Does Cancer Hurt?

How Common is Cancer Pain and What Causes It?

man feeling pain
Does cancer hurt?.

The answer is to this question about whether cancer is painful is not as simple as a yes-or-no. Some people with cancer have a lot of pain, whereas others experience minimal pain. How does cancer cause pain and what factors determine how bad the pain will be? Why is cancer pain often under-treated, and what can you do so you or your loved one receives the best control of pain 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 and surgery cannot cure the disease. 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.                                           
  • The Type of Cancer - Some cancers are more likely to cause pain than others, though pain can occur with any form of cancer.                                                                                  

  • 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 - 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 causes pain. the cancer itself or the treatment. These include:

  • Growth of a Tumor Causing Compression of Nearby Structures - Cancer can cause pain by compressing organs and nerves adjacent to the tumor.
  • Metastases - Spread (metastases) of cancers to other regions of the body, especially the bones, can cause pain.

This article talks more about Types of Cancer Pain.

How Can You Communicate Your Pain Level With Your Doctor?

There are several terms that doctors use to describe pain in people with cancer.


  • 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?
  • What makes it worse and what makes it better?
  • How does the pain affect your daily activities?
  • How does the pain affect your sleep?

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 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. Learn more about pain scales.

Managing Cancer Pain

Though many people with cancer harbor fears about pain, the management of pain - 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. The following article goes into depth on Pain Management for Cancer.

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 rare for someone with cancer to become "addicted" to these medications. 
  • Lack of access - both to physicians to manage pain, and to pay the cost of pain medications.
  • Fear that pain medication is used now, it will not be effective later "when you really need it." (This is not true.)

Next Steps

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. The following article can help you write down your symptoms and needs so you can share these with your doctor.Sources:

Breuer, B. et al. How Well Do Medical Oncologists Manage Chronic Cancer Pain?: A National Survery. Oncologist. 2015 Jan 12. (Epub ahead of print)>

Deandrea, S., Montanari, M., Moja, L., and G. Apolone. Prevalence of undertreatment in cancer pain. A review of published literature. Annals of Oncology. 2008. 19(12):1985-91.

Greco, M. et al. Quality of Cancer Pain Management: An Update of a Systematic Review of Undertreatment of Patients With Cancer. Journal of Clinical Oncology. 2014. 32(36):4149-4154.

Kwon, J. Overcoming barriers in cancer pain management. Journal of Clinical Oncology. 2014. 32(16):1727-33.

National Cancer Institute. Pain Control: Support for People With Cancer. Accessed 05/22/16.