- How Cancer Causes Pain and What to Do About It
- Pain: Causes and Diagnosis
- Causes of pain
- Diagnosing pain
- Managing and treating pain
- Related Resources
- More Information
- Why it Hurts: Researchers Seek Mechanisms of Cancer Pain
- Modeling Cancer Pain
- From Bones to Brain
- The New Painkillers
- Facts About Cancer Pain
- How might pain affect people with cancer?
- Can cancer pain be relieved?
- What causes pain in people with cancer?
- Pain from the cancer itself
- Pain from cancer surgery, treatments, and tests
- What Can I Do About Cancer Pain? What Are the Treatments?
- Is Cancer Painful? Tumors, Tests & Treatment
- Surgical pain
- Side effect pain
- Testing pain
- Acute pain
- Chronic pain
- Breakthrough pain
How Cancer Causes Pain and What to Do About It
KatarzynaBialasiewicz / Getty Images
Many people ask the question, “Does cancer hurt?” The answer to this question is not simple for many reasons. There are many different types of cancer pain, and these may all be experienced in different ways. Some people with cancer will have a lot of pain, whereas others experience minimal pain.
To understand cancer pain it's important to look at the different ways that cancer may cause pain, the factors that can affect the degree of pain, and more.
It's also important to learn about how to communicate with your doctor about pain so that you receive the best pain relief possible with the fewest side effects.
There are many variables that affect whether a cancer (or treatments for cancer) cause pain, and how severe that pain will be. Some of these include:
- The Stage of the Cancer: When cancer is in the early stages, many people do not experience pain. In fact, this is one of the reasons that some cancers, such as pancreatic cancer, are often diagnosed only after their cancer has spread and become inoperable. For example, a breast cancer detected only on a mammogram may not cause any discomfort, whereas a stage 4 breast cancer may cause a lot of pain due to bone metastases or other mechanisms.
- The Type of Cancer: Some cancers are more ly to cause pain than others, though pain can occur with any form of cancer. Two people with the same type and stage of cancer may have completely different pain experiences. This does not mean that one person has a high pain tolerance and the other a low tolerance. Instead, as we will note, there are many ways that cancer can cause pain, and these can vary significantly even among similar-appearing cancers.
- Pain Tolerance: Pain tolerance varies considerably among different people, and even between different locations or types of pain experienced by an individual. Pain tolerance is defined as the amount of pain a person can handle before breaking down physically or emotionally. Pain threshold, in contrast, is defined as the point at which a sensation becomes painful. Whether a sensation is interpreted as painful is determined by genetic makeup, history of pain, and medical conditions among other factors. It is not right or wrong to experience pain. In fact, one of the reasons people forego pain medications during cancer treatment which could improve quality of life is the desire to “be a good patient” and appear “strong.”
- Conditions in Addition to Cancer: Doctors use the term “co-morbidities” to describe additional medical conditions that may be affecting a person with cancer, and these co-morbidities are very important to consider when evaluating pain. Not all pain experienced by people with cancer is due to cancer or cancer treatments. For example, someone with lung cancer may also experience pain due to arthritis or degenerative disc disease.
- Cancer Treatments: Many of the treatments for cancer such as surgery, chemotherapy, and radiation therapy can cause pain. In the early stages of cancer, the pain due to treatments may be worse than pain due to cancer itself.
When cancer is in the early stages, especially those cancers that are detected on screening exams, there may be very little pain. For people with advanced cancer, however, the majority of people experience moderate to severe pain at some point in their journey.
There are several ways that cancer or treatments for cancer can cause pain. It's important to identify these causes, as the most effective treatments can vary depending on the type of pain.
For example, neuropathic pain may not respond to medications that are used for pain caused by the growth of a tumor in a particular region.
For bone pain, there are specific medications (bone-modifying therapies) that may be effective, but these will not reduce pain due to other causes. Some types of cancer pain include:
- Growth of a Tumor Causing Compression of Nearby Structures: Cancer can cause pain by compressing organs and nerves adjacent to the tumor.
- Metastases to Other Organs: Spread (metastases) of cancers to other regions of the body can cause pain.
- Bone metastases: The spread of cancer to bones can be very painful. While some pain medications may be used to control pain caused in a number of different ways by cancer, pain related to bone metastases is often addressed locally, through radiation or bone-modifying medications.
