Cancer pain: Relief is possible

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 experiences cancer pain, but 1 out of 3 people undergoing cancer treatment does. If you have advanced cancer — cancer that has spread or recurred — your chance of experiencing cancer pain is even higher.

Cancer pain occurs in many ways. Your pain may be dull, achy or sharp. It could be constant, intermittent, mild, moderate or severe.

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

What causes cancer pain?

Cancer pain can result from the cancer itself. Cancer can cause pain by growing into or destroying tissue near the cancer. Cancer pain can come from the primary cancer itself — where the cancer started — or from other areas in the body where the cancer has spread (metastases). As a tumor grows, it may put pressure on nerves, bones or organs, causing pain.

Cancer pain may not just be from the physical effect of the cancer on a region of the body, but also due to chemicals that the cancer may release in the region of the tumor. Treatment of the cancer can help the pain in these situations.

Cancer treatments — such as chemotherapy, radiation and surgery — are another potential source of cancer pain. Surgery can be painful, and it may take time to recover. Radiation may leave behind a burning sensation or painful scars. And chemotherapy can cause many potentially painful side effects, including mouth sores, diarrhea and nerve damage.

How do you treat cancer pain?

There are many different ways to treat cancer pain. One way is to remove the source of the pain, for example, through surgery, chemotherapy, radiation or some other form of treatment. If that can't be done, pain medications can usually control the pain. These medications include:

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

These drugs can often be taken orally, so they're easy to use. Medications may come in tablet form, or they may be made to dissolve quickly in your mouth. However, if you're unable to take medications orally, they may also be taken intravenously, rectally or through the skin using a patch.

Specialized treatment, such as nerve blocks, also may be used. Nerve blocks are a local anesthetic that is injected around or into a nerve, which prevents pain messages traveling along that nerve pathway from reaching the brain.

Other therapies such as acupuncture, acupressure, massage, physical therapy, relaxation, meditation and humor may help.

What are some reasons for not receiving adequate treatment for cancer pain?

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

  • Reluctance of doctors to ask about pain or offer treatments. Some doctors and other health care professionals may not specifically ask about pain, which should be a normal part of every visit with your doctor.

    People with cancer should be asked if they are having any pain. If they are, the doctor should stop there and deal with the issue.

    Some doctors don't know enough about proper pain treatment. If this is the case, your doctor might refer you to a pain specialist.

    Other doctors may be concerned about prescribing pain medications because these drugs can be abused. However, people in pain are very unlikely to abuse pain medications.

  • Reluctance of patients to speak up about pain. A second factor might be a person's own reluctance. Some people might not want to "bother" their doctors with the information, or they may fear that the pain means that their cancer is getting worse.

    Some are reluctant to report it or report it as thoroughly as they should because they're worried about what doctors or others might think of them if they complain. They might feel that because they have cancer, they're supposed to have pain and be able to deal with it. That simply isn't true.

  • Fear of addiction. Another factor might be a person's fear of becoming addicted to pain medications. This is something that we know doesn't typically happen if you take medications for pain.

    If you take medications when you're not in pain or to get high, then, yes, you can get addicted. But the risk of addiction for people who take pain medications in an appropriate fashion — for pain — is very low, so this shouldn't be a concern.

  • Fear of side effects. Some people fear the side effects of pain medications. Many are afraid of being sleepy, being unable to communicate with family and friends, acting strangely, or being seen as dependent on medications. People are also sometimes afraid that taking morphine may shorten their life. There is no evidence of any of these happening if the medication is dosed appropriately.

    Recent evidence suggests that good control of symptoms, including pain, actually helps people to live longer.

    And although strong pain medications can cause drowsiness when you first take them, that side effect usually goes away with steady dosing.

Oct. 18, 2014 See more In-depth