Does Cancer Hurt?

How Common is Cancer Pain and What Causes It?

man feeling pain
Does cancer hurt?. istockphoto.com

Many people ask the question, "Does cancer hurt?" The answer to this question is not simple for many reasons. There are many different types of cancer pain, and these may all be experienced in different ways. Some people with cancer will have a lot of pain, whereas others experience minimal pain. To understand cancer pain it's important to look at the different ways that cancer may cause pain, the factors that can affect the degree of pain, and more. It's also important to learn about how to communicate with your doctor about pain so that you receive the best pain relief possible with the fewest side effects.

Factors That Determine the Amount of Cancer Pain

There are many variables that affect whether a cancer (or treatments for cancer) cause pain, and how severe that pain will be. Some of these 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 cancers, such as pancreatic cancer, are often diagnosed only after their cancer has spread and become inoperable. For example, a breast cancer detected only on a mammogram may not cause any discomfort, whereas a stage 4 breast cancer may cause a lot of pain due to bone metastases or other mechanisms.                                           
  • The Type of Cancer: Some cancers are more likely to cause pain than others, though pain can occur with any form of cancer. 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. Instead, as we will note, there are many ways that cancer can cause pain, and these can vary significantly even among similar appearing cancers.                                                                         
  • Pain Tolerance:  Pain tolerance varies considerably among different people, and even between different locations or types of pain experienced by an individual. Pain tolerance is defined as the amount of pain a person can handle before breaking down physically or emotionally. Pain threshold, in contrast, is defined as the point at which a sensation becomes painful. Whether a sensation is interpreted as painful is determined by genetic makeup, history of pain, and medical conditions among other factors  It is not right or wrong to experience pain. In fact, one of the reasons people forego pain medications during cancer treatment which could improve quality of life is the desire to "be a good patient" and appear "strong.
  • Conditions in Addition to Cancer: Doctors use the term "co-morbidities" to describe additional medical conditions that may be affecting a person with cancer, and these co-morbidities are very important to consider when evaluating pain. Not all pain experienced by people with cancer is due to cancer or cancer treatments. 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. In the early stages of cancer, the pain due to treatments may be worse than pain due to the cancer itself.

How Common Is Pain in People With Cancer?

When cancer is in the early stages, especially those cancers that are detected on screening exams, there may be very little pain. For people with advanced cancer, however, the vast majority of people experience moderate to severe pain at some point in their journey.

How Does Cancer Cause Pain?

There are several ways that cancer or the treatments for cancer can cause pain. It's important to identify these causes, as the most effective treatments can vary depending on the type of pain. For example, neuropathic pain may not respond to medications that are used for pain caused by the growth of a tumor in a particular region. For bone pain, there are specific medications (bone-modifying therapies) that may be effective, but these will not reduce pain due to other causes. Some types of cancer pain include:

  • Growth of a Tumor Causing Compression of Nearby Structures: Cancer can cause pain by compressing organs and nerves adjacent to the tumor.
  • Metastases to Other Organs: Spread (metastases) of cancers to other regions of the body can cause pain.
  • Bone metastases: The spread of cancer to bones can be very painful. While some pain medications may be used to control pain caused in a number of different ways by cancer, pain related to bone metastases is usually addressed locally, through radiation or bone-modifying medications.
  • Substances Secreted by the Tumor: Some cancers actually secrete proteins that can cause pain.  Examples include some of the paraneoplastic syndromes seen with small cell lung cancer and squamous cell lung cancer.
  • Neuropathic pain: Neuropathic pain is usually severe pain, and may be caused by the pressure of a tumor on nerves, due to chemotherapy (especially drugs such as Taxol) and radiation therapy. There is currently a lot of research looking at treatments for peripheral neuropathy caused by chemotherapy.

    How Can You Communicate Your Pain Level With Your Doctor?

    There are several terms that doctors use to describe pain in people with cancer, and this can be confusing. Learning about these descriptions, as well as how to describe and rank your pain, will help your physician have a better grasp on how to best control your pain.

    • Acute pain often comes on rapidly and lasts for only a short period of time.
    • Chronic pain is pain that tends to be present 24/7 and may persist for days, weeks, or even years.
    • Breakthrough pain is pain that you feel despite your pain treatment regimen (in other words, is not controlled by the pain medication you are using). 
    • 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 in your leg after an amputation for sarcoma, or feeling pain in your nipple or your "breast" 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 done by asking you how you would 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 Cancer Pain

    Though many people with cancer harbor fears about pain, pain management for cancer, even for people with advanced cancer, has progressed significantly in the past few decades. The majority of people with cancer can now experience adequate pain management throughout their treatment. That said, physicians can't read minds, and can only meet the pain management needs of patients if they are made aware of the pain and its severity.

    Why Is Cancer Pain Under-Treated?

    Studies suggest that a-third-to-half of people with cancer do not receive adequate treatment of pain.The reasons are many, but some include:

    • Reluctance of physicians to prescribe narcotic pain medicines.
    • The desire to be a "good" patient.
    • Fear of becoming addicted: While people with cancer often develop a tolerance to pain medications, meaning that it takes a larger dose to achieve the same level of pain relief, it is uncommon for someone with cancer to become "addicted" to these medications. 
    • Lack of access: There are many ways in which a lack of access can affect pain control, ranging from the reluctance of some physicians to prescribe opioids, to a lack of physician understanding of pain management, to a person's inability to afford pain medications.
    • Fear that pain medication is used now, it will not be effective later "when you really need it." This is not true, and there are many options for pain control. These include not only pain medications, but radiation, nerve blocks, and more.

    A Word From Verywell

    Taking an active role in your medical care can help ensure you get the best possible treatment for your pain as well as other symptoms, with cancer.

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