- Substances Secreted by the Tumor: Some cancers actually secrete proteins that can cause pain. Examples include some of the paraneoplastic syndromes seen with small cell lung cancer and squamous cell lung cancer.
- Neuropathic pain: Neuropathic pain is usually severe pain, and may be caused by the pressure of a tumor on nerves, due to chemotherapy (especially drugs such as Taxol) and radiation therapy. There is currently a lot of research looking at treatments for peripheral neuropathy caused by chemotherapy.
There are several terms that doctors use to describe pain in people with cancer, and this can be confusing. Learning about these descriptions, as well as how to describe and rank your pain, will help your physician have a better grasp on how to best control your pain.
- Acute pain is caused by something specific and often comes on rapidly. It may last only a few moments or go on for a while, but does not last longer than six months.
- Chronic pain is pain that is ongoing and usually lasts for longer than six months.
- Breakthrough pain is pain that you feel despite your pain treatment regimen (in other words, is not controlled by the pain medication you are using).
- Referred pain is pain that is felt in an area away from the actual source of the pain, for example feeling shoulder pain during a gallbladder attack.
- Phantom pain is pain that is felt in a region of the body that isn't there. For example, feeling pain in your leg after an amputation for sarcoma, or feeling pain in your nipple or your “breast” after a mastectomy.
Other ways that pain is characterized include the:
- Severity: Is the pain barely there, or is it the worst pain imaginable?
- Quality: What does the pain feel ? Is it achy, sharp, dull, gnawing, stabbing, or burning?
- Frequency: How often does the pain occur, or is it constant?
- Location: Where do you feel the pain?
- Modifying factors: What makes it worse and what makes it better?
- Effect on quality of life: How does the pain affect your daily activities?
- Effect on sleep: How does the pain affect your sleep? Do you have difficulty falling asleep, or does the pain awaken you during the night?
In order to understand objectively how severe your pain is (and to monitor how well pain medication and other forms of pain relief are working,) doctors often use pain scales. The simplest of these is done by asking you how you would rate your pain on a scale of 1 to 10, with 1 being pain that you barely notice, and 10 being the worst pain you can imagine.
Though many people with cancer harbor fears about pain, pain management for cancer, even for people with advanced cancer, has progressed significantly in the past few decades.
The majority of people with cancer can now experience adequate pain management throughout their treatment.
That said, physicians can't read minds, and can only meet the pain management needs of patients if they are made aware of the pain and its severity.
Studies suggest that a-third-to-half of people with cancer do not receive adequate treatment of pain. The reasons are many, but some include:
- The reluctance of physicians to prescribe narcotic pain medicines.
- The desire to be a “good” patient.
- Fear of becoming addicted: While people with cancer often develop a tolerance to pain medications, meaning that it takes a larger dose to achieve the same level of pain relief, it is uncommon for someone with cancer to become “addicted” to these medications.
- Lack of access: There are many ways in which a lack of access can affect pain control, ranging from the reluctance of some physicians to prescribe opioids, to a lack of physician understanding of pain management, to a person's inability to afford pain medications.
- Fear that if pain medication is used now, it will not be effective later “when you really need it.” This is not true, and there are many options for pain control. These include not only pain medications, but radiation, nerve blocks, and more.
Taking an active role in your medical care can help ensure you get the best possible treatment for your pain as well as other symptoms, with cancer.
Pain: Causes and Diagnosis
People with cancer commonly experience pain. However, up to 95% of cancer pain can be treated successfully. Untreated pain can make other aspects of cancer seem worse. These include:
- Shortness of breath
- Sleep disturbances
- Mental confusion
Causes of pain
Pain can come from the tumor itself, the cancer treatment, or causes unrelated to cancer. A good pain treatment plan will take care of pain from all causes.
The tumor. A tumor growing in an organ, such as the liver, may stretch part of the organ. This stretching causes pain.
If a tumor grows and spreads to the bones or other organs, it may put pressure on nerves and damage them, causing pain. Or if a tumor spreads or grows around the spinal cord, it can compress the spinal cord.
This eventually leads to severe pain or paralysis if not treated.
Surgery. It is normal to experience pain from cancer surgery. Most pain goes away after a while. But some people may have pain that lasts for months or years. This long-lasting pain can be from permanent damage to the nerves and the development of scar tissue.
