How to Manage Pain with Cancer Treatment

Pain is a common side effect of cancer and cancer treatments. Yet many people with cancer are hesitant to talk about their pain or have reservations about taking pain medications. These worries are understandable, but it’s important to know that pain management is an essential part of your healthcare when you’re being treated for cancer. Here’s what you need to know about managing cancer-related pain.

Types of pain

Knowing some terminology used to describe different kinds of pain can help you give your healthcare team an accurate picture of how you’re feeling and treat your pain more effectively. These terms help describe when pain occurs and how long it lasts:

Acute – Short-term or intense pain that starts suddenly. The pain that you might feel right after an injury or surgery and that decreases as you recover is an example of acute pain.
Chronic – Long-term pain that can be continuous or may come and go. Chronic pain is often related to nerve damage or pressure, like a tumor pressing on a nerve. Acute pain can sometimes develop into chronic pain.
Breakthrough – An increase in pain that happens despite being on medication meant to control pain. Breakthrough pain can happen as your medication wears off before you take the next dose, or it might be caused by a specific activity.

Here are some additional terms to describe pain that you might experience during cancer treatment:

Nerve pain – Pain that’s often tingling, burning, or shooting and that’s related to damage to or pressure on the nerves.
Bone pain – Aching or throbbing in the bones, also called ostealgia.
Mucositis – Inflammation or sores in mucous membranes, like the mouth and throat.
Dermatitis – Skin inflammation and irritation.
Painful urination – Pain felt while urinating due to irritation of the bladder and / or urinary tract.
Phantom pain – Pain felt from a part of the body that has been removed. For example, some people who have had a mastectomy feel pain in the area of the removed breast.
Referred pain – Pain felt in one part of the body that is caused by a problem in another part of the body. For instance, someone with a swollen liver can have pain in their right shoulder, because the swollen organ presses on a nerve that reaches the shoulder area.

Causes of cancer-related pain

People with cancer can experience pain for several different reasons.

Medical tests and surgery

Some medical tests and procedures, like biopsies and surgeries, can be painful. This pain is often acute and goes away after the test or as you recover from a surgery. Your healthcare team will work to control pain related to procedures, but don’t hesitate to ask if you have questions about this, including what level and type of pain is typical during and after the procedure, how long it’s likely to last, and what your options are for treating it. Sometimes surgery can also lead to nerve pain or phantom pain, which can be chronic and require longer-term treatment.

The cancer itself

Cancer itself can cause pain. This is especially likely when cancer spreads or recurs. Pain can arise from the cancer tissue growing and pressing on nerves or other structures in the body or from tissue damage. Pain can also be the result of tumors releasing certain chemicals. Treatments that fight the cancer directly also help relieve this kind of pain.

Radiation and chemotherapy

These cancer-fighting treatments don’t usually hurt by themselves, but common side effects can cause pain. Chemotherapy damages some healthy cells along with cancer, which can cause pain. Other side effects can include headaches, muscle pain, painful urination, stomach pain and pain from nerve damage in your hands and feet (this is called chemotherapy-induced peripheral neuropathy, or CIPN). The side effects of radiation therapy are usually limited to the part of the body that the treatment was targeting.

The intensity of pain from chemotherapy and radiation treatments varies from person to person—even among people with the same type of cancer who are receiving the same kind of treatment. This is why it’s important to discuss your pain with your healthcare team, so they understand exactly what you are experiencing and determine the most appropriate treatment.

Other treatments

Other therapies used in cancer treatment may also come with some painful side effects. Drugs called granulocyte colony-stimulating factors (also called Filgrastim or G-CSF) used to stimulate the body’s production of white blood cells, can cause bone pain. Aromatase inhibitor drugs, a hormone therapy used to fight some types of breast cancer, can cause joint and muscle pain. Your healthcare team should discuss all potential side effects you may experience with your treatment.

Why treating pain matters

It’s important to take pain seriously for several reasons. We’ll walk through each in detail.

Pain can provide information about your health condition.

First, sometimes the type or location of pain might offer useful insights to your health care team about changes to your health condition. Try to describe any pain you’re experiencing in as much detail as possible, including its location in your body, when it started, whether it is continuous or comes and goes, and how severe it is and what it feels like (sharp, dull, achy, tingling, shooting, etc.). If the pain is linked to a particular time of day or an activity, make sure to mention that too. If you’ve found anything on your own that helps it feel better, this is also worth mentioning.

Pain can have its own impacts on your health.

“Toughing it out” might be a reasonable approach to short-term, moderate pain—things that occasionally happen to everyone and tend to go away quickly on their own, like a scraped knee. But pain that’s severe or chronic can have significant impacts on your overall health, so it’s important not to downplay the severity and to get help when you need it.

Chronic pain, in particular, is strongly linked with mental health problems, like anxiety and depression. The psychological effects can be caused by the experience of pain itself and from the other impacts pain has on a person’s life. For example, pain can cause people to restrict social activities, leading to loneliness and isolation. Pain that interferes with your sleep can also lead to greater health impacts, since sufficient sleep is crucial for both psychological and physical health.

