Cancer pain

Not everyone with cancer will have pain. Those who do experience pain may not be in pain all the time. It may come and go.

During cancer treatment, about six out of ten people (55%) say they experience some degree of pain. After treatment, about four out of ten people (39%) say they experience pain. People with advanced cancer are more likely to have pain. Advanced cancer is cancer that has spread from its original site or has come back. Nearly seven out of ten people with advanced cancer (66%) have pain.

Some people with cancer have pain caused by the cancer itself, by the cancer treatment, or by other health issues not related to cancer, such as arthritis. Pain can be experienced at any stage of the disease.

Before diagnosis – Cancer can cause pain before a diagnosis and the pain may come and go. In some cases, pain comes from the tumour itself, e.g. abdominal pain from the tumour pressing on bones, nerves or organs in the body.

Diagnosis – Tests to diagnose cancer can sometimes cause short-term pain or feel uncomfortable, e.g. you may need surgey to remove a sample of tissue for examination. Most pain caused by tests can be relieved.

During treatment – Some treatments cause pain, e.g. surgery; radiation therapy leading to skin redness and irritation; and cancer drug therapies such as chemotherapy, targeted therapy and immunotherapy leading to numbness and tingling in hands and feet (peripheral neuropathy).

After treatment – Pain may continue for months or years. Causes include scars after surgery; numbness in the hands or feet (peripheral neuropathy); swelling caused by a build up of lymph fluid (lymphoedema); and pain in a missing limb or breast.

Advanced cancer – If the cancer has spread, it can cause pain by a tumour pressing on a part of the body such as a nerve, bone or organ.

There are many types of pain. Pain can be described or categorised depending on how long the pain lasts or what parts of the body are affected.

Acute pain – This is pain that starts suddenly and lasts a short time, possibly for a few days or weeks. It may be mild or severe. Acute pain usually occurs because the body is hurt or injured in some way, but it generally disappears when the body has healed.

Chronic pain – This is pain that lasts longer than three months. It may be due to an ongoing problem, but can also develop after any tissue or nerve damage has healed. It is also called persistent pain.

Breakthrough pain – This is a sudden flare-up of pain that can occur despite taking regular pain medicine for cancer pain. It may happen because the dose of medicine is not high enough or because the pain changes when the person changes position or moves around. Other causes of breakthrough pain include stress, anxiety or other illnesses.

Nerve (neuropathic) pain – This is pain caused by pressure on nerves or the spinal cord, or by nerve damage. It can come and go. People often describe nerve pain as numbness, burning or tingling, or as “pins and needles”. Nerve pain can occur anywhere nerves get damaged. For example, after breast surgery, some women have nerve pain in the chest wall or armpit that doesn’t go away over time. This is called post-mastectomy pain syndrome.  Nerve damage from some chemotherapy drugs is felt as pain in the hands and feet and is called peripheral neuropathy.Download our fact sheet ‘Understanding Peripheral Neuropathy and Cancer’

Bone pain – This is pain caused by cancer spreading to the bones and damaging bone tissue in one or more areas. It is often described as dull, aching or throbbing, and it may be worse at night.

Soft tissue pain – This is pain caused by damage to or pressure on soft tissue, including muscle. The pain is often described as sharp, aching or throbbing.

Visceral pain – This is pain caused by damage to or pressure on internal organs. Visceral pain can be difficult to pinpoint. It may cause some people to feel sick in the stomach (nauseous). This type of pain is often described as having a throbbing sensation.

Referred pain – This is pain that is felt in a different area of the body from the area that is damaged (e.g. a swollen liver can cause pain in the right shoulder because the liver presses on nerves that end in the shoulder).

Localised pain – This is pain at the spot where there’s a problem (e.g. pain in the back from a tumour pressing on nerves in the area).

Phantom pain – This is a pain sensation in a body part that is no longer there, such as breast pain after the breast has been removed. This type of  pain is very real.

As well as the physical cause of the pain, your environment, fatigue levels, emotions and thoughts can affect how you feel and react to pain. It’s important for your health care team to understand the way these factors affect you.

Where you are – Things and people in your environment – at home, at work and elsewhere – can have a positive or negative impact on your experience of pain.

