What is pain and its causes?

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 people feel pain is influenced by emotional, environmental, behavioural and physical factors. 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 way you experience pain. Health professionals assess all these factors to help treat pain.

If left untreated, pain can lead to anxiety or depression, and prevent you from doing the things you want to do. 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.

Learn more about:

• 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 medicines?
• Is palliative care the same as pain management? 

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Listen to our podcast on Managing Cancer Pain

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Does everyone with cancer have pain?

Cancer pain is a broad term for the different kinds of pain people may experience when they have cancer. Not everyone with cancer will have pain. Those who do experience pain may not be in pain all the time – it may come and go.

During treatment, about six out of ten people (55%) say they experience pain. People with advanced cancer are slightly more likely to experience pain (66%). After treatment, about one in three people (39%) say they experience pain.

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What causes cancer pain?

People with cancer may have pain caused by the cancer itself or by cancer treatment. They may also have pain from other causes, such as arthritis.

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 surgery, radiation therapy, chemotherapy, targeted therapy or immunotherapy
• 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. This is a common concern when pain levels change.

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What affects pain?

As well as the physical cause of the pain itself, your emotions, thoughts, 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, embarrassed, angry, inadequate, irritable, anxious, frightened or frantic. You may notice your behaviour changes. Some people become more withdrawn and isolated.

Fatigue

Extreme tiredness can make it harder for you to cope with pain. Lack of sleep can increase your pain. Ask your health care team for help if you are not sleeping well.

Environment

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

Thoughts

How you think about pain can influence how you experience the pain, e.g. whether you see it as overwhelming or manageable.

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How is cancer pain treated?

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

• surgery, radiation therapy and drug therapies
• medicines specifically for pain
• interventions such as nerve blocks or spinal procedures such as epidurals
• other treatments, such as physiotherapy, psychological interventions and complementary therapies
• self-management strategies, such as pain management plans and goal setting.

Many people need a combination of treatments to achieve good pain control. It might take time to find the right pain relief for you, and you may need to continue taking pain medicines while waiting for some treatments to take effect.

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. 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.

Sometimes pain cannot be completely controlled. You may still feel some discomfort. However, your health professionals can help make you as comfortable as possible. If your pain persists, you can seek a second opinion or ask for a referral to a specialist pain management clinic.

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When can I use pain medicines?

You can use different types of pain medicines whenever you feel any level of pain. If you have pain, it’s better to get 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 medicine to take (the dose) and how often (the frequency). The aim is for pain to be continuously controlled.

Many people believe that they should delay using pain medicines 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.

There is no need to save pain medicines until your pain is severe. Severe pain can cause anxiety and difficulty sleeping. These things can make the pain harder to control. For more on this, see Using pain medicines.

If the pain doesn’t improve the first time you use a new pain relief method, 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.

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Is palliative care the same as pain management?

To “palliate” means to relieve. Palliative care aims to relieve symptoms of cancer without trying to cure the disease. Pain management is only one aspect of palliative care. The palliative care team may include doctors, nurses, physiotherapists, social workers, occupational therapists, psychologists and spiritual care practitioners. They work together to:

• maintain your quality of life by relieving physical symptoms
• support your practical, emotional, spiritual and social needs
• provide support to families and carers
• help you feel in control of your situation and make decisions about your treatment and ongoing care.

Your cancer specialist or nurse can put you in touch with a palliative care team for treatment in hospital or at home. This type of care can improve quality of life from the time of diagnosis, and can be given alongside other cancer treatments.

For more on this, see Palliative care.

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