Radiation therapy. Pain may develop after radiation therapy and go away on its own. It can also develop months or years after radiation therapy to some parts of the body, such as the chest, breast, or spinal cord.
Chemotherapy. Some chemotherapy can cause pain and numbness in the fingers and toes, called peripheral neuropathy. Usually this pain goes away when treatment is finished. But sometimes the damage is permanent.
Learn more about the side effects of surgery, radiation therapy, and chemotherapy.
Other causes. People with cancer can still have pain from other causes. These include migraines, arthritis, or chronic low back pain. The treatment plan your health care team develops with you should include these kinds of pain. Any pain decreases your quality of life.
You know your pain best. So it is important to discuss any new symptoms or a change in symptoms with your doctor or a pain specialist. They can help you find a medication or other pain relief method that works for you.
To help your doctor better understand your pain, he or she may ask the following questions:
- Where does it hurt?
- When does the pain stop and start?
- How long has the pain been there?
- How much pain are you having on a scale of 0 to 10?
- What does the pain feel , in your own words? For example, is it burning, stabbing, throbbing, or aching?
Managing and treating pain
Some people worry that pain medication is addictive or will make them sleepy or groggy. But there are many ways to manage and treat cancer pain, including medication and methods that don't use medication. Talk with your doctor to find the best treatment for your pain.
ASCO Answers: Managing Pain
What is Palliative Care?
LIVESTRONG: Chronic Pain
National Cancer Institute: Cancer Pain
Download ASCO’s free booklet, Managing Cancer-Related Pain in English and in Spanish.
This 36-page printable PDF provides information about the importance of pain relief, including its causes, how it is diagnosed, and types of pain-relief strategies.
It also includes a pain tracking sheet to help patients record how pain affects them. Order printed copies of the booklet in English from the ASCO Store.
Why it Hurts: Researchers Seek Mechanisms of Cancer Pain
Pain is universal, but cancer pain is particularly vicious. “Cancer patients have a bond that surpasses a healthy person’s understanding,” prostate cancer patient Cornelius Ryan, a prominent historian, wrote in his journal.
“The presence of fear and the agony of pain are transmitted without words … . My young friend [with lung cancer] wanted to die. [She] was being crucified by pain she could no longer endure. Now she is one more statistic.
”* The following year Ryan, in constant agony from bone metastases to his hips and legs, also died from his cancer.
While acknowledging the severity of cancer pain, doctors—until a few years ago—did not view it as fundamentally different, in terms of neurophysiology, from other kinds of pain.
Cancer pain was thought to be caused by the growing tumor mass compressing or infiltrating soft tissue, pressing on peripheral nerves, and sometimes cutting off blood flow to defined areas of tissue.
But doctors and neuroscientists knew next to nothing about the molecular and biochemical sources of this cancer pain and had little to go on. Cancer pain seemed no different than ordinary pain, except in degree.
“Most clinicians and researchers failed to consider the basic mechanisms that underlie cancer pain,” said University of Minnesota neuroscientist Alvin Beitz, Ph.D. The situation is now beginning to change as new knowledge of the mechanisms of cancer pain emerges. This work, in turn, is leading to a new generation of rationally designed painkillers.
Modeling Cancer Pain
Two mouse models of cancer pain developed in the late 1990s at the University of Minnesota started everything.
In one model, cancer cells are injected into the leg of the mouse, and the injection hole is then plugged to prevent the growing tumor from escaping into soft tissue.
The other model involves generating a tumor in the mouse’s foot and allowing tumors to spread to the surrounding soft tissue. Various neurochemical studies have been performed using both models with some striking and unexpected results.
Un other forms of pain, the number of astrocytes in the spinal cord rises dramatically in mouse models of cancer pain. Astrocytes are glial cells, one of the two main types of cells in the brain and spinal cord (the other being nerve cells, or neurons), and they perform a variety of nerve cell support functions.
In cancer pain models, “you get a tremendous number of [astrocytes],” said Beitz. “Then they communicate with one another and with nerve cells and really alter what the nerve cells are doing, and that probably leads in part to the development of chronic pain.”
Cytokines, small messenger proteins secreted by astrocytes, are probably the immediate cause of the pain. Profound astrocyte proliferation is unique to cancer pain, and is probably one of the things that makes it so severe.
