The Empowered Patient’s Guide to Cancer Pain

Getting into the ring with cancer isn't how anyone should have to prove their strength. Forgeit this fight by bringing pain to the attention of your healthcare provider as soon as you can. Don't ignore pain—it can be an early warning sign of cancer. Here's how to recognize and treat cancer-related pain. 

 

No one likes to think about "the C word" but pain can be an early sign of cancer so it's important to bring it to the attention of your healthcare provider. Catching and treating cancer early drastically improves your chances of making a full recovery.

Does Cancer Pain Hurt?

Yes