About cancer pain

Having cancer does not mean you will have pain. But if you have pain there are different medicines and treatments than can help. These include non-drug treatments and things you can do to help relieve pain.

The amount of pain a person has is not related to how advanced a cancer is. Pain does not always get worse as cancer develops. Some people may not experience any pain.

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How we experience pain

Physical pain is usually caused by an injury or illness in the body. Nerves in the damaged part of the body send warning signals to the brain. The brain responds by making us feel pain or discomfort. 

But pain is also an emotional experience. How we feel can be linked to how we experience pain. Pain can feel worse when we feel anxious and easier to cope with when we are more relaxed.

When pain is not treated, it is common to feel anxious, irritable, frustrated and depressed. Tiredness and lack of sleep also make pain feel worse and harder to cope with. Your home or work life and the people around you can also have a positive or negative effect on pain.

Controlling pain

Different health professionals can help to make sure the pain is well controlled. This can help you to keep doing the things in your life that are important to you.

Everyone’s experience with pain is different. The aim is to find the pain relief that suits you and allows you the best possible quality of life. Pain control is more effective when it starts as soon as possible. But it should continue through treatment and your follow-up care if needed.

What causes cancer pain?

Cancer or cancer treatment

People with cancer may have pain for different reasons. Pain may be caused by the cancer, or its treatments, or have another cause.

Pain can affect people with cancer at any stage. But it is more common when cancer is advanced. Having the pain controlled is an important part of your treatment and care.

Some possible reasons for pain are:

  • The cancer pressing on tissues or nerves, or on a bone or an organ nearby.
  • The cancer blocking a part of the body, for example the bowel, and stopping it working normally.
  • Surgery causing nerve or tissue damage in the area.
  • Radiotherapy damaging the skin or nerves in the treated area.
  • Side effects of anti-cancer drugs, such as a sore mouth, nerve damage (peripheral neuropathy), or muscle or joint stiffness or pain.
  • Late effects of treatment – side effects that do not improve after treatment, or start months or years later.

If you get a new ache or pain you may worry the cancer has come back, or is getting worse. This is a common worry. But there are different reasons for changes in pain levels.

Always tell your doctor about any new pain or symptom, so you can get the right treatment.

Other health conditions

Some people have pain from other health conditions, for example, arthritis or diabetes. Your pain treatment plans should also include other conditions that cause pain

What can make pain feel worse?

Pain is not always due to cancer. Other causes of pain include:

  • Emotional stress

    Sometimes, emotional stress such as anxiety, depression and tiredness can make pain feel worse. But people may also develop these problems if pain is not controlled. Getting emotional support may help to relieve pain.

  • Social effects

    Social or work stresses can also affect how you experience pain. For example, not being able to get out and see friends or go to work may make pain feel worse.

Types of pain

Your doctors or nurses may talk about your pain in different ways. Pain can be described or grouped depending on:

  • how long it lasts
  • the parts of the body that are affected.

There are many types of pain.

  • Acute 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.

    Acute pain can be caused by things such as:

    • an operation
    • a broken bone
    • an infection.

    If acute pain is not relieved, it may become chronic pain. For example, if you have pain after surgery, it may cause you to move the area less. This may mean it takes longer for the area to heal.

  • Chronic pain

    Chronic pain lasts for a longer time, usually for 3 months or more. It may be caused by the cancer or sometimes by long-term effects of cancer treatments (called late effects).

  • Breakthrough pain

    This is a sudden pain that ‘breaks through’. It usually happens when chronic pain is being controlled with regular long-acting painkillers. Breakthrough pain is common.

    Sometimes it is not clear why it happens. It may be because

    • the effect of the regular long-acting painkillers has worn off and the dose is not high enough 
    • the pain is worse at a certain time of day or evening 
    • of sudden movement or even coughing.

    Breakthrough pain can be successfully treated with short-acting painkillers. Increasing the dose of your painkillers can also help. People often take long-acting painkillers and use short-acting painkillers when they need to.

    Using a short-acting pain killer can be especially helpful if you plan to do something more energetic or if there is an event you want to go to.

  • Bone pain

    If the cancer has spread to the bones, it can cause pain. If the cancer started in the bones, this can also cause pain, but it is less common. The pain may be a dull ache that does not go away. It is often worse when you move.

  • Soft tissue pain

    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).

  • Nerve pain

    Nerve pain is also called neuropathic pain. It is caused by pressure on the nerves or by nerve damage due to the cancer or its treatments. It can come and go and the area may feel numb or sensitive. You might describe the pain as:

    • burning or tingling
    • stabbing or shooting
    • pins and needles.

    Certain anti-nerve pain drugs and other treatments can be used to treat nerve pain.

  • Referred pain

    This is when you feel pain in one part of the body in another area that is further away. For example, someone with a swollen liver may feel pain in their right shoulder. This is because pain signals from the liver travel along the same nerves as signals from the skin. The brain confuses them and thinks the pain is coming from a different place.