Another contributor to cancer pain is acidosis, the creation of an acidic environment around the tumor. Tumor cells have a pH around 6.8, as opposed to 7.4 for a normal cell, and this acidic environment can be painful in itself.
“It’s thought that, when the tumor cells lyse, they can also stimulate acid-sensing ion channels,” said University of Minnesota neuroscientist Patrick Mantyh, Ph.D. The opening of such ion channels electrically depolarizes neurons, causing them to fire and transmit pain signals.
From Bones to Brain
The pain is worst when cancer spreads to bone, as it often does in many common cancers. “Almost everybody who’s dying of either breast cancer or prostate cancer has bone metastases,” said Gregory Mundy, M.D., professor of cellular and structural biology at the University of Texas Health Science Center in San Antonio.
As bone metastases spread, cells called osteoclasts break down bone tissue. (In prostate cancer this bone resorption occurs together with new bone formation.) Osteoclasts generate a highly acidic environment to degrade bone.
The pH at the osteoclast–bone interface is between 4 and 5, “a thousand times lower than what you’ll see in a normal cell,” Mantyh pointed out, and this profound acidosis opens other ion channels, firing nerves and generating pain signals.
Visceral pain is another hallmark of cancer. It occurs, for example, when tumors cause a bowel obstruction or enlarge the liver capsule. “Visceral pain can be very disturbing to the patient,” said Mantyh. “It has a real strong affective component.
” Neurosurgeons at the University of Texas Medical Branch in Galveston have shown that a separate pathway exists for the transmission of visceral pain from the spinal cord to the brain.
But fuller knowledge of visceral pain mechanisms awaits the creation of a rodent model.
Neuropathic pain, pain caused by nerve damage, is also poorly understood in cancer. “Close to half of patients with advanced cancer and cancer pain have some form of neuropathic pain,” said neurologist Paolo Manfredi, M.D., a pain specialist at the Memorial Sloan-Kettering Cancer Center in New York.
Neuropathic pain in cancer patients is layered on top of the initial “tumorigenic” pain, caused by growth factors released by the tumor, and inflammatory pain, generated by the infiltration of inflammatory cells. “You really have three pains in one,” said Mantyh.
“It’s probably why cancer pain is more difficult to treat.”
The New Painkillers
But researchers are making progress in understanding the tumorigenic component, and this may soon lead to new pain treatments. In 1995, Joel Nelson, M.D., at Johns Hopkins Hospital in Baltimore, showed that prostate cancer cells secrete a peptide called endothelin-1.
Three years later, neurologist Gudarz Davar, M.D., at Brigham and Women’s Hospital in Boston, demonstrated that endothelin-1 caused pain in animals via endothelin-A receptors.
Two years ago, Laura Eikmeier, a researcher in Beitz’s laboratory, blocked pain in mice by injecting endothelin receptor antagonists directly into tumors, and Davar worked out the mechanism.
“You block the endothelin-A receptor, you block the endothelin-1 signal,” said Davar, who believes that this signal opens a sodium ion channel in nerve cells that leads to pain transmission.
Interest in endothelin-1 is not merely academic. An endothelin-A receptor antagonist, Abbott Laboratories’ Atrasentan, is showing promise as an effective painkiller in cancer patients.
Although a phase III trial was halted in February because of a lack of anticancer efficacy, Atrasentan did show efficacy for pain. “Some patients will get reductions in their pain—significant reductions,” noted Davar.
Phase II and III trials of Atrasentan in patients with prostate cancer are ongoing.
Other bone cancer treatments may be on the way newly identified molecular pathways. One reason so many tumors metastasize aggressively in bone is the presence of growth factors that stimulate their proliferation.
Tumors “love to grow in bone marrow—adore it,” said Mundy. “It’s fertilizer to them.
” Tumors in bone, particularly in breast cancer, express parathyroid hormone-related peptide (PTHrP), which activates osteoclasts, perpetuating a vicious cycle of bone resorption and tumor growth.
But the cycle can be interrupted. For example, Chugai Pharmaceuticals has an anti-PTHrP antibody in phase III clinical trials for bone metastases, and Amgen is testing osteoprotegerin, a soluble receptor for RANK ligand, which is in early clinical trials.
