafaxine (Effexor®) may help with nerve damage pain.
• Corticosteroids: Steroids such as dexamethasone and prednisone help with inflammation and bone pain.
• Laxatives: Opioids may cause constipation.

What are 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?

Applying heat and/or cold may help cancer pain:

• Apply heat: Warm packs and heating pads may help ease muscle spasms, encourage circulation and make you feel more comfortable. You can apply heat for 10 or 20 minutes at a time. (If you had radiation therapy, don’t apply heat to your treatment sites. You should also avoid applying heat to areas where you have tumors.)
• Apply cold: 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.

When should I call a healthcare provider for cancer pain or pain medication side effects?

Cancer pain can be hard to manage. It’s important that you take medication as prescribed to avoid severe pain. You should call your healthcare provider if:

• You have breakthrough pain. This sudden and severe pain isn’t controlled with the medications your healthcare provider has prescribed.
• You’re taking pain medication as prescribed but feel like you’re having trouble staying ahead of your pain.
• Your cancer pain medication side effects are stronger than you expect.