Overcoming Cancer Pain

Tuesday 1 September, 2015

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On this page: What is pain? | Does everyone with cancer have pain? | What causes cancer pain? | What types of pain are there? | What affects pain? | How is cancer pain treated? | When can I use pain relief? | Is palliative care the same as pain management? | Who helps manage my pain?Key points


What is pain?

Pain is not just a sensation that hurts. It is an unpleasant sensory and emotional experience associated with actual or possible tissue damage.

People experience pain in different ways and even people with the same type of cancer can have different experiences. The way pain is felt is influenced by emotional, environmental and physical factors (see below). These factors act directly or indirectly on the body’s nervous system (the brain, spinal cord and nerves). The type of cancer, its stage, the treatment you receive, other health issues, your attitudes and beliefs about pain, and the significance of the pain to you will also affect the pain experience. Health professionals assess all these factors to help treat the pain.

If left untreated, pain can lead to anxiety or depression, loss of function and changes to your day-to-day activities. Learning to control pain may allow you to return to many of the activities you enjoy and improve your quality of life.

Your experience of pain

Only you can describe your pain – it may be steady, burning, throbbing, stabbing, aching or pinching. Health professionals, family members and carers will rely on your description to work out the level of pain and its impact on your life. See describing pain for different ways to let health professionals know how you’re feeling. 

Does everyone with cancer have pain?

Cancer pain is a broad term for different kinds of pain that people may experience when they have cancer.

During treatment, about six out of 10 people (59%) say they experience pain. People with advanced cancer are slightly more likely to experience pain (64%). After treatment, about one in three people (33%) say they experience pain. They may not be in pain all the time – it may come and go. 

What causes cancer pain?

People with cancer may have pain for a variety of reasons. It may be caused by the cancer itself or by the cancer treatment, or it may have another cause. Some reasons for pain include:

  • a tumour pressing on organs, nerves or bone
  • a fracture if the cancer has spread to the bones
  • side effects from chemotherapy, radiotherapy or surgery
  • poor circulation due to blocked blood vessels
  • blockage of an organ or tube in the body, such as the bowel
  • infection or swelling and redness (inflammation)
  • muscle stiffness from tension or inactivity
  • poor posture, which can lead to back pain, for example.

New pain or an increase in pain doesn’t necessarily mean that the cancer has advanced or spread to another part of the body (metastasised). This is a common concern for people with changing pain levels.

What types of pain are there?

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

Acute pain

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

Chronic pain

Pain that lasts for three months or more. Chronic pain may be due to an ongoing problem, but it can develop even after any tissue damage has healed.

Breakthrough pain

A flare-up of pain that can occur despite taking medicine. It may happen because the dose of medicine is not high enough or because the pain is worse at different times of the day. Other causes of breakthrough pain include anxiety or other illnesses such as a cold or urinary tract infection.

Nerve (neuropathic) 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 burning or tingling, or the sensation of ‘pins and needles’.

Bone pain

Caused by cancer spreading to the bones, which damages bone tissue in one or more areas. It is often described as aching, dull or throbbing, and it may be worse at night.

Soft tissue pain

Caused by damage to or pressure on soft tissues, including muscle. The pain is often described as sharp, aching or throbbing.

Visceral pain

Caused by damage or pressure on internal organs. This type of pain can be difficult to pinpoint. It may cause some people to feel nauseous.

Referred pain

Pain is felt in a site away from the area of the problem (e.g. a swollen liver can cause pain in the right shoulder).

Localised pain

This occurs directly where there’s a problem (e.g. pain in the back due to a tumour pressing on nerves in that area).

Phantom pain

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 to those affected. Phantom pain can be difficult to control with medicines and often non-drug strategies need to be used. 

"I had some numbness and pain in my hands from one of the chemotherapy drugs. Doing hand stretches and exercises, and soaking my hands in warm water, helped. The doctors stopped that drug so the numbness wouldn’t become permanent." - Ann

What affects pain?

As well as the cause of the pain itself, your emotions, environment and fatigue levels 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.

Emotions

You may worry or feel easily discouraged when in pain. Some people feel hopeless, helpless, isolated, embarrassed, inadequate, irritable, angry, frightened or frantic.

Environment

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

Fatigue

Extreme tiredness can make it harder for you to cope with pain. Lack of sleep can increase your pain. Ask your doctor, nurse practitioner or nurse for help if you are not sleeping well. 

How is cancer pain treated?

There are many ways of treating both acute and chronic cancer pain. Treatment depends on the cause of the pain, but relief is still available even if the cause is unknown.

Cancer pain is often treated in a variety of ways, such as:

Many people find a combination of treatments helps, but everyone is different, so it might take time to find the right pain relief for you. It may be a few weeks before you feel the benefits of some treatments, so in the meantime you will usually be given strong pain medicine.

Different things might work at different times, so it is important to try a variety of pain relief methods and persist in finding the best options for you.

Sometimes it’s not possible to completely control all pain. You may still feel some discomfort. However, your health professionals can help make you as comfortable as possible.

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.

When can I use pain relief?

You can use different types of pain relief whenever you feel any level of pain. If you have pain, it’s better to get help and relief as soon as possible. This results in better pain control and less pain overall.

If pain lasts longer than a few days without much relief, see your doctor for advice. It’s important not to let the pain get out of control before doing something about it.