(RANK ligand signaling leads to osteoclast differentiation and activation.) Mantyh’s laboratory was the first to show, in 2000, that osteoprotegerin reduced pain-related behavior in mice with bone tumors.
Although bisphosponates, which inhibit osteoclast activity and have analgesic effects, have been on the market for more than a decade, osteoprotegerin is “probably more powerful,” said Mundy.
An extremely popular, though completely unpublicized, experimental approach to treating pain in general—including cancer pain—is to directly target ion channels. Classic work in the 1950s by Alan Hodgkin, Sc.D., and Andrew Huxley, Sc.D.
, of Trinity College, Cambridge, demonstrated that the movement of ions through channels in the nerve cell membrane depolarizes the nerve cell and causes it to fire. This leads to the release of neurotransmitters at the nerve ending and impulse transmission to connecting nerve cells, and ultimately the brain.
Pain is one such impulse, with neuropathic pain resulting from “ectopic,” or abnormal, firing of neurons, leading to a constant state of neuronal hyperexcitability in the spinal cord or brain.
Recently, a series of these ion channels have been identified and cloned. Most relevant to cancer pain are the vanilloid receptors and the acid-sensing ion channel (ASIC) receptors. In 1997, David Julius, Ph.D., of the University of California at San Francisco, cloned the first vanilloid receptor, VR1.
Although VR1 is the receptor for capsaicin, the main pungent ingredient in chili peppers, Julius and others quickly discovered that heat and acidity were also capable of opening the VR1 channel to ions, thus exciting nerves and generating pain.
Around the same time, ASIC receptors were identified by researchers at the Centre National de la Recherche Scientifique in Valbonne, France.
Because the tumor environment is acidic, and acidosis contributes to cancer pain, VR1 receptor antagonists and ASIC antagonists could be extremely effective painkillers. “Pharmaceutical companies are actively developing drugs to target … both of those ion channels,” said Mantyh.
Side effects, in theory, should be minimal, because these ion channels are mainly or exclusively found on specialized pain sensing neurons. “The expression pattern itself should limit potential side effects with this drug,” said Mantyh. “That’s why there’s such interest.” Development is at an early stage, though, so drug companies are keeping their programs under wraps.
But Mantyh knows of at least five companies already in the hunt for a VR1 receptor antagonist.
Morphine, first chemically extracted from the poppy plant in 1805, remains the principal drug for treating severe cancer pain. A new generation of treatments now seems on the verge of replacing, or at least augmenting, morphine and its derivatives. For bone pain, new drugs targeting endothelin-1, PTHrP, and osteoclast activity look promising.
And although the verdict will not be in for many years on ion channel inhibitors, their success would not only offer badly needed pain relief to cancer patients, but would validate the new molecular approach to pain.
“I’m not saying any of these is going to be the magic bullet,” said Mantyh. But, he predicted, the molecular approach will eventually bear fruit, giving doctors “real power in designing new therapies to fit the individual.
From A Private Battle, by Cornelius Ryan and Kathryn Morgan Ryan. Simon & Schuster, 1979.
Open in new tabDownload slide In bone metastases, the peptide endothelin-1 causes pain by setting off a signaling cascade that opens a sodium ion channel in pain-sensing neurons. Inhibitors to the endothelin-A receptor are now in advanced clinical trials for prostate cancer. (© 2002 by the Society for Neuroscience. Reprinted with permission.) (Source: Sep 1;:-96.)
Facts About Cancer Pain
Having cancer does not always mean having pain. But if you do have pain, you can work with your health care team to make sure a pain relief plan is part of your care. There are many different kinds of medicines, different ways to take the medicines, and non-drug methods that can help relieve it.
How might pain affect people with cancer?
Any type of pain, not just cancer pain, can affect all parts of a person's life. Some days it may be better or worse than others.
If you have pain, you might not be able to do your job well or take part in other day-to-day activities. You may have trouble sleeping and eating. You might be irritable with the people you love.
It’s easy to get frustrated, sad, and even angry when you’re in pain. Family and friends don’t always understand how you’re feeling, and you may feel very alone.
This is not unusual, so it's important to talk about your pain with your health care team so they can help.
Can cancer pain be relieved?
You should never accept pain as a normal part of having cancer. It's important to remember that all pain can be treated. Cancer pain may not always be completely relieved, but your doctor can work with you to control and lessen it as much as possible. Knowing how to report and describe it can help your health care team know how to treat it.
