Overview
Cancer pain is pain caused by the cancer itself or cancer treatment.
There are many types of pain, including pain that starts suddenly and lasts a short time (acute pain), and pain that lasts longer than three months (chronic pain).
Explaining how the pain feels can help your healthcare team work out the cause of the pain and the best treatment. Using a pain scale or a pain diary may be helpful.
What's on this page
What is pain?
Pain is an unpleasant physical feeling. The International Association for the Study of Pain defines it as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”.
When there is damage to any part of your body, nerves in that part of the body send messages to your brain. When your brain receives these messages, you feel pain. This includes pain caused by cancer.
Cancer pain is a broad term for the different kinds of pain people may experience when they have cancer. Even people with the same type of cancer can have different experiences. The type of cancer, its stage, the treatment you receive, other health issues, your attitudes and beliefs about pain, and the significance of the pain to you, will also affect the way you feel pain.
Does everyone have cancer pain?
Not everyone with cancer will have pain. Those who do experience pain may not be in pain all the time. In recent years, the number of people with cancer who say they experience pain has decreased due to changes to treatment and improvements in pain management.
During cancer treatment, almost half of people (45%) say they experience some degree of pain. Almost a third say they experience moderate to severe pain. People with advanced cancer are more likely to have pain.
Types of cancer pain
There are many types of pain. Pain can be described or categorised depending on how long the pain lasts or what parts of the body are affected.
Acute pain
This is pain that starts suddenly and lasts a short time, possibly for a few days or weeks. It may be mild or severe. Acute pain usually occurs because the body is hurt or injured in some way, but it generally disappears when the body has healed.
Chronic pain
This is pain that lasts longer than three months. It may be due to an ongoing problem, but can also develop after any tissue or nerve damage has healed. It is also called persistent pain.
Breakthrough pain
This is a sudden flare-up of pain that can occur despite taking regular pain medicine for cancer pain. It may happen because the dose of medicine is not high enough or because the pain changes when the person changes position or moves around. Other causes of breakthrough pain include stress, anxiety or other illnesses.
Nerve (neuropathic) pain
This is pain caused by pressure on nerves or the spinal cord, or by nerve damage. It can come and go. People often describe nerve pain as numbness, burning or tingling, or as “pins and needles”. Nerve pain can occur anywhere nerves get damaged. For example, after breast surgery, some women have nerve pain in the chest wall or armpit. This is called post-mastectomy pain syndrome. Nerve damage from some chemotherapy drugs is felt as pain in the hands and feet and is called peripheral neuropathy.
Bone pain
This is pain caused by cancer spreading to the bones and damaging bone tissue in one or more areas. It is often described as dull, aching or throbbing, and it may be worse at night.
Soft tissue pain
This is pain caused by damage to or pressure on soft tissue, including muscle. The pain is often described as sharp, aching or throbbing.
Visceral pain
This is pain caused by damage to or pressure on internal organs. Visceral pain can be difficult to pinpoint. It may cause some people to feel sick in the stomach (nauseous). This type of pain is often described as having a throbbing sensation.
Referred pain
This is pain that is felt in a different area of the body from the area that is damaged (e.g. a swollen liver can cause pain in the right shoulder because the liver presses on nerves that end in the shoulder).
Localised pain
This is pain at the spot where there’s a problem (e.g. pain in the back from a tumour pressing on nerves in the area).
Phantom pain
This is a pain sensation in a body part that is no longer there, such as breast pain after the breast has been removed. This type of pain is very real.
During the treatment, I had pins and needles in my hands and in my feet. Walking just got to be almost impossible because I couldn’t quite walk properly at all.
Common questions about cancer and pain
What causes cancer pain?
What causes cancer pain?
Some people with cancer have pain caused by the cancer itself, by the cancer treatment, or by other health issues not related to cancer, such as arthritis. Pain can be experienced at any stage of the disease.
Before diagnosis
Cancer can cause pain before a diagnosis and the pain may come and go. In some cases, pain comes from the tumour itself, e.g. abdominal pain from the tumour pressing on bones, nerves or organs in the body.
Diagnosis
Tests to diagnose cancer can sometimes cause short-term pain or feel uncomfortable, e.g. you may need surgery to remove a sample of tissue for examination. Most pain caused by tests can be relieved.
During treatment
Some treatments cause pain, e.g. surgery; radiation therapy leading to skin redness and irritation; and cancer drug therapies such as chemotherapy, targeted therapy and immunotherapy leading to numbness and tingling in hands and feet (peripheral neuropathy).