How you feel – You may worry or feel easily discouraged when in pain. Some people feel hopeless, helpless, embarrassed, angry, inadequate, irritable, anxious, frightened or frantic. You may notice your mood changes. Some people become more withdrawn and isolated.

How tired you feel – Extreme tiredness (fatigue) can make it harder for you to manage pain. Lack of sleep can increase your pain. Ask your health care team for help if you are not sleeping well.

What you’re thinking – How you think about pain can affect how you experience the pain, e.g. whether you believe it is overwhelming or manageable.

The way cancer pain is managed depends on the cause of the pain, but relief is still possible even if the cause is unknown. Often a combination of methods is used. Options may include:

• medicines specifically for pain
• surgery, radiation therapy and cancer drug therapies
• procedures to block pain signals such as nerve blocks or spinal injections
• other therapies, such as physiotherapy, psychological support and complementary therapies
• pain management plans.

It might take time to find the right pain relief for you, and you may need to continue taking pain medicines while waiting for some treatments to take effect.

Different pain relief methods might work at different times, so you may need to try a variety. The World Health Organization estimates that the right medicine, in the right dose, given at the right time, can relieve 80–90% of cancer pain.

If you have a new pain, a sudden increase in pain or pain that doesn’t improve after taking medicines, let your doctor or nurse know. Like a cancer diagnosis, pain that is not well controlled can make you feel anxious or depressed.

The aim is for pain to be continuously controlled. You should take your pain medicine as prescribed. Sometimes this means taking pain medicine even when you don’t feel pain. If pain lasts longer than a few days without much relief, or you notice you are in more pain than usual, see your doctor. It’s better to get relief early rather than allowing it to get worse. This makes it easier to control and means you are likely to have less pain overall.

Your doctor will talk to you about how much medicine to take (the dose) and how often to take it (the frequency).

Many people believe that they should put up with pain for as long as possible and that they should only use pain medicines when pain becomes unbearable. If you do this, it can mean that you are in pain when you don’t need to be.

There is no need to save pain medicines until your pain is severe. Severe pain can cause anxiety and difficulty sleeping. These things can make the pain feel worse and harder to control.

If you think your pain medicine isn’t working or the pain returns before the next dose, it’s important to let your doctor know. They may need to adjust the dose, prescribe a different medicine or give an extra dose of medicine.

If the pain doesn’t improve the first time you use a new pain relief method, try it a few more times. If you’re taking medicine that doesn’t seem to work or has stopped working, talk to your doctor – don’t change the dose yourself.

Different health professionals help manage pain. They will often discuss ways to manage pain at a multidisciplinary team (MDT) meeting. If your pain is not well controlled, ask your general practitioner (GP) or palliative care specialist for a referral to a pain medicine specialist who is part of a  multidisciplinary pain team.

Health professionals you may see

general practitioner (GP) – assists with treatment decisions; provides ongoing care in partnership with specialists

surgeon – surgically removes tumours from the body

radiation oncologist – treats cancer by prescribing and overseeing a course of radiation therapy

medical oncologist – treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy (systemic treatment)

palliative care specialist – treats pain and other symptoms to maximise wellbeing and improve quality of life

pain medicine specialist – treats all types of pain, particularly ongoing pain or pain that is difficult to control

pain management team – includes pain specialist and nurses who work together to treat pain, particularly if it is difficult to control

nurse practitioner – works in an advanced nursing role; may prescribe some medicines and tests

nurse – administers drugs and provides care, information and support

pharmacist – dispenses medicines and gives advice about dosage and side effects

anaesthetist – provides anaesthetic medicines, monitors you during surgery, and provides pain relief during and after surgery

physiotherapist – helps with restoring movement and mobility, and preventing further injury

exercise physiologist – prescribes exercise to help people with medical conditions improve their overall health, fitness, strength and energy levels

occupational therapist – assists in adapting your living and working environment to help you resume usual activities

psychologist – helps identify and manage the thoughts, emotions and behaviours that affect your pain

counsellor – helps you understand and manage your emotional response to diagnosis and treatment, usually in the short term

social worker – helps with emotional, practical or financial issues