  • Phantom pain

    This is when you experience pain in a part of the body that has been removed. For example, this could be after having a limb amputated, or sometimes after 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. 

How to talk about your pain

It is important to tell your doctor or nurse if you have pain and how it is affecting you. Relieving pain is an important part of your treatment and care.

Some people may not want to talk about the pain they are having. They may feel they are complaining and should accept having pain. Or they may worry that the pain means the cancer has got worse. But there are many reasons pain happens. Controlling pain will help you do the things you want to do and stay more positive and active.

You can play an active role in managing your pain by:

  • being open with your healthcare team about the pain
  • describing the pain, where it is and how it affects your life
  • telling your healthcare team if the pain gets worse or lessens
  • talking to your healthcare team about any worries you have about the different ways the pain can be managed.

Having a pain assessment

Your doctor or nurse will start by asking you lots of different questions about the pain and how it affects you. This is called a pain assessment. It helps to make sure your doctors give you the best painkillers or treatment for your situation.

Your doctor also usually examines you. If they need to check the cause of the pain, they may arrange some tests for you.

All this information helps your team, you and your family to plan the best way to manage the pain.

Keeping a pain diary

Describing your pain helps your doctors find the right treatment for the type of pain you have.

Sometimes it is hard to put this into words. You might find our pain diary helpful to keep a record of your pain. It has a diagram of the body so you can mark where you feel pain. It also gives examples of words and questions that you may find helpful when describing your pain.

Keeping a record of the pain can be helpful and show a pattern which can be used to help improve pain control.

Who can help when you have pain

Different health and social care professionals may be involved in managing your pain. It is important that you and your family know who is responsible for managing your pain control. You need to know who to contact if you have problems and what numbers to call.

If you are at home, your GP will usually be your first point of contact. If you are in hospital, it is important to talk to the nurses and doctors looking after you. If you are having cancer treatment, you may have contact numbers for your cancer nurse or doctor. You can contact them directly if you have problems.

You may have a specialist symptom control nurse who visits you at home, or you may attend a pain clinic. If you are not sure who you should contact, ask your GP.

People you can talk to about your pain:

  • GP

    When you are at home, your GP can talk to you about medicines or treatments to help control the pain. They can prescribe painkillers and check to see how well they are working for you. 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. For example, this could be to a specialist palliative care team or to a pain clinic team.

  • Cancer doctor or nurse

    If you are having treatment or going to clinic regularly, it is important to tell your cancer doctor (oncologist) or nurse about any pain. 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 very important to follow their advice.

  • District nurse

    A district nurse can visit you at home to help you manage your pain. They can check your pain relief is working and advise you about taking your medicines. They can also advise you about:

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

    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 the 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.

  • Occupational therapist

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

  • Pharmacist

    A pharmacist will know about any pain medicines you have been prescribed. They can check your prescription, give you advice about your medicines and explain 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.

  • Specialist palliative care team

    Specialist palliative care doctors and nurses are experts in managing symptoms. 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, a counsellor or a psychologist.

  • Counsellor or psychologist

    Some people find it helpful to see a counsellor or psychologist. This is a person trained to help you manage your emotions. They can help you think about other 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.

  • Pain team

    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.

  • Anaesthetist

    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.

  • Hospices

    Sometimes it can help to spend some time in a hospice having your pain, symptoms and other problems treated. This is often 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 the dose of painkillers, or give you new ones, more quickly than if you were at home. Once your pain is controlled, you can go home again.

Painkillers and treatments to manage pain

Painkillers

Painkilling drugs are known as analgesics. There are many painkillers available to treat different types and levels of pain.

There are other drugs you often have with painkillers to help relieve pain. These include bisphosphonates and steroids.

Your medical team will aim to find the right combination of medicines for you. They will find out how the pain is affecting you by doing a pain assessment (see above).

We have more information about types of painkillers and ways they are used.

Managing pain with treatments

Cancer treatments given along with painkillers can also be used to help manage pain. It may take up to a few weeks for them to work and improve the pain.

  • Radiotherapy

    Radiotherapy uses high energy rays to shrink a cancer and can be used to reduce pain and other symptoms. It is often used to control pain when a cancer has spread to the bones. This is called secondary bone cancer. You usually only need 1 to 5 sessions of radiotherapy.

  • Surgery

    Surgery can help with pain control by removing part or all of a tumour to relieve pressure on organs or a nerve. It can also help by repairing or strengthening a damaged bone when cancer has spread to the bones.

  • Anti-cancer drugs

    You may be having drug treatments that help to shrink the cancer and reduce pain. These include:

  • Nerve blocks

    A nerve block is a treatment that blocks nerves from sending messages to the brain. It is a way of switching off a nerve to stop it causing pain. If you have pain that is difficult to treat, your doctor might suggest a nerve block.