What causes pain in people with cancer?
The cancer itself often causes pain. The amount of pain you have depends on different factors, including the type of cancer, its stage (extent), other health problems you may have, and your pain threshold (tolerance for pain). People with advanced cancer are more ly to have pain.
Cancer surgery, treatments, or tests can also cause pain. You may also have pain that has nothing to do with the cancer or its treatment. anyone, you can get headaches, muscle strains, and other aches or pains.
Pain from the cancer itself
Pain from the cancer can be caused by a tumor pressing on nerves, bones, or organs.
Spinal cord compression: When a tumor spreads to the spine, it can press on the nerves of the spinal cord. This is called spinal cord compression.
The first symptom of spinal cord compression is usually back and/or neck pain, and sometimes it is severe. Pain, numbness, or weakness may also happen in an arm or leg. Coughing, sneezing, or other movements often make the pain worse.
If you have this kind of pain, it is considered an emergency and you should get help right away.
Spinal cord compression must be treated right away to keep you from losing control of your bladder or bowel or being paralyzed. If you’re treated for the compression soon after the pain begins, you can usually avoid serious outcomes.
Treatment for spinal cord compression usually involves radiation therapy to the area where the tumor is pressing on the spine and steroids to shrink the tumor.
Or you may be able to have surgery to remove a tumor that’s pressing on the spine, which may then be followed by radiation.
Bone pain: This type of pain can happen when cancer starts in or spreads to the bones. Treatment may be aimed at controlling the cancer, or it can focus on protecting the affected bones. External radiation may be used to treat the weakened bone.
Sometimes a radioactive medicine is given that settles in the affected areas of bone to help make them stronger. Bisphosphonates are drugs that can help make weakened bones stronger and help keep the bones from breaking. These are examples of treatments that are aimed at stopping the cause of the bone pain.
You may still need pain medicines, but sometimes these treatments themselves, can greatly reduce your pain.
Bone pain can also happen as a side effect of medicines known as growth factor drugs or colony-stimulating factors (CSFs). These drugs may be given to help prevent white blood cell (WBC) counts from dropping after treatment. CSF drugs help the body produce more WBCs which are made in the bone marrow. Because the bone marrow activity is higher with these drugs, bone pain may occur.
Pain from cancer surgery, treatments, and tests
Surgical pain: Surgery is often part of the treatment for cancers that grow as solid tumors. Depending on the kind of surgery you have, some amount of pain is usually expected and can last from a few days to weeks.
Talk to your doctor about pain medicines you may need after surgery so you won’t be in pain when your surgery is over.
You may need stronger pain medicine at first after surgery, but after a few days or so you should be able to control it with less strong medicines.
Phantom pain: Phantom pain is a longer-lasting effect of surgery, beyond the usual surgical pain. If you’ve had an arm, leg, or even a breast removed, you may still feel pain or other unusual or unpleasant feelings that seem to be coming from the absent (phantom) body part. Doctors are not sure why this happens, but phantom pain is real; it’s not “all in your head.”
No single pain relief method controls phantom pain in all patients all the time. Many methods have been used to treat this type of pain, including pain medicine, physical therapy, antidepressant medicines, and transcutaneous electric nerve stimulation (TENS). If you’re having phantom pain, ask your cancer care team what can be done.
Side effects of chemotherapy and radiation treatments: Some treatment side effects cause pain. Pain can even make some people stop treatment if it’s not managed. Talk to your cancer care team about any changes you notice or any pain you have.
Here are some examples of pain caused by cancer treatment:
- Peripheral neuropathy (PN). This refers to pain, burning, tingling, numbness, weakness, clumsiness, trouble walking, or unusual sensations in the hands, arms, legs, and/or feet. Peripheral neuropathy is due to nerve damage caused by certain types of chemotherapy, vitamin deficiencies, a tumor pressing on a nerve, or other health problems such as diabetes and infections. When caused by chemotherapy, it's sometimes called chemotherapy-induced peripheral neuropathy (CIPN). Some non-cancer medications can also have peripheral neuropathy as a possible side effect. Be sure to talk to your health care team about other health problems and medications you are taking, and be sure to tell your doctor right away if you notice any symptoms that you think may be from peripheral neuropathy.
