Learn what causes cancer pain and how you can work with your doctor to ensure your cancer pain is controlled.

By Mayo Clinic Staff

Not everyone with cancer has cancer pain, but some do. If you have cancer that's spread or recurred, your chance of having pain is higher.

Cancer pain takes many forms. It can be dull, achy, sharp or burning. It can be constant, intermittent, mild, moderate or severe. How much pain you feel depends on a number of factors, including the type of cancer you have, how advanced it is, where it's situated and your pain tolerance.

Keep in mind that most cancer pain is manageable and that controlling your pain is essential to your treatment.

Timothy J. Moynihan, M.D., a cancer specialist at Mayo Clinic in Rochester, Minnesota, offers some insight into cancer pain, why people might not get the pain treatment they need and what they can do about it.

If the pain is from the cancer itself, it can be from the cancer growing into or destroying nearby tissue. As a tumor grows, it can press on nerves, bones or organs. The tumor can also release chemicals that can cause pain. Or your body's reaction to the chemicals can cause pain.

Treatment of the cancer can help the pain in these situations. However, cancer treatments, including surgery, radiation and chemotherapy, also can cause pain.

There are a variety of ways. One is to remove the source of the pain through surgery, chemotherapy, radiation or other treatment.

If that can't be done, pain medications can usually control the pain. These medications include:

  • Over-the-counter and prescription pain relievers, such as aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others)
  • Weak opioid (derived from opium) medications, such as codeine
  • Strong opioid medications, such as morphine (Kadian, Ms Contin, others), oxycodone (Oxycontin, Roxicodone, others), hydromorphone (Dilaudid, Exalgo), fentanyl (Actiq, Fentora, others), methadone (Dolophine, Methadose) or oxymorphone (Opana)

Some medications come in tablets or liquids you swallow; others dissolve quickly in your mouth. You can receive some medications by shots, either under the skin or in a vein; through rectal suppositories; or by wearing a skin patch.

Other medications used to treat cancer pain are antidepressants, anti-seizure drugs and steroids.

Also, there are specialized treatments, such as a nerve block, which is a local anesthetic that's injected around or into a nerve. The block prevents pain messages along that nerve pathway from reaching the brain.

Other therapies, such as acupuncture, acupressure, massage, physical therapy, relaxation, meditation and hypnosis, might help.

Unfortunately cancer pain is often undertreated. Many factors can contribute to that, some of which include:

  • Reluctance of doctors to ask about pain or offer treatments. Health care professionals should ask people with cancer about pain at every visit. Some doctors don't know enough about pain treatment. In that case, request a referral to a pain specialist.

    Given current concerns about opioid use and abuse, many doctors might be reluctant to prescribe these medications. Maintaining a close working relationship with your cancer specialists is essential to proper use of these medications.

  • Reluctance of people to mention their pain. Some people don't want to "bother" their doctors, or they fear that the pain means the cancer is worsening. Others are worried their doctors will think of them as complainers or that they can't afford pain medications.
  • Fear of addiction. If you take medications when you're not in pain or to get high, then the chance of developing addiction is high. But the risk of addiction for people who take pain medications as directed for cancer pain is low.

    You might develop a tolerance for your pain medication, which means you might need a higher dose to control your pain. Tolerance isn't addiction. If your medication isn't working as well as it once did, talk to your doctor about a higher dose or a different drug. Don't increase the dose on your own.

  • Fear of side effects. Some people fear being sleepy, unable to communicate, acting strangely, or being seen as dependent on medications. You might have these side effects when you start taking strong pain medications, but they often resolve once your doctors find the correct level of pain medications for you and once you achieve a steady level of pain medications in your body.

Each type of treatment has its own side effects.

  • Surgery. Surgical removal of cancer can result in pain in the area of the surgery. Much of post-surgical pain is thought to be related to nerve injury that occurred during the surgery. People who have a limb or breast removed might feel pain as though the limb or breast is still present (phantom pain).
  • Radiation therapy. These treatments can cause redness and a burning sensation of the skin. Depending on what part of the body the radiation is applied to, it can cause diarrhea, mouth sores or other problems, such as fatigue.
  • Chemotherapy. Side effects can include nausea, fatigue, infection, hair loss and nerve pain (neuropathy). Medications can help ease these side effects. Relaxation techniques also might help.
  • Strong pain medications. One of the common side effects of opioids is constipation. It can be treated with stool softeners and laxatives recommended by your doctor. Preventing constipation is easier than treating it, so before you start taking opioids ask your doctor what you should take to keep your bowels moving.

    Other side effects of strong pain medications include nausea, vomiting and drowsiness. These commonly occur with the first several doses and go away after a few days of taking the medication.

  • Other pain medications. Common over-the-counter pain relievers might damage your kidneys, cause ulcers or increase your blood pressure. Aspirin can cause gastrointestinal bleeding, and acetaminophen (Tylenol, others) can cause liver damage if you take too much or drink alcohol while taking it.

Discuss the possible side effects of any medication with your doctor before taking it.

If the pain interferes with your life or is persistent, report it. It might help to keep track of your pain by jotting down:

  • How severe the pain is
  • What type of pain (stabbing, dull, achy) you have
  • Where you feel the pain
  • What brings the pain on
  • What makes the pain worse or better
  • What pain relief measures you use — such as medication, massage, and hot or cold packs — how they help and any side effects they cause

Using a pain-rating scale from 0 to 10 — with 0 being no pain and 10 being the worst pain imaginable — might help you to report your pain to your doctor.

First, talk to your doctor or health care provider about your pain.

Second, you and your doctor can set a goal for pain management and monitor the success of the treatment. Your doctor should track the pain with a pain scale, assessing how strong it is. The goal should be to keep you comfortable. If you aren't comfortable, talk to your doctor.

If you're not getting the answers you need, request a referral to a facility skilled in the care of pain. All major cancer centers have pain management programs. The medications and treatment for pain are generally covered by standard insurance.

Oct. 10, 2017