Pain

This often starts suddenly and feels ‘sharp’. It usually lasts days or weeks. Acute pain usually stops when the cause of the pain has been treated, or tissue in the area has healed.

• an operation
• a broken bone
• an infection.

If acute pain is not relieved, it may become chronic pain.

Chronic pain lasts for longer, usually for 3 months or more. It may be caused by the cancer. Sometimes it can be due to an ongoing side effect of cancer treatment or a late effect of cancer treatments. It is sometimes called persistent pain.

If you are taking regular painkillers for chronic pain, you may still feel sudden pain. This is called breakthrough pain. It is common and usually feels like the chronic pain, only worse.

Breakthrough pain can last for a short time. It may be treated with a short-acting painkiller. People who take long-acting painkillers will often use short-acting painkillers when they need to. Your doctors may need to increase the dose of long-acting painkillers if their effect is wearing off too soon.

Cancer that has spread to the bones (secondary bone cancer) can cause pain. The pain can feel different to different people but may be a dull ache that does not go away. It is often worse when you move.

This is when there is damage to, or pressure on, your organs or muscles. For example, when the liver is swollen it causes pain and discomfort in the tummy (abdomen).

This is caused by pressure on the nerves or by nerve damage. This may be due to the cancer or cancer treatments. You may have nerve pain at some times but not others. The area may feel numb or sensitive. The pain may be:

• burning or tingling
• stabbing or shooting
• like pricking, tingling or numbness on the skin.

Your doctor can prescribe drugs and other treatments to treat nerve pain.

An injury or problem in one part of the body may sometimes cause a person to feel pain in a different part of the body.

For example, someone with a swollen liver may feel pain in their right shoulder. This is because pain messages from the liver travel along the same nerves as messages from the skin of the right shoulder. The brain confuses them and thinks the pain is coming from a different place.

Some people experience pain in a part of the body that has been removed. For example, they may feel pain after having a limb removed (amputated), or a breast is removed (mastectomy).

Phantom pain can cause different pain sensations which are very real to the people who experience it. It can improve with time and may eventually go away. It may be complicated to treat and is usually managed by expert doctors at a pain clinic.

When you are at home, your GP can talk to you about medicines or treatments to help control pain. They can prescribe painkillers and check with you to see how well they are working. They can increase the dose of the painkiller or change you to a different drug if needed. Your GP can also contact your cancer doctor or nurse for further advice.

Your GP can arrange for a district nurse to visit. They can also refer you to other health professionals such as a specialist palliative care team or a pain team.

If you see your cancer doctor (oncologist) or nurse regularly, it is important to tell them about any pain you have. They can explain what is causing the pain and how to treat or control it. Some people may need tests to find out the cause of the pain.

Your cancer doctor or nurse may ask you to contact them if you have pain, or if it gets worse. It is important to follow their advice.

A district nurse can visit you at home to help you manage your pain. They can check that your pain medicines and treatment are working. They can advise you about:

• taking your medicines
• different ways of managing the pain
• getting equipment that helps make you more comfortable.

Seeing a physiotherapist can be helpful in certain situations. They may be able to show you different ways of moving to help manage the pain. If pain is affecting how far you can walk, they can suggest ways to make getting around easier. For example, they can arrange for you to have a wheelchair.

An occupational therapist can help provide equipment to make you more comfortable. For example, they may suggest special cushions or mattresses. If you have difficulty moving around, they can arrange handrails and ramps for your home to help you move more easily. They can also suggest ways to improve your energy levels and be more active.

A pharmacist can check your prescription, give you advice about your medicines and tell you how they may affect you. Tell your pharmacist if you are buying any over-the-counter medicines. They can tell you whether it is safe to take them with your prescribed painkillers and other drugs.

Specialist palliative care doctors and nurses are experts in managing symptoms such as pain. They also provide emotional support. Specialist palliative care teams work in hospitals, in the community and in hospices. The team may also include a physiotherapist, an occupational therapist and a counsellor or psychologist.

Some people find it helpful to see a counsellor or psychologist. This is a person who gives advice about managing feelings and behaviours. They can help you understand things that may be causing you pain or making it worse. They can help you find ways of coping with the pain and dealing with any worries or emotions that may be making the pain worse.

Many hospitals have specialist pain teams. The team includes doctors, nurses and usually an anaesthetist. Some teams also have a psychologist.

Your GP, cancer doctor or specialist palliative care team can refer you to a pain team. This can be very useful if your pain is difficult to control or you need a nerve block or other specialist treatment.

Some anaesthetists are also experts in pain management and help treat cancer pain. They may be part of a pain team. They can give you specialist treatments, such as a nerve block.

Sometimes it can help to spend some time in a hospice having your pain, symptoms and other problems treated. This may be for 1 to 2 weeks. Your community specialist palliative care team or GP can arrange this for you.

In the hospice, the doctors and nurses can adjust your medicines to get better control of your pain. They can often do this more quickly than if you were at home. Once your pain is controlled, you can go home again.

Below is a sample of the sources used in our cancer pain information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Fallon M, Giusti R, Aielli F, et al. Management of Cancer Pain in Adult Patients: ESMO Clinical Practice Guidelines, Annals of Oncology, 2018; 29 (Suppl 4): 166–191. Available from:  www.esmo.org/guidelines/guidelines-by-topic/supportive-and-palliative-care/cancer-pain (accessed Jan 2022)

Pain and symptom control guidelines for adults; Greater Manchester and Eastern Cheshire Strategic Clinical Networks 2019. Available from: www.england.nhs.uk/north‑west/wp‑content/uploads/sites/48/2020/01/Palliative‑Care‑Pain‑and‑Symptom‑Control‑Guidelines.pdf (accessed Jan 2022)

Palliative cancer care – pain. National Institute for Health and Care Excellence March 2021. Available from: cks.nice.org.uk/topics/palliative‑cancer‑care‑pain (accessed Jan 2022)

Scottish Palliative Care Guidelines. Available from: www.palliativecareguidelines.scot.nhs.uk (accessed Jan 2022)

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical professionals and people living with cancer. It has been approved by our Senior Medical Editor, Dr Ollie Minton, Macmillan Consultant in Palliative Medicine.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.