Key questions about cancer pain

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 individual ways. The way pain is felt and how it affects people is influenced by physical, emotional  and environmental factors. These act directly or indirectly on the body’s nervous system (the brain, spinal cord and nerves). Doctors assess these factors to help treat the pain.

You may have pain occasionally or often. It may be steady, throbbing, stabbing, aching or pinching. Pain can cause discomfort, distress or agony. If left untreated, it can also result  in anxiety or depression. However you feel pain, it is personal and only you can describe or define it.

What is cancer pain? Does everyone with cancer have it?

Cancer pain is a broad term for different kinds of pain that people may experience when they have cancer. Not everyone with cancer has pain – about one in three people who are treated for cancer experience pain after treatment.

These people may not be in pain all the time – it may come and go. Pain is more common with advanced cancer. About six out of 10 people with advanced cancer say they have pain.

Your experience of pain

The way you feel cancer pain depends on several factors, such as the type of cancer you have, its stage, the treatment you receive, other health issues, your attitudes and beliefs about pain, and the significance of the pain to you.

Pain can have a huge impact on your life, preventing you from doing the things you want to do or normally do.

Learning to control pain may allow you to return to many of the activities you enjoy.

What causes cancer pain?

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

  • a tumour pressing on organs, nerves or bone
  • a bone fracture if the cancer has spread
  • 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 causing back pain.

Pain can occur in more than one area of the body at once. Although it is more common in people with advanced cancer
(metastatic or secondary cancer), increasing pain doesn’t necessarily mean that the cancer is getting worse or spreading.

If your pain is getting worse, talk to your health care team about its causes and any fears you may have.

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-lasting your pain experience is.

  • Acute pain – Severe pain that lasts a short time only, possibly for days or weeks. It usually occurs because the body is hurt or strained in some way. The pain 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 severe pain that can occur despite taking medication. It may happen because the dose of medication is not high enough or because the pain is worse at different times of the day or after certain activities. Doctors can prescribe extra doses or a different medication for this.
  • Soft tissue pain – Caused by damage to or pressure on an organ or muscle. It may be hard to describe exactly where the pain is, but it tends to be sharp, aching or throbbing.
  • Nerve pain – Caused by pressure on nerves or the spinal cord, or damage to nerves. It is also called neuropathic pain. People often describe it as burning or tingling, or the sensation of ‘pins and needles’.
  • Bone pain – Caused by the spread of cancer into the bones, which damages bone tissue in one or more areas. People often describe it as aching, dull or throbbing, and it may be worse at night.
  • Referred pain – Pain is felt away from the site of the problem (e.g. a swollen liver can cause pain in the right shoulder). This is different to localised pain, which 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 strange sensation of pain 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 who experience it. It can usually be controlled with specialised pain relief used for nerve pain.

What affects pain?

As well as the cause of the pain itself, your emotions, your environment and your fatigue levels can affect how you feel and react to pain. It’s important for your health care team to understand the way any physical, emotional and environmental factors are impacting on you.

  • Emotions – People often have an emotional reaction to pain. You may feel worried, depressed or easily discouraged when you’re in pain. Some people feel hopeless, helpless, isolated, embarrassed, inadequate, irritable, angry, frightened or frantic. 

Ongoing pain can cause anxiety and depression, and these emotions can make the pain even worse. This does not mean that pain is all in the mind, but it is important to look at the emotional causes and effects of pain as much as the physical ones.

  • Environment – Things and people in your environment – at home, at work and elsewhere – can have a positive or negative impact on your pain. For example, worrying about a child who is being bullied can increase 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 or nurse for help if you are not sleeping well.

How can cancer pain be 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.

Treatments include the same methods used to treat cancer, such as:

  • surgery, radiotherapy and chemotherapy
  • medications and other treatments specifically for pain
  • a range of non-medication methods, such as physiotherapy and complementary therapies.

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

Different things might work at different times, so it is important to persist in finding the best options for you. When you’re tired, you might need some relief that doesn’t take much effort, such as a heat pack. It may also be beneficial to try relaxation or meditation exercises after you have taken some medication. 

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.

Try various pain relief methods more than once. If it doesn’t work the first time, try it a few more times before you give up. If you’re taking medication that doesn’t seem to work or has stopped working, talk to your doctor – don’t change the dose yourself.

When can I use pain relief?

You can use different types of pain relief whenever you feel any level of pain.

It is not true that having cancer means you will experience pain. If you have pain, there is no advantage to being brave or stoic, it’s better to get help and relief.

It’s important not to let your pain get out of control before doing something about it. The sooner and more effectively the pain is treated, the less likely it will be a long-term problem. If pain lasts longer than a few days without much relief, see your doctor for advice.

Many people try to avoid taking pain medication thinking it is better to hold out for as long as possible. However this usually makes the situation worse. It is better to take medication as prescribed rather than just at the time you feel the pain.

Your doctor can talk about dosages and how often to take pain relief.

Is palliative care the same as pain management?

To ‘palliate’ means to relieve. Palliative care includes many aspects, one of which is pain management.

The palliative care team includes doctors, nurses, social workers, physiotherapists, occupational therapists and pastoral care workers. They work to maintain your quality of life by easing symptoms of cancer, without trying to cure the disease. This includes:

  • helping you with pain relief
  • reducing your stress
  • working with you to relieve other symptoms caused by cancer, such as nausea, constipation or breathlessness
  • focusing on addressing emotional, practical and spiritual needs to aid your comfort
  • helping you maintain your independence for as long as possible. 

Your hospital doctor or nurse can put you in touch with a palliative care team for treatment in hospital, and your general
practitioner (GP) can refer you to a community palliative care team so you can have treatment at home. Referral to palliative care is not just for end-of-life care. You can use the team when you need to access services. This may be for months or years.

For more information, call Cancer Council Helpline 13 11 20 for a free copy of the Understanding Palliative Care booklet.

This information was last reviewed in November 2013

This information has been reviewed by: Dr Melanie Lovell, Consultant Palliative Care Physician, Senior Lecturer, Sydney Medical School, University of Sydney, NSW; Prof Frances Boyle AM, Professor of Medical Oncology, Mater Hospital and University of Sydney, NSW; Prof Michael J Cousins AM, Professor & Head, Pain Management & Research Centre, Royal North Shore Hospital, NSW; Carol Kanowski, Clinical Nurse Consultant, North Queensland Persistent Pain Management Service, QLD; Brenda Kirkwood, Helpline Operator, Cancer Council QLD; A/Prof Odette Spruyt, Director, Pain and Palliative Care, Peter MacCallum Cancer Centre, VIC; and Sally White, Consumer.

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