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 healthcare provider about your pain so that you can get effective pain relief with the fewest side effects.

What Determines Cancer Pain Levels

When cancer is in the early stages, and 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.

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

The Stage of the Cancer

When cancer is in the early stages, many people do not experience pain symptoms. 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 symptoms.

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 Threshold and Tolerance

Pain threshold is defined as the point at which a sensation becomes painful. Pain tolerance is defined as the amount of pain it takes to bother you. Pain threshold and tolerance vary between people, and your personal levels also fluctate.

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.

Even so, 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. Healthcare providers 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 cancer treatments can cause pain, including:

• Surgery
• Chemotherapy
• Radiation therapy

In the early stages of cancer, the pain from treatments may be worse than the pain due to cancer itself.

How Cancer Causes Pain

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

Some causes of cancer pain include:

• Tumor growth: Cancer can cause pain by compressing organs and nerves adjacent to the tumor.
• Metastases: Metastasis (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 from bone metastases is often treated with radiation or bone-modifying medications.
• Substances secreted by the tumor: Some cancers secrete proteins that lead to pain. This includes some paraneoplastic syndromes that can develop due to some types of lung cancer.
• Neuropathic pain: Neuropathic (nerve) pain is usually severe and may come from nerve damage from chemotherapy or tumors putting pressure on nerves.

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.

Describing Cancer Pain Symptoms

Healthcare providers use several terms 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 healthcare provider 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: Ongoing; usually lasts longer than six months
• Breakthrough pain: Pain you feel despite pain-relieving treatments
• Referred pain: Felt away from the actual source of the pain (for example, feeling shoulder pain during a gallbladder attack); common with nerve pain.
• Phantom pain: Felt in a region of the body that isn't there, such as in a leg or breast that's been removed

Providers may also ask you about the quality and nature of your pain.

Pain Scales

To understand objectively how severe your pain is and monitor how effective your pain treatments are, healthcare providers often use pain scales. The simplest ones ask you to rate your 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.

Depending on the severity of your pain, you may be given:

• Over-the-counter pain relievers such as Tylenol (acetaminophen) or Advil (ibuprofen)
• Opioid painkillers such as Vicodin (hydrocodone-acetaminophen) or OxyContin (oxycodone)
• Strong, quick-acting painkillers for breakthrough pain, such as morphine

Other pain-management options include:

• Antidepressants
• Anti-seizure drugs
• Corticosteroids
• Nerve blocks
• Epidurals

Psychological approaches to help cope with pain include:

• Short-term psychotherapy
• Cognitive behavioral therapy
• Structured support

The first step toward pain management is letting your care team know about it.

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 to pain medication
• 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 healthcare provider 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.