People with cancer may have pain for a number of reasons. Healthcare professionals can help you manage your pain in the hospital, local community, or at home.
Not everyone with cancer will have pain. Around half of the people who have treatment for cancer have some pain. When cancer has come back or spread, up to 9 out of 10 people (90%) have pain.
The way people feel and experience pain varies. Even people with the same type of cancer can have very different experiences. Having pain doesn’t always mean that the cancer is advanced or more serious.
Pain doesn’t always get worse as the cancer develops. You might find it helpful to keep a record of your pain in the pain diary.
It is important to remember that cancer pain can almost always be reduced. If you have pain, it’s important to tell your doctors and nurses (healthcare team) so they can treat it. The earlier you have treatment for pain, the more effective it is.
Cancer or cancer treatment
People with cancer may have pain for a number of reasons.
- pressing on the tissue around it, such as a bone or a nerve.
- stopping parts of the body from working normally. For example, a cancer can block the bowel, which causes pain.
If you develop a new ache or pain, or another new symptom, you may worry that the cancer has come back. Or you may think it is getting worse or has spread. But these are not necessarily the reasons for the pain. It is always best to tell your doctor about any new pain or symptom, so you can get the right treatment.
Cancer treatments can affect normal tissues in the body, sometimes leading to pain, for example:
- Surgery causes pain, as tissues are cut or damaged.
- Chemotherapy can cause a sore mouth.
- Radiotherapy can damage the skin in the area being treated.
The pain usually goes away once the treatments are completed and the tissues have healed.
Other health conditions
Other conditions, such as arthritis or diabetes, can cause pain.
What can make pain feel worse?
Pain isn’t always due to cancer. Other causes of pain include:
Sometimes emotional stress such as anxiety, depression and tiredness can make your pain feel worse. This doesn’t mean that cancer pain is completely due to your emotions. But it is important to get the right help, and this may mean treating emotional stress as well as the physical causes of your pain.
Social or work stresses can also affect how you experience pain. For example, not being able to see friends or not being able to work can make pain feel worse.
Your doctors or nurses may talk about your pain in different ways. Below are different types of pain you may hear about:
Acute pain often starts suddenly and feels ‘sharp’. It can be caused by many different things, such as an operation, a broken bone or an infection. Most acute pain will go away when the reason for the pain has been treated or the tissues have healed. If acute pain is not relieved, it may become a chronic pain.
Chronic pain lasts for a longer period of time. It’s usually caused by the cancer itself, but it can sometimes be caused by the longer-term effects of cancer treatments.
This is a sudden pain. It sometimes breaks through when chronic pain is being well-controlled with long-acting painkillers. It may be brought on by moving or coughing. Or it can happen when the effect of the regular painkiller wears off. Breakthrough pain is common, but it can usually be successfully managed with short-acting painkillers.
If cancer is affecting a bone, it can cause pain. The cancer may have started in the bone (primary bone cancer) or spread there from another part of the body (secondary bone cancer). The pain may be a dull, persistent ache that doesn’t go away.
Soft tissue pain
This is pain we feel when our organs, muscles or tissues are damaged, injured or inflamed. An example is when the liver becomes enlarged, causing pain and discomfort in the tummy (abdomen). Soft tissue pain is also called visceral pain.
Nerve pain is also called neuropathic pain. This is pain caused by nerve damage. It may be due to the cancer or cancer treatments. The pain can often continue even when cancer treatment has finished. You may describe it as burning, stabbing, shooting or tingling. There are specific medicines and treatments used to treat nerve pain.
This is when pain from an internal organ can be felt in a different part of the body. For example, if the liver is enlarged, it can cause pain in the right shoulder. This may happen because pain messages from the liver travel along the same nerve pathways as messages from the skin. The brain confuses them and thinks the pain is coming from a different place.
This is when the brain ‘feels’ pain in a part of the body that has been removed. It can sometimes happen after surgery to amputate an arm or a leg, and occasionally after a breast is removed (mastectomy). Phantom pain may feel like cramping, stabbing or burning, but can cause many different pain sensations. It is important to let your doctor or specialist nurse know about phantom pain because there are specific medicines that may help.
