Cancer, cancer treatment, or diagnostic tests may cause you pain.

Pain is one of the most common symptoms in cancer patients. Pain can be caused by cancer, cancer treatment, or a combination of factors. Tumors, surgery, intravenous chemotherapy, radiation therapy, targeted therapy, therapies such as bisphosphonates, and diagnostic procedures may cause you pain.

Younger patients are more likely to have cancer pain and pain flares than older patients. Patients with advanced cancer have more severe pain, and many cancer survivors have pain that continues after cancer treatment ends.

This summary is about ways to control cancer pain in adults.

Pain can be managed before, during, and after tests and procedures.

Some tests and procedures are painful. It helps to start pain control before a procedure begins. Some drugs may be used to help you feel calm or fall asleep. Therapies such as imagery or relaxation can also help control pain and anxiety related to treatment. To help lower your anxiety, ask about the test before it begins so you know what to expect. Have a family member or friend stay with you during the procedure.

Different cancer treatments may cause specific types of pain.

Patients may have different types of pain from the treatments they receive, including:

• Postoperative pain.
• Spasms, stinging, and itching caused by intravenous chemotherapy.
• Mucositis caused by chemotherapy or targeted therapy.
• Ostealgia (bone pain) caused by filgrastim or pegfilgrastim, which are granulocyte colony-stimulating factors that help the body make more white blood cells.
• Peripheral neuropathy caused by chemotherapy or targeted therapy.
• Pain in joints and muscles caused by paclitaxel or aromatase inhibitor therapy.
• Osteonecrosis of the jaw caused by bisphosphonates given for cancer that has spread to the bone.
• Avascular necrosis caused by long-term use of corticosteroids.
• Pain syndromes caused by radiation therapy, including:

  • Pain from brachytherapy.
  • Pain from lying in the same position during treatment.
  • Mucositis (inflammation of the mucous membranes in areas that were treated with radiation).
  • Dermatitis.
  • Pain flares.

Peripheral neuropathy is a type of pain that can be caused by chemotherapy.

Peripheral neuropathy is a nerve problem that can cause pain, numbness, and tingling in the hands and feet. Patients on chemotherapy may have chemotherapy-induced peripheral neuropathy (CIPN). In some patients, CIPN may continue after chemotherapy has ended.

Studies of drugs and natural products used to treat CIPN have shown mixed results. Duloxetine is a drug that has been studied to treat CIPN.

Studies of acupuncture for CIPN have been reported. For more information about these studies, see the Chemotherapy-induced peripheral neuropathy section in Acupuncture.

Cancer pain may continue after treatment ends.

Pain that is severe or continues after cancer treatment ends increases the risk of anxiety and depression. If you feel depressed or have anxiety, your pain may feel worse and make it harder to control. Some patients are unable to work because of the pain.

Pain control can improve your quality of life.

Pain can be controlled in most patients who have cancer. Although cancer pain cannot always be relieved completely, there are ways to lessen pain in most patients. Pain control can improve your quality of life during cancer treatment and after it ends.

Each patient needs a personal plan to control cancer pain.

Each person's diagnosis, cancer stage, response to pain, and personal likes and dislikes are different. For this reason, each patient needs a personal plan to control cancer pain. You, your family, and your health care team can work together to manage your pain. As part of your pain control plan, your health care provider can give you and your family members written instructions to manage your pain at home. Ask your health care provider who you should call if you have questions about your pain.

Your health care team will ask you about your pain to determine the best treatment.

It's important that the cause of your pain is found early and treated quickly. Your health care team will help you measure pain levels often, including at the following times:

• After you start cancer treatment.
• After you start a new pain treatment.
• When you have new pain.

To learn about your pain, the health care team will ask you the following questions:

• When did the pain start?
• How long does the pain last?
• Where is the pain? You will be asked to show exactly where the pain is on your body or on a drawing of a body.
• How strong is the pain? You will be asked to rate your pain between 1-10, with 10 being the strongest.
• Have there been changes in where or when the pain occurs?
• What makes the pain better or worse?
• Is the pain worse during certain times of the day or night?
• Is there breakthrough pain?
• Do you have trouble sleeping, or do you feel tired, depressed, or anxious?
• Does pain get in the way of activities of daily life, such as when you eat, bathe, or move around?

Your health care team will also review your health history, including the following information:

• Past and current pain treatments.
• Prognosis.
• Other conditions you may have, such as kidney, liver, or heart disease.
• Past and current use of nicotine, alcohol, or sleeping pills.
• Personal or family history of substance use disorder.
• Personal history of mental health disorders or abuse.
• Your choices for your pain control plan.

The information you give your health care team will be used to decide how to help relieve your pain. Treatment may include drugs or non-drug therapies. In some cases, patients are referred to pain or palliative care specialists. Your health care team will work with you to decide whether the benefits of treatment outweigh any risks. They will also let you know how much relief to expect from your pain treatment. Your doctor will continue to ask you how well your treatment is working and make changes if needed.

A family member or caregiver may be asked to give answers for a patient who has problems with speech, language, or understanding.

Physical and neurological exams will be done to help plan pain control.

The following exams will be done:

• Physical exam: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual.
• Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks your mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.

Your health care team will also assess your psychological, social, and spiritual needs.

Drugs will be given based on whether your pain is mild, moderate, or severe.

Your doctor will prescribe drugs to help relieve your pain. These drugs need to be taken at scheduled times to keep a constant level of the drug in the body to help keep the pain from coming back. Drugs may be taken by mouth or given in other ways, such as by infusion or injection.