- Mouth sores (stomatitis or mucositis). Chemotherapy can cause sores and pain in the mouth and throat. The pain can cause people to have trouble eating, drinking, and even talking.
- Radiation mucositis and other radiation injuries. Pain from external radiation depends on the part of the body that’s treated. Radiation can cause skin burns, mucositis (mouth sores), and scarring – all of which can cause pain. The throat, intestine, and bladder are also prone to radiation injury, and you may have pain if these areas are treated.
Procedures and testing: Some tests used to diagnose cancer and see how well treatment is working can be painful. When you are scheduling a procedure or test, ask your health care team if pain is expected.
If you need such a procedure, concern about pain should not keep you from having it done. Any pain you have during and after the procedure can be treated. You may be told that the pain from the procedure can’t be avoided or that it won’t last long.
Even so, you should ask for pain medicine if you need it.
What Can I Do About Cancer Pain? What Are the Treatments?
Pain can be part of having cancer, but you don’t have to take it. Just doctor appointments and tests, managing pain is another way to take control of your treatment.
When you're in pain, it can affect everything from your sleep and appetite to the simplest tasks in your daily routine. Pain can also affect your emotions.
Speak up about your pain. Your doctors will want to know. It could be a sign that you have an infection, your cancer has spread, or there's a problem with your cancer treatment.
You're the only one who knows how cancer pain feels in your body. You’ll want to understand it, know how to communicate about it, and get the relief you need to live your life.
Cancer pain has many sources. It sounds simple, but it's often caused by the cancer itself.
When cancer grows and harms tissue nearby, it can cause pain in those areas. It releases chemicals that irritate the area around the tumor. As tumors grow, they may put stress on bones, nerves, and organs around them.
Cancer-related tests, treatments, and surgery can cause aches and discomfort. You may also feel pain that has nothing to do with cancer, normal headaches and tight muscles.
Each person is different. How you experience cancer pain depends on the type you have, its stage, and whether you have a low or high tolerance for pain. Most people with feel it in one of these three ways:
- Acute pain: Imagine that you've been punched in the stomach. It hurts a lot at the beginning then eases off quickly. Acute pain tells your body you've been injured and heals as you do.
- Chronic pain: This kind of pain hangs around a long time. It can be a low throb or sharp and affect your life in many ways. Although it won’t completely disappear, you can manage it with pain medication.
- Breakthrough pain: If you treat chronic pain with medication, you may still feel a flash of pain every once in a while. This is called “breakthrough pain” because it breaks through the effects of your medication. It often happens quickly, lasts a short time and can feel very strong.
Your doctor may not always ask if you're feeling pain. It's up to you to say what hurts and ask for help.
If you have religious or cultural reasons to be concerned about taking medicines, share that. Set aside any worries you may have about looking weak. It’s actually a sign of strength to say how you feel. And you deserve to feel as good as possible.
Before your appointment, keep track of your pain so you can be as detailed as possible with your doctor. Use these questions as a guide:
- Where do you feel the pain?
- What does it feel ? Sharp or dull? Burning or throbbing? Shooting or steady?
- On a scale of 1 to 10, with 1 being the lowest, how strong is the pain?
- How long does it last? A few minutes? Three hours? All day?
- What makes it feel better? When you lie down? Putting heat on it? Massaging the area?
- Does it change with treatment?
Take your answers and all prescriptions, vitamins, and over-the-counter drugs with you to the appointment.
You've done your part. Now it's time for your doctor to do his. Removing the cancer with surgery, chemotherapy or radiation is the first option to explore. If those aren't possible — or you're waiting to have a procedure — prescription medication can control the pain.
Medicines for pain fall into three categories:
You can take many opioids by mouth, in pill or liquid form. Some can be put inside the cheek or under the tongue.
If you can't take medications that way, you may be able to take them through an IV, suppository or skin patch.
Any time your doctor gives you a new medication, make sure you know how much to take, how often to take it, and how long it takes to work. To make sure you get the most every dose, ask your doctor those questions and and a few more:
- What are the side effects?
- If the pain doesn't go away, should I call you before taking more than my normal dose?
- How long will this prescription last?
- Should I take it with food?
- What if I forget to take it?
- What other drugs can I take with this?
- Can I get addicted to this medication?