Total pain is a term doctors and nurses use to describe all the different parts of a person’s pain. This includes how the pain affects, and can be affected by, our emotions, behaviours, spiritual beliefs and social activities. Your healthcare team will consider these things when assessing your pain. Tell them about any worries you have, even if they are not about your illness.
It’s important to talk about your pain and how it’s affecting you. Having pain that is not properly controlled can make you miserable and affect your everyday life.
Talking about pain.
Keeping a pain diary
Describing your pain as well as you can will help your doctors and nurses find the best way of treating it.
You might find using a 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.
To help manage your pain in the best way, your doctor or nurse will examine you and ask some questions about the pain. This is called a pain assessment. They may also arrange for you to have some tests and investigations. A pain assessment is important and will help your healthcare team make sure you get the best painkillers for your situation.
Various health and social care professionals may be involved in managing your pain. If you need support or extra help doing everyday things because of your pain, there are organisations that may be able to offer this.
It’s important that you and your family know who is supervising your pain control and who you should contact if you have pain or other symptoms.
While you are at home, your GP will usually be your first point of contact. If you are in hospital, you should talk to the nurses or your cancer doctor. If you are unsure who you should contact, ask your GP.
People you can talk to about your pain:
Your GP can tell you about medicines or other treatments you may need to control your pain. They can monitor you regularly to see what has helped. Your GP can arrange for a district nurse to visit, or refer you to other people who can help.
A district nurse can visit you at home to help you manage your pain. They can make sure your pain relief is working and help you with your medicines. They can contact the GP to renew prescriptions and give you advice about pain treatments.
Not everyone needs to see a physiotherapist, but they can be very helpful in some situations. They may be able to show you different ways of moving so that your pain doesn’t feel worse. If pain is affecting how far you can walk, a physiotherapist can suggest ways to make getting around easier. For example, they can arrange for you to have a wheelchair.
An occupational therapist may be able to sort out equipment to make you more comfortable. For example, special cushions or mattresses for when you are sitting or lying down. They can arrange handrails and ramps for your home to help you move around more easily. They can also suggest ways to help improve your energy and be more active.
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 your pain worse.
A pharmacist will know about any 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 helping people who are in pain. They can help you to manage other symptoms of cancer. They also provide emotional support. Specialist palliative care teams are found in hospitals, hospices and the community.
Sometimes it can help to spend a short period of time, often one to two weeks, in a hospice having your pain, symptoms and other problems treated. Your community specialist palliative care team or GP can arrange this for you. In the hospice, the doctors and nurses can often 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.
Many hospitals have specialist pain teams. The team will include doctors and nurses and usually an anaesthetist. Some teams also have a psychologist. Your GP or specialist palliative care team can refer you to a pain team. This is very useful if your pain is difficult to control or you need a nerve block.
Anaesthetists give drugs during and after operations. Some are also experts in pain relief and can help treat cancer pain. They may be part of a pain team. They can give you specialist treatments, such as a nerve block.
It is important to discuss your pain with your cancer specialist (oncologist) to ensure that the cause of the pain is diagnosed correctly. In some cases this may lead to a change in the way in which your cancer is treated.
Painkilling drugs are known as analgesics. There are many painkillers available to treat different types and levels of pain.
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.
Treatments to manage cancer pain
As well as being on the right painkillers, there are lots of other things that can help manage your pain. These include surgery and medical treatments.
Some people may have an operation to remove part, or all, of a tumour. This can help to relieve pressure on organs or a nerve. Surgery can be used to repair damaged bones. These treatments can sometimes help to relieve or improve cancer pain.
Chemotherapy and targeted therapies
Nerve blocks may help relieve pain by preventing pain messages getting to the brain. Nerves can be blocked using drugs such as local anaesthetics or other chemicals. Nerve blocks are usually short-acting. They are usually carried out by a pain specialist.
Other treatments for bone pain
Physical therapies to help pain
Many people find non-drug treatments can help relieve pain.