After treatment
Pain may continue for months or years. Causes include scars after surgery; numbness in the hands or feet (peripheral neuropathy); swelling caused by a build up of lymph fluid (lymphoedema); and pain in a missing limb or breast.
Advanced cancer
If the cancer has spread, it can cause pain by a tumour pressing on a part of the body such as a nerve, bone or organ.
What affects pain?
What affects pain?
As well as the physical cause of the pain, your environment, fatigue levels, emotions and thoughts can affect how you feel and react to pain. It’s important for your healthcare team to understand the way these factors affect you.
Where you are
Things and people in your environment – at home, at work and elsewhere – can have a positive or negative impact on your experience of pain.
How tired you feel
Extreme tiredness (fatigue) can make it harder for you to manage pain. Lack of sleep can increase your pain. Ask your healthcare team for help if you are not sleeping well.
How you feel
You may worry or feel easily discouraged when in pain. Some people feel hopeless, helpless, embarrassed, angry, inadequate, irritable, anxious, frightened or frantic. You may notice your mood changes. Some people become more withdrawn and isolated.
What you’re thinking
How you think about pain can affect how you experience the pain, e.g. whether you believe it is overwhelming or manageable.
How is cancer pain managed?
How is cancer pain managed?
The way cancer pain is managed depends on the cause of the pain, but relief is still possible even if the cause is unknown. Often a combination of methods is used. Options may include:
- medicines specifically for pain
- surgery, radiation therapy and cancer drug therapies
- procedures to block pain signals such as nerve blocks or spinal injections
- other therapies, such as physiotherapy, psychological support and complementary therapies
- pain management plans.
It might take time to find the right pain relief for you, and you may need to continue taking pain medicines while waiting for some treatments to take effect.
Different pain relief methods might work at different times, so you may need to try a variety. The World Health Organization estimates that the right medicine, in the right dose, given at the right time, can relieve 80–90% of cancer pain.
If you have a new pain, a sudden increase in pain or pain that doesn’t improve after taking medicines, let your doctor or nurse know. Like a cancer diagnosis, pain that is not well controlled can make you feel anxious or depressed.
Listen to Cancer Council's podcast episode Managing Cancer Pain. The discussion includes some practical pain relief strategies.
When can I use pain medicines?
When can I use pain medicines?
The aim is for pain to be continuously controlled. You should take your pain medicine as prescribed. Sometimes this means taking pain medicine even when you don’t feel pain. If pain lasts longer than a few days without much relief, or you notice you are in more pain than usual, see your doctor. It’s better to get relief early rather than allowing it to get worse. This makes it easier to control and means you are likely to have less pain overall.
Your doctor will talk to you about how much medicine to take (the dose) and how often to take it (the frequency).
Many people believe that they should put up with pain for as long as possible and that they should only use pain medicines when pain becomes unbearable. If you do this, it can mean that you are in pain when you don’t need to be.
There is no need to save pain medicines until your pain is severe. Severe pain can cause anxiety and difficulty sleeping. These things can make the pain feel worse and harder to control.
If you think your pain medicine isn’t working or the pain returns before the next dose, it’s important to let your doctor know. They may need to adjust the dose, prescribe a different medicine or give an extra dose of medicine.
If the pain doesn’t improve the first time you use a new pain relief method, try it a few more times. If you’re taking medicine that doesn’t seem to work or has stopped working, talk to your doctor – don’t change the dose yourself.
Who helps manage my pain?
Who helps manage my pain?
Different health professionals help manage pain. They will often discuss ways to manage pain at a multidisciplinary team (MDT) meeting. If your pain is not well controlled, ask your general practitioner (GP) or palliative care specialist for a referral to a pain medicine specialist who is part of a multidisciplinary pain team.
Health professionals you may see
- general practitioner (GP) – assists with treatment decisions; provides ongoing care in partnership with specialists surgeon surgically removes tumours from the body radiation oncologist treats cancer by prescribing and overseeing a course of radiation therapy
- medical oncologist – treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy (systemic treatment)
- palliative care specialist – treats pain and other symptoms to maximise wellbeing and improve quality of life
- pain medicine specialist – treats all types of pain, particularly ongoing pain or pain that is difficult to control
- pain management team – includes pain specialist and nurses who work together to treat pain, particularly if it is difficult to control
- nurse practitioner – works in an advanced nursing role; may prescribe some medicines and tests
- nurse – administers drugs and provides care, information and support
- pharmacist – dispenses medicines and gives advice about dosage and side effects
- anaesthetist – provides anaesthetic medicines, monitors you during surgery, and provides pain relief during and after surgery
- physiotherapist – helps with restoring movement and mobility, and preventing further injury
- exercise physiologist – prescribes exercise to help people with medical conditions improve their overall health, fitness, strength and energy levels
- occupational therapist – assists in adapting your living and working environment to help you resume usual activities
- psychologist – helps identify and manage the thoughts, emotions and behaviours that affect your pain
- counsellor – helps you understand and manage your emotional response to diagnosis and treatment, usually in the short term
- social worker – helps with emotional, practical or financial issues.
