How Cancer Causes Pain and What to Do About It

Many people ask, "Does cancer hurt?" The answer is not simple. There are many different types of cancer pain, and some people with cancer will have a lot of pain, whereas others experience minimal pain. Cancer causes pain in different ways, and several factors can affect the degree of pain. It's helpful to communicate with your doctor about your pain so that you can get effective pain relief with the fewest side effects.

Cancer patient in bed holding hands with caregiver
KatarzynaBialasiewicz / Getty Images

Factors That Determine the Amount of Cancer Pain

There are many variables that affect whether cancer or cancer treatments will cause pain, and how severe that pain will be.

Some factors in cancer pain include:

  • The Stage of the Cancer: When cancer is in the early stages, many people do not experience pain. In fact, this is one of the reasons that some types of cancer, such as pancreatic cancer, are often diagnosed at very late stages. It's also why surveillance is so important for some types of cancer. For example, breast cancer that's only detectable on a mammogram may not cause any discomfort, whereas stage 4 breast cancer may cause a lot of pain due to issues like bone metastases.
  • The Type of Cancer: Some cancers are more likely to cause pain than others, though pain can occur with most forms of cancer. Furthermore, two people with the same type and stage of cancer may have completely different pain experiences. This does not mean that one person has a high pain tolerance and the other a low tolerance. The variation can happen because the effects of cancer can vary significantly even among similar cancers.                              
  • Pain Tolerance:  Pain tolerance varies among different people, and it can even fluctuate for an individual. Pain threshold is defined as the point at which a sensation becomes painful. Pain tolerance is defined as the amount of pain a particular person needs to feel bothered. Whether a sensation is interpreted as painful is determined by genetic makeup, history of pain, medical conditions, and other factors. It is not right or wrong to experience pain. In fact, one of the reasons people forego pain medications that could improve quality of life during cancer treatment is the desire to "be a good patient" and to appear "strong."
  • Conditions in Addition to Cancer: Not all pain experienced by people with cancer is due to cancer or cancer treatments. Doctors use the term "co-morbidities" to describe the presence of more than one medical condition. And co-morbidities that you have alongside cancer can be a major cause of pain. For example, someone with lung cancer may also experience pain due to arthritis or degenerative disc disease.
  • Cancer Treatments: Many of the treatments for cancer, such as surgery, chemotherapy, and radiation therapy can cause pain to develop. In the early stages of cancer, the pain due to treatments may be worse than pain due to cancer itself.

How Common Is Pain?

When cancer is in the early stages, especially those cancers that are detected on screening exams, pain is very uncommon. Most people with advanced cancer, however, experience moderate to severe pain at some point in their journey.

How Cancer Causes Pain

There are several ways that cancer or its treatments can cause pain. You can have pain for one or more of these reasons at different times during your cancer care.

Some types of cancer pain include:

  • Growth of a Tumor: Cancer can cause pain by compressing organs and nerves adjacent to the tumor.
  • Metastases: Metastases (spread) of cancers to other regions of the body can cause pain.
  • Bone metastases: The spread of cancer to bones can be very painful. Pain that's related to bone metastases is often treated with radiation or bone-modifying medications.
  • Substances Secreted by the Tumor: Some cancers secrete proteins, and the effects can lead to pain. Examples include some of the paraneoplastic syndromes that can develop due to small cell lung cancer and squamous cell lung cancer.
  • Neuropathic pain: Neuropathic pain is usually severe pain, and may occur due to nerve damage from chemotherapy or may be caused by the pressure of a tumor on nerves. There is currently a lot of research looking at treatments for peripheral neuropathy caused by chemotherapy.

The interventions used to control pain can vary depending on the type of pain. For example, neuropathic pain may not improve with medications that are used to treat pain that's caused by tumor growth. And bone pain is treated with specific medications that will not reduce pain due to other causes.

How to Communicate Your Pain Level With Your Doctor

There are several terms that doctors use to describe cancer-associated pain. Learning about these descriptions, as well as how to describe and rank your pain, will help you communicate with your doctor so they can have a better grasp on how to best control your pain.

  • Acute pain comes on rapidly. It may last only a few moments or go on for days at a time.
  • Chronic pain is pain that is ongoing and usually lasts for longer than six months.
  • Breakthrough pain is pain that you feel despite your pain treatment regimen. 
  • Referred pain is pain that is felt in an area away from the actual source of the pain—for example feeling shoulder pain during a gallbladder attack.
  • Phantom pain is pain that is felt in a region of the body that isn't there. For example, feeling pain where your leg used to be after an amputation for sarcoma, or feeling pain where your breast used to be after a mastectomy.

Other ways that pain is characterized include the:

  • Severity: Is the pain barely there, or is it the worst pain imaginable?
  • Quality: What does the pain feel like? Is it achy, sharp, dull, gnawing, stabbing, or burning?
  • Frequency: How often does the pain occur, or is it constant?
  • Location: Where do you feel the pain?
  • Modifying factors: What makes it worse and what makes it better?
  • Effect on quality of life: How does the pain affect your daily activities?
  • Effect on sleep: How does the pain affect your sleep? Do you have difficulty falling asleep, or does the pain awaken you during the night?

Pain Scales

In order to understand objectively how severe your pain is (and to monitor how well pain medication and other forms of pain relief are working,) doctors often use pain scales. The simplest of these is your rating of your own pain on a scale of 1 to 10, with 1 being pain that you barely notice, and 10 being the worst pain you can imagine.

Managing Pain

Though many people with cancer harbor fear about pain, the majority of people with cancer can experience adequate pain management throughout their treatment. That said, your physician can only meet your pain management needs of patients if you talk to them about your pain and its severity.

Why Cancer Pain Is Under-Treated

Studies suggest that one-third to one-half of people with cancer do not receive adequate treatment of pain.

The reasons are many, but some include:

  • The dangers of narcotic pain medicines
  • The desire to be a "good" patient
  • Fear of becoming addicted
  • Lack of access
  • Fear that if pain medication is used now, it will not be effective later when you really need it

Talk to your doctor about any apprehension you have about pain management so you can get a treatment that you are comfortable with—both physically and emotionally.

A Word From Verywell

Living with pain takes a toll on your quality of life. Taking an active role in your cancer care can help you get the best possible treatment for your pain.

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Article Sources
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