These non-drug treatments or therapies can be used on their own or with painkillers:
Physiotherapy and exercise
Pain may stop you from using the part of your body that hurts. This may lead to muscle or joint stiffness. You may be able to see a physiotherapist who will help treat the problem with gentle massage and exercise. This may help to relieve the pain.
When you exercise your body releases natural substances that have a similar effect to morphine and help to reduce pain. Ask your doctor or physiotherapist whether it is safe to exercise.
TENS (trans-cutaneous electrical nerve stimulation)
TENS is a way of managing pain using a mild electrical current. A TENS machine is a small battery-powered device with wires. The wires are attached to sticky pads, which are put on the surface of your skin (usually near the area of your pain).
The machine sends a small electrical current into your body that feels like a tingling sensation. It is important to check with your healthcare team before using a TENS machine. They are not suitable for everyone.
There are various complementary therapies that may help with pain. Some teach techniques that relax your body and mind. You may find some therapies helpful, but they may not work for everyone.
If you decide to use a complementary therapy, always talk to your doctor first. Complementary therapies should not replace any treatments prescribed by your doctor.
If you do use any complementary therapies, you should always use a qualified therapist.
Other things that can help with pain
Many people assume that drugs or other treatments are the only way to control cancer pain. But they are only one part of treatment. There are a lot of simple things that you and other people can do to make you feel better.
Stay as comfortable as possible
The way you sit or lie down can affect your pain. You can ask a family member or friend to help you change position as often as you need. This will also reduce the risk of your skin becoming sore because of being in one position for a long time. Your bedding may need to be regularly tidied or changed. You may feel a lot better when you get back into a cool bed with fresh sheets.
Equipment that can help you stay comfortable includes:
- v-shaped pillows or supports that help reduce backache and neck pain
- a bed cradle to keep the weight of blankets off weak or painful limbs
- a special mattress and cushions
- equipment to help with moving around and sitting.
Your district nurse can help you get these things, or tell you where to get them.
Use heat or cold
Heat pads and warm baths can help relieve aches and pains. They may help relax muscles and reduce joint stiffness. Ice packs can help relieve pain where there is inflammation and swelling. Some people find that alternating heat with cold helps them.
Always take care to protect your skin from burns when using heat pads and ice packs. Heat should not be used on areas of the body that are already inflamed or swollen, as it can make the swelling worse.
Watching TV, reading, playing computer games, listening to music or chatting to a friend are ways of using your mind to think of something else. Short periods of entertainment can help you feel better and cope better with your pain.
Short, regular visits from friends and family may help too.
It may also help to be as physically active as you can, with help if needed.
Music or art therapy
This is using music or art to help with anxiety and relax you. It may help you to express your feelings in a creative way. You don’t have to be musical or artistic. Music or art therapists often run classes at hospitals or hospices.
Going out and meeting other people while enjoying an activity may also distract you from any pain.
Although smoking may give a short-term relief from pain, it may be making things worse. Stopping smoking can be stressful, especially if you are coping with other problems, such as pain. But research has shown that smoking may have an effect on the nervous system and increase pain sensation. Smoking may also affect how painkillers work, making them less effective.
Pain and practical worries
Often, family or friends can help by getting information from doctors and nurses for you, or by researching services that can help. Getting help with the things that worry you can help you cope better with pain. If you are less stressed, this can make pain easier to control.
If you're worried about your pain affecting things like how you get to appointments or use public transport, find out more about what practical support is available.
Cancer pain and your emotions
Having cancer affects every part of your life. Being in pain not only affects your body, it also interferes with your thoughts and feelings. People can have lots of emotions when they are in pain. These include feeling angry, frustrated, anxious, isolated or depressed.
There are many people and organisations that can help you cope with your 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 a partner, a close friend or a family member.
If you don’t want to talk to anyone you know about your feelings, 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.
It can often help to share how you are feeling with other people who understand what you’re going through. Self-help or support groups offer a chance to talk to other people who may also be managing pain.
Many people get support on the internet. There are online support groups, social networking sites, forums, chat rooms and blogs for people affected by cancer. These include Macmillan’s Online Community. You can use these to share your experience and ask questions, get advice, or just read about other people’s experiences.