Pain is best treated early.

The best time to treat pain is early, before it becomes chronic or severe. Leaving pain untreated for a long time or allowing it to get worse can make it harder to control and sometimes leads to long-term changes to the nervous system. This is another reason it’s important to discuss pain with your healthcare team.

Pain treatment options

There are a variety of treatments that can help relieve pain that people with cancer experience. There are medications, medical procedures, and a range of behavioral and complementary techniques. It’s common to combine several of these options for the most effective treatment.

Medication

Pain medications used in cancer care can range from over-the-counter drugs most people are familiar with to powerful prescription opioids. Other medications can be combined with painkillers to make them more effective. Medications can be taken by mouth as pills or liquids or they can come in other forms like skin patches, topical creams or ointments, rectal suppositories, injections, or infusion pumps implanted in the body.

Over-the-counter medications

These medications, like acetaminophen (Tylenol), ibuprofen (Advil), aspirin, and naproxen (Aleve) can be used for mild to moderate pain. Most of these medications work by fighting inflammation—they are NSAIDs, or non-steroidal anti-inflammatories. The exception is acetaminophen. It’s important not to take too much of it, since it can cause liver damage. Discuss how much of any of these medications is right for you with your doctor, as they can all have detrimental side effects if taken improperly.

Prescription opioids

Opioids are strong pain medications for treating moderate to severe pain. These medications include morphine, fentanyl, codeine, oxycodone, oxymorphone, hydrocodone, hydromorphone and methadone. These can be combined with non-opioid pain medications, with a doctor’s supervision.

There are both short-acting and long-acting (time release) opioids. Time-release pills should not be broken since that can cause too much medication to be released at once. You should always take prescription opioids exactly as they’re prescribed. Taking more or less medication than prescribed can be dangerous. If you want to change the dosage or schedule of an opioid medication, talk to your doctor first.

While opioids can be very effective in treating pain, they can also cause unwanted side effects (including constipation, drowsiness, nausea and vomiting) and carry the risk of dependence and addiction. Talk to your healthcare team about all the potential impacts of opioid use.

Palliative surgery, radiation and chemotherapy

If tumor growth is pressing on organs or nerves, surgery, radiation or chemotherapy treatment can be used primarily to relieve pain by shrinking the tumor. This treatment is usually for people whose cancer is more advanced.

Non-medication techniques

There are many non-medication options to help with pain, too. These approaches can lessen pain and also help you cope with it better.

Meditation and relaxation techniques – Practices that help reduce anxiety and stress can also help you experience less pain and reduce negative emotions related to pain. If you’re new to meditation, look for free online guides (Insight Timer is a good one). There are also meditation programs created specifically for people with cancer to help manage pain and stress. We recommend meditation apps like Calm and Headspace. Other techniques include imagery and visualization, progressive muscle relaxation, breathing exercises and mindfulness. Research shows deep and slow breathing techniques can help reduce the experience of pain.
TENS devices. Transcutaneous electrical nerve stimulators are devices that deliver low-level electrical current to electrodes on your skin. There’s some debate about how they work, but they seem to engage with your body’s own pain-management system, either by affecting nerve signals or raising endorphin levels, so your perception of pain is reduced. They shouldn’t be used on broken skin or at all by people with certain health conditions, so check with your healthcare team if you’re interested in using a TENS device.
Heat and cold. A heating pad or chilled gel packs can help reduce swelling or numb pain. These shouldn’t be used for long periods or in areas of the body with poor circulation, so check with your healthcare team about safe use of heat and cold for pain.
Gentle movement. Moving your body can sometimes help with pain relief directly, or indirectly, by relieving stress. Tai chi, yoga, stretching or walking are all good options.
Massage and physical therapy. Physical therapists can help you learn exercises that reduce pain. Gentle massage can provide temporary pain relief and promote relaxation.
Counseling and support groups. Cognitive behavioral therapy or other individual counseling or support groups can help you learn strategies to cope with pain better. Some counselors have special training in helping people handle pain. Ask your healthcare team for help finding one.
Distracting activities. Keeping your mind engaged in activities like books, puzzles, music, and movies on your smartphone can help reduce your perceptions of pain.
Biofeedback. Biofeedback training uses devices that track physiological changes in your body, like your heart rate, muscle tension and breathing, to help you learn to control them better. This can reduce pain and anxiety. You’ll work with a biofeedback therapist (usually in a hospital or physical therapy office) to develop these skills.
Acupuncture and acupressure. These complementary therapies stem from traditional Chinese medicine and are used to treat many health conditions. The published research on these techniques is mixed, but many people find them effective methods of pain and stress reduction. Ask your healthcare team if acupuncture or acupressure is safe for you. (Read more about the research on acupuncture here). In acupuncture a trained therapist inserts very thin needles in certain locations on your body. In acupressure, pressure is applied instead of needles.

The content on this website is intended to provide the best possible information for you, but should not be considered—or used as a substitute for—medical advice. If you have questions about your diagnosis or treatment, please contact your health care provider(s). For questions or comments about this content, please email us at [email protected].