- Can I overdose on this medication?
- How should I store this medication?
If medicine doesn't help enough, doctors may try a treatment to stop pain messages from getting through.
When pain doctors inject medication in the nerve or spin to relieve pain, it's called a nerve block. Transcutaneous electric nerve stimulation (TENS) involves a small power pack that uses a light current to offset pain. You can attach it to yourself or carry it with you.
There are plenty of nonmedical treatments as well. Relaxing, distraction, and getting massages send positive messages to your body.
You could also try acupuncture, hypnosis or biofeedback, which uses a machine that gives information to help you control your body. If your body is up for it, check out methods yoga, tai chi and reiki.
Meditation, prayer, and the company of loved ones may also help you get through, moment by moment.
American Cancer Society: “Cancer pain.”
Mayo Clinic: “Cancer pain: Relief is possible.”
National Cancer Institute: “Pain Control: Support for People With Cancer.”
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Is Cancer Painful? Tumors, Tests & Treatment
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There’s no simple answer to if cancer causes pain. Being diagnosed with cancer doesn’t always come with a prognosis of pain. It depends on the type and stage of the cancer.
Also, some people have different pain-related experiences with cancer. Not all people react the same way to any particular cancer.
As you consider the potential of pain accompanying cancer, keep in mind that all pain can be treated.
Pain associated with cancer is often attributed to three sources:
- the cancer itself
- treatment, such as surgery, specific treatments, and tests
- other medical conditions (comorbidity)
The primary ways that cancer itself can cause pain include:
- Compression. As a tumor grows it can compress adjacent nerves and organs, resulting in pain. If a tumor spreads to the spine, it can cause pain by pressing on the nerves of the spinal cord (spinal cord compression).
- Metastases. If the cancer metastasizes (spreads), it can cause pain in other areas of your body. Commonly, spreading of cancer to the bone is particularly painful.
Cancer surgery, treatments, and tests can all cause pain. Although not directly attributable to the cancer itself, this pain associated with cancer typically includes surgical pain, pain from side effects, or pain from testing.
Surgery, for example to remove a tumor, can result in pain that can last days or weeks.
The pain lessens over time, eventually going away, but you might need your doctor to prescribe medication to help you manage it.
Side effect pain
Treatments such as radiation and chemotherapy have side effects that can be painful such as:
- radiation burns
- mouth sores
- peripheral neuropathy
Peripheral neuropathy is pain, tingling, burning, weakness, or numbness in the feet, legs, hands, or arms.
Some cancer testing is invasive and potentially painful. Types of testing that may cause pain include:
Comorbidity is a way of describing a situation in which two or more medical disorders are occurring in the same person. It’s also referred to as multimorbidity or multiple chronic conditions.
For example, if someone with throat cancer and arthritis of the neck (cervical spondylosis) is feeling pain, the pain could be from the arthritis and not the cancer.
The one constant in cancer pain is the need to clearly communicate your pain to your doctor so they can provide an appropriate medication that delivers the best possible pain relief with minimal side effects.
One way your doctor determines the best treatment is through understanding your type of pain, such as acute, persistent, or breakthrough.
Acute pain typically comes on quickly, is severe, and doesn’t last for a long time.
Chronic pain, also called persistent pain, can range from mild to severe and can come on slowly or quickly.
Pain that lasts for more than 3 months is considered chronic.
This type of pain is unpredictable pain that can happen while you’re regularly taking pain medication for chronic pain. It typically comes on very quickly and can vary in intensity.
Other ways to communicate the type of pain to your doctor include answering the following questions:
- Where exactly does it hurt? Be as specific about location as possible.
- What does the pain feel ? Your doctor might prompt you with descriptive words such as sharp, dull, burning, stabbing, or aching.
- How severe is the pain? Describe the intensity — is it the worst pain you’ve ever felt? Is it manageable? Is it debilitating? Is it just noticeable? Can you rate the pain on a scale of 1 to 10 with 1 being barely perceptible and 10 being the worst imaginable?
Your doctor will most ly ask how the pain is impacting your daily life such as possible interference with sleep or typical activities driving or working at your job.
Is cancer painful? For some people, yes.
Pain, however, is dependent on a number of factors including the type of cancer you have and its stage. The important takeaway is that all pain is treatable, so if you experience pain, your doctor can help you manage it.