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

Many people believe that they should delay using pain-killers for as long as possible, and that they should only get help when pain becomes unbearable. If you do this, it can mean you are in pain when you don’t need to be. It can also make the pain more difficult to control. There is no need to save pain-killers until your pain is severe. Severe pain can cause anxiety and difficulty sleeping. These things can make the pain harder to control. The aim is for pain control to be constant. See for more information on using pain medicines.

Try various pain relief methods more than once. If the pain doesn’t improve the first time, try it a few more times before you give up. 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. 

Pam’s story

"I had found two lumps but, after a mammogram and ultrasound, the doctor said they looked like hormonal cysts. I decided to have surgery to correct my inverted nipple, and they found that my two hormonal cysts were in fact cancer. I then had my breast removed along with 14 lymph nodes with one infected.

"After the mastectomy, I was in a lot of pain as the wound had been stitched up tight and firm. I took strong Panadol every four hours for two months.

"A few years later, a mammogram picked up a tiny spot. I was told it was precancer, so I had the other breast removed. After the surgery I was in a lot of pain and resumed taking strong Panadol every four hours. Exercising my arm also helped. I would stretch my arm regularly, pointing my fingers to the stars, and gradually it became easier to move my arm. I also attended a breast cancer support group, and this was a good way to share the emotional pain with people who had been through the same experience. Losing a breast is like losing your womanhood; I felt disfigured and needed time to heal emotionally.

"To help with the pain of the implant, I was given Panadeine Forte®, but this made me feel not connected to the world. I was then given tramadol, but this made me feel dizzy. As these didn’t agree with me I took strong Panadol for a while.

"After the surgery and the implant, I developed lymphoedema. The swelling was painful but I saw a physiotherapist and he massaged my arm. I did this every week for a couple of months and this really helped.

"The combination of Panadol, massage and being with my breast group has helped me cope with pain during my breast cancer diagnosis."

Tell your cancer story.

Is palliative care the same as pain management? 

To ‘palliate’ means to relieve. Pain management is only one aspect of palliative care. The palliative care team includes doctors, nurses, social workers, physiotherapists, occupational therapists and pastoral care workers. They work together to:

  • maintain your quality of life by easing symptoms of cancer
  • ease your physical, practical, emotional and spiritual needs
  • help you feel in control of your situation and make decisions about your treatment and ongoing care.

Your hospital doctor or nurse can put you in touch with a palliative care team for treatment in hospital or at home. Referral to palliative care is possible throughout the course of cancer treatment, not just at end of life.

For more information, see our palliative care section or call Cancer Council 13 11 20

Who helps manage my pain?

Different health professionals work together to help manage your pain. This is called a multidisciplinary team (MDT). The MDT may include some of the professionals listed below. If your pain is not well controlled, you may want to ask your GP or palliative care physician for a referral to a pain medicine specialist. 

Health professional Role
general practitioner (GP)
takes care of your general health and coordinates specialist treatment
medical oncologist
prescribes and coordinates the course of chemotherapy (anti-cancer medicine)
radiation oncologist
prescribes and coordinates the course of radiotherapy to treat painful areas
surgeon
performs surgery to remove tumours or unblock affected organs
palliative care team
assesses physical, practical, emotional and spiritual needs, and coordinates care
pain medicine specialist specialises in treating all types of pain, particularly severe or difficult pain
nurses and nurse practitioners administer medicines and provide support during all stages of your treatment
pharmacist dispenses medicines and can give advice about drugs, dose and side effects
physiotherapist and occupational therapist
help you with physical and practical problems
 psychologist assesses emotional factors that affect your pain and provides psychological methods of pain management
counsellor, social worker and pastoral care worker  help you with emotional and spiritual issues and can advise on support services 

Key points

  • Pain experienced during treatment can usually be controlled and often decreases after treatment ends. People with advanced cancer are slightly more likely to have pain.
  • There are many types of pain, which are felt in different areas of the body and have different sensations.
  • Acute pain can be mild or severe but usually resolves within a few days or weeks. Chronic pain is often constant and can vary in intensity, and usually lasts for more than three months.
  • Cancer pain has many causes, including the after-effects of surgery, a tumour pressing on a nerve or organ, side effects of chemotherapy or radiotherapy, or bone pain from the spread of cancer.
  • Pain can be treated using conventional treatments and medicines. Other ways of controlling pain without drugs include complementary therapies.
  • Use pain relief as prescribed when you experience pain. It is better not to wait until the pain is severe before taking pain relief medicine.
  • A palliative care team works to improve a person’s quality of life by easing cancer symptoms. Pain relief is an important part of palliative care.
  • A multidisciplinary team (MDT) works together to help you manage cancer pain. The MDT will be made up of various health professionals, including nurses, specialists and allied health practitioners.
  • If your pain is not well controlled, ask your GP or palliative care physician if a referral to a pain medicine specialist would be helpful.

Reviewed by: Dr Melanie Lovell, Clinical Ass Prof, Medicine, Northern Clinical School, Sydney Medical School, University of Sydney, and Palliative Medicine Consultant Physician, Greenwich Hospital, NSW; Nathaniel Alexander, 13 11 20 Consultant, Cancer Council NSW, NSW; Anne Booms, Palliative Care Nurse Practitioner, Canberra Hospital, ACT; Dr Roger Goucke, Consultant, Department of Pain Management, Specialist Pain Medicine Physician, Sir Charles Gairdner Hospital, and Clinical Ass Prof, School of Medicine and Pharmacology, University of Western Australia, WA; John Marane, Consumer; and Dr Jane Trinca, Director, Barbara Walker Centre for Pain Management, St Vincent’s Hospital, VIC.

Updated: 01 Sep, 2015