Your doctor may prescribe extra doses of a drug for pain that occurs between scheduled doses of the drug. The doctor will adjust the drug dose for your needs.

A scale from 0 to 10 is used to measure how severe the pain is and decide which pain medicine to use. On this scale:

• 0 means no pain.
• 1 to 3 means mild pain.
• 4 to 6 means moderate pain.
• 7 to 10 means severe pain.

Other pain scales that use happy or sad faces may be used for those who have trouble giving their pain a number. These scales are useful for adults who have trouble with memory or thinking, and with young children.

Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to relieve mild pain.

Acetaminophen and NSAIDs help relieve mild pain. They may be given with opioids for moderate to severe pain.

Pain relievers of this type include:

• Celecoxib.
• Diclofenac.
• Ibuprofen.
• Ketoprofen.
• Ketorolac.

Side effects of NSAIDs include stomach, kidney, heart, and blood problems. Patients, especially older patients, who take acetaminophen or NSAIDs need to be closely watched for side effects. For more information, see Treating Cancer Pain in Older Patients.

Opioids are used to relieve moderate to severe pain.

Opioids work well to relieve moderate to severe pain. Some patients with cancer stop getting pain relief from opioids if they take them for a long time. This is called tolerance. Larger doses or a different opioid may be needed if your body stops responding to the same dose. Tolerance of an opioid is a physical dependence on it. This is not the same as addiction (psychological dependence).

Since 1999, the number of prescriptions written for opioids and the number of deaths caused by drug overdose in the United States have increased. Although most patients who are prescribed opioids for cancer pain use them safely, some patients may become addicted to opioids. Your doctor will monitor your opioid doses so that you are treated for pain safely.

There are several types of opioids:

• Buprenorphine.
• Codeine.
• Fentanyl.
• Hydrocodone.
• Hydromorphone.
• Methadone.
• Morphine (the most common opioid for cancer pain).
• Oxycodone.
• Oxymorphone.
• Tapentadol.
• Tramadol.

The doctor will prescribe drugs and the times they should be taken to best control your pain. It is important that patients and family caregivers know how to safely use, store, and dispose of opioids.

Other drugs may be added to help treat your pain.

Other drugs may be given while you take opioids for pain relief. These are drugs that help the opioids work better, treat symptoms, and relieve certain types of pain. The following types of drugs may be used:

• Antidepressants.
• Anticonvulsants.
• Local anesthetics.
• Corticosteroids.
• Bisphosphonates and denosumab.

Patients will not always respond in the same way to these drugs. Side effects are common and should be reported to your doctor.

Bisphosphonates (pamidronate, zoledronic acid, and ibandronate) are drugs that may be given when cancer has spread to the bones. They are given as an intravenous infusion and combined with other treatments to decrease pain and reduce risk of broken bones. However, bisphosphonates sometimes cause severe side effects. Talk to your doctor if you have severe muscle or bone pain. Bisphosphonate therapy may need to be stopped.

The use of bisphosphonates is also linked to the risk of bisphosphonate-associated osteonecrosis (BON). For more information, see Oral Complications of Cancer Therapies.

Denosumab is another drug that may be used when cancer has spread to the bones. It is given as a subcutaneous injection and may help prevent and relieve pain.

Nerve blocks

A nerve block is the injection of either a local anesthetic or other drug into or around a nerve to block pain. Nerve blocks help control pain that can't be controlled in other ways. Nerve blocks may also be used to find where the pain is coming from, to predict how the pain will respond to long-term treatments, and to prevent pain after certain procedures.

Neurological treatments

Surgery can be done to insert a device that delivers drugs or stimulates the nerves with mild electric current.

Cordotomy

Cordotomy is a less common surgery that is used to relieve pain by cutting certain nerves in the spinal cord. This blocks pain and hot/cold feelings. This procedure may be chosen for patients who are near the end of life and have severe pain that cannot be relieved in other ways.

Palliative care

Certain patients are helped by palliative care services. Palliative care providers may also be called supportive care providers. They work in teams that include doctors, nurses, mental health specialists, social workers, chaplains, pharmacists, and dietitians. Some of the goals of palliative care are to:

• Improve quality of life for patients and their families.
• Manage pain and non-pain symptoms.
• Support patients who need higher doses of opioids, have a history of substance use disorder, or are coping with emotional and social problems.

For more information, see Planning the Transition to End-of-Life Care in Advanced Cancer.

Radiation therapy

Radiation therapy is used to relieve pain in patients with skin lesions, tumors, or cancer that has spread to the bone. This is called palliative radiation therapy. It may be given as local therapy directly to the tumor or to larger areas of the body. Radiation therapy helps drugs and other treatments work better by shrinking tumors that cause pain. Radiation therapy may help patients with bone pain move more freely and with less pain.

The following types of radiation therapy may be used:

Physical medicine and rehabilitation

Patients with cancer and pain may lose their strength, freedom of movement, and ability to manage their daily activities. Physical therapy or occupational therapy may help these patients.

Physical medicine uses physical methods, such as exercise and machines, to prevent and treat disease or injury.

Some patients may be referred to a physiatrist (a doctor who specializes in physical medicine) who can develop a personal plan for them. Some physiatrists are also trained in procedures to treat and manage pain.

Integrative therapies

Complementary and alternative therapies combined with standard treatment may be used to treat pain. They are also called integrative therapies. Acupuncture, support groups, and hypnosis are a few integrative therapies that have been used to relieve pain.

Certain factors affect cancer pain treatment in older adults.

Some problems are more likely in patients 65 years and older. For caregivers of these patients, the following should be kept in mind:

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