    There are different types of nerve blocks. They are usually called by the names of the nerves that are blocked. After having the nerve block, you may be able to reduce your dose of strong painkillers. This can often be repeated.

    Nerve blocks are carried out by an expert pain specialist. This is usually an anaesthetist. They will talk over the benefits and possible risks with you. Your GP or hospital specialist can refer you to a pain team.

    The doctor may block the nerve using drugs, such as

    • local anaesthetics (sometimes given with steroids) – these produce a short-lasting nerve block
    • alcohol and phenol – these deliberately damage the nerve and give a long-lasting block. They  are less commonly used because of the side effects.

    Nerve blocks do not usually have many side effects. Some nerve blocks may cause low blood pressure or diarrhoea. But this usually improves after a few days.

 

Non-drug treatments and complementary therapies to help with pain

Some people find non-drug treatments and complementary therapies helpful in pain management. They can be used along with painkillers or sometimes on their own.

Certain treatments or talking therapies aim to help you cope with pain. For example, this can be with techniques to relax and de-stress your body and mind. Others use physical therapies to relieve the pain.

We have more information about pain management without drugs

Practical, financial and emotional support

Pain and practical worries

Coping with pain can be harder if you are anxious about:

Getting help with these things may help you feel less stressed. This can make pain easier to control.

Having more information about treatments and side effects may help. Talk to your doctors and nurses about concerns you have. You can also talk to one of our cancer support specialists on the Macmillan Support Line.

Voluntary and community organisations

There are voluntary and community organisations that may be able to offer support.

  • British Red Cross

    The British Red Cross has volunteers who can help you with things such as shopping, posting letters or changing library books. They may even help with taking you to a hospital appointment. They can also lend equipment such as wheelchairs and commodes (portable toilets).

  • Disabled Living Foundation (DLF)

    The Disabled Living Foundation (DLF) give information and advice to disabled people. They also have advisers and occupational therapists who can advise about mobility aids and equipment.

  • Good Neighbour Schemes

    Some parts of the UK have schemes called Good Neighbour Schemes. They help people with things like shopping, meeting other people or transport. The schemes are usually run by social services or local community organisations.

Cancer pain and your emotions

Having cancer affects every part of your life. Being in pain affects not only your body, but also how you think and feel. People can have lots of emotions when they are in pain. These include feeling angry, frustrated, frightened or isolated.

Controlling the pain will improve the way you feel. It also means you will be able to do the things you enjoy and see other people. Always talk to your doctor if the pain is not controlled. Talking therapies such as cognitive behavioural therapy (CBT) may also help you to manage pain.

Depression

If pain is not well controlled, you may feel depressed. You may have a low mood most of the time. You may also have difficulty sleeping or no appetite. The pain may feel worse and harder to cope with.
If you think you may be depressed, talk to your GP. They can help you to get the right treatment and support.

Emotional support

There are many people and organisations that can help you cope with these feelings. Non-medical treatments may also help. Ask your doctor or specialist palliative care nurse which ones would be best for you.

It can help to talk about your feelings. You could talk to your partner, a close friend or a family member. If you do not talk, they may not realise you are in pain or how the pain is making you feel. They may not understand why you are angry or upset.

If you prefer not to talk to anyone you know, talk to your GP or specialist palliative care nurse. They can help by putting you in contact with a counsellor. You could also contact the British Association for Counselling and Psychotherapy. Or you can speak to our cancer support specialists on 0808 808 00 00.

  • Useful organisations

    Different organisations offer advice, support and information about pain, such as:

  • Support groups

    It can often help to share how you are feeling with other people who understand what you are going through. Support groups offer a chance to talk to other people who may also be managing pain.

  • Online support

    Many people find support on the internet. There are social networking sites and support groups for people affected by cancer. There are also forums, chat rooms and blogs. These include Macmillan’s Online Community. You can use these to share your experience, ask questions and get advice. Or you can just read about other people’s experiences.

  • Spiritual support
    A person’s spirituality can be an important source of comfort and strength. It may be part of your religious beliefs. Or it may be part of your personal values, beliefs and relationships.

    Some people with cancer find their spiritual beliefs are challenged by their situation. They may experience ‘spiritual pain’ and feel abandoned, or frightened. Sometimes they may withdraw from family and friends.

    If you feel like this, it can often help to talk to someone about these feelings. You can talk to friends and family, a hospital chaplain or a religious leader. A counsellor or someone from a cancer support organisation may also be able to help.

About our information

  • References

    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, Giusti, Aielli et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Annals of Oncology. 2018. 29: 166–191. 

    O'Brien, Christrup, Drewes, et al. European Pain Federation position paper on appropriate opioid use in chronic pain management. European Journal of Pain. 2017. 21: 3-19.  


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Viv Lucas, 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.