Describing pain
Only you can describe your pain. How it feels and how it affects what you can do will help your healthcare team plan the most appropriate way to treat the pain. This is called a pain assessment. You may have regular pain assessments to see how well medicines and other ways of controlling pain are working, and to manage new or changed pain.
You can use different scales to describe your pain and how it is affecting you. These can help your healthcare team find the best pain control methods for you.
Questions your healthcare team may ask you about your pain
- Where in your body do you feel pain or discomfort?
- How would you describe the pain? (See Use a pain scale)
- How does it compare to pain you have felt in the past?
- What does it feel like? For example, is it dull, throbbing, aching, shooting, stabbing or burning? Are there any pins and needles or tingling? Are there areas where it feels numb?
- Does your pain spread from one area to another (radiate)?
- When did the pain or discomfort begin?
- How often are you in pain? How long does the pain last each time it occurs? (Try timing the pain.) What makes the pain better or worse?
- Do you have any flare-ups of pain?
- Which activities does it prevent you from doing (e.g. getting up, dressing, concentrating, bending down, walking, sitting for long periods, exercising, carrying things, driving, sleeping, having sex)
- What activities would you like to do if the pain improves?
- How does the pain make you feel emotionally?
- What pain relief methods have you tried? What helped or didn’t help?
- Did you have any side effects from pain medicines?
- What have you done in the past to relieve pain? How did this work?
- What does the pain mean to you?
Use a pain scale
Some people rate the level of pain on a scale. There are different kinds of scales.
| Word scale rates the pain from none or mild through to moderate or severe |
Number scale rates the pain from 1–10; the higher the number, the worse the pain |
Activity tolerance scale rates how much the pain affects what you can do, e.g. thinking, walking, carrying things |
Facial scale uses facial expressions to show how the pain makes you feel |
| no pain | 0, 1 | no pain |  |
| mild pain | 2 | can be ignored |  |
| moderate pain | 3, 4 | interferes with tasks |  |
| moderate pain | 5, 6 | interferes with concentration |  |
| severe pain | 7, 8 | interferes with basic needs |  |
| worst pain possible | 9, 10 | bed rest required |  |
Make a note of triggers
Write down what seems to cause or increase your pain. This is called a trigger, and it may be a specific activity or situation. Knowing what triggers your pain might help you find ways to manage these triggers.
Keep a pain diary
A written record of your pain can help you and those caring for you understand more about your pain and how it can be managed. Note down how the pain feels at different times of the day, what you have tried for relief and how it has worked. Some people track their pain using an app on a mobile device, such as a smartphone or tablet.
Keep a contact list
Make a list of the health professionals in your team and their contact details. Keep this handy in case you (or your carer) need to get in touch.
When to seek help
Talk to your doctors about what should prompt you to call them and who you can call, particularly after hours. For example, you may be instructed to call if you need to take four or more doses of breakthrough pain relief, or if you are feeling very sick or sleepy.
Seeking support
Cancer-related pain can affect every aspect of your life. You will probably experience a range of emotions – fear, sadness, anxiety and frustration are all common reactions.
There are many sources of support to help you, your family and carers cope with cancer-related pain, including:
- access to benefits and programs to ease the financial impact
- home care services, such as Meals on Wheels, visiting nurses and home help
- aids and appliances
- support groups and programs
- counselling services.
The availability of services may vary depending on where you live, and some services will be free but others might have a cost. To find good sources of support and information, you can talk to the social worker or nurse at your hospital or treatment centre, or get in touch with Cancer Connect on 13 11 20.
If you are living with pain, you may need help around the home or with children. It may be hard to tell people what to do, so you might prefer to ask a relative or close friend to coordinate offers of help. Your local council may also have volunteers or community services available.
You may think that people don’t understand the pain you’re in and the other emotions you’re feeling. Visit our our Emotions and Cancer page.
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