Cancer treatment - dealing with pain

The pain from cancer can have a few different causes:

• The cancer. When a tumor grows, it can press on nerves, bones, organs, or the spinal cord, causing pain.
• Medical tests. Some medical tests, such as a biopsy or bone marrow test, can cause pain.
• Treatment. Many types of cancer treatments can cause pain, including chemotherapy, radiation, and surgery.

Everyone's pain is different. Your pain can range from mild to severe and may last for only a short time or continue for a long time.

Many people with cancer do not get enough treatment for their pain. This may be because they do not want to take pain medicine, or they do not think it will help. But treating your pain is part of treating your cancer. You should get treatment for pain just as you would for any other side effect.

Managing pain can also help you feel better overall. Treatment can help you:

• Sleep better
• Be more active
• Want to eat
• Feel less stress and depression
• Improve your sex life

Some people are afraid to take pain medicines because they think they will become addicted. Over time, your body may develop a tolerance for pain medicine. This means that you may need more of it to treat your pain. This is normal and can happen with other medicines as well. It does not mean you are addicted. As long as you are taking the medicine as prescribed by your doctor, you have little chance of becoming addicted.

To make sure you get the right treatment for your pain, it is important to be as honest as possible with your provider. You will want to tell your provider:

• What your pain feels like (aching, dull, throbbing, constant, or sharp)
• Where you feel the pain
• How long the pain lasts
• How strong it is
• If there is a time of day it feels better or worse
• If there is anything else that makes it feel better or worse
• If your pain keeps you from doing any activities

Your provider may ask you to rate your pain using a scale or a chart. It may be helpful to keep a pain diary to help track your pain. You can also keep track of when you take medicine for your pain and how much it helps. This will help your provider know how well the medicine is working.

There are three main types of medicines for cancer pain. Your provider will work with you to find a medicine that works best for you with the least amount of side effects. In general, you will start with the least amount of medicine with the fewest side effects that relieves your pain. If one medicine does not work, your provider may suggest another. It may take a little time to find the right medicine and the right dose that is right for you.

• Non-opioid pain relievers. These medicines include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others), and naproxen (Aleve). They are best to treat mild to moderate pain. You can buy most of these medicines over the counter.
• Opioids or narcotics. These are stronger medicines that are used to treat moderate to severe pain. You need to have a prescription to take them. Some common opioids include codeine, fentanyl, morphine, hydrocodone, and oxycodone. You may take these medicines in addition to other pain relievers.
• Other types of medicines. Your provider may prescribe other medicines to help with your pain. These can include anticonvulsants or antidepressants for nerve pain or steroids to treat pain from swelling.

It is important to take your pain medicine exactly as your provider tells you to. Here are some tips to get the most out of your pain medicine:

• Tell your provider about all other medicines you are taking. Some pain medicines can interact with other medicines.
• Do not skip doses or try to go longer between doses. Pain is easiest to treat when you treat it early. Do not wait until pain is severe before taking your medicine. This may make your pain harder to treat and cause you to need larger doses.
• Do not stop taking the medicine on your own. Tell your provider if you have side effects or other issues. Your provider can help you find ways to deal with side effects or other problems. If the side effects are too severe, you may need to try another medicine.
• Tell your provider if the medicine is not working. They may increase your dose, have you take it more often, or try another medicine.

In some cases, your provider may suggest another type of treatment for your cancer pain. Some options include:

• Transcutaneous electric nerve stimulation (TENS). TENS is a mild electrical current that can help ease pain. You place it on the part of your body where you feel pain.
• Nerve block. This is a special type of pain medicine injected around or into a nerve to ease pain.
• Radiofrequency ablation. Radio waves heat up regions of nerve tissue to help ease pain.
• Radiation therapy. This treatment can shrink a tumor that is causing pain.
• Chemotherapy. These medicines can also shrink a tumor to reduce pain.
• Surgery. Your provider may use surgery to remove a tumor that is causing pain. In some cases, a type of brain surgery can cut the nerves that carry pain messages to your brain.
• Complementary or alternative treatments. You may also choose to try treatments such as acupuncture, chiropractic, meditation, or biofeedback to help treat your pain. In most cases, people use these methods in addition to medicines or other types of pain relief.

Palliative - cancer pain

National Cancer Institute website. Cancer pain (PDQ) - Health professional version. www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-hp-pdq. Updated September 2, 2022. Accessed October 20, 2022.

Nesbit S, Browner I, Grossman SA. Cancer-related pain. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 37.

Scarborough BM, Smith CB. Optimal pain management for patients with cancer in the modern era. CA Cancer J Clin. 2018;68(3):182-196. PMID: 29603142 pubmed.ncbi.nlm.nih.gov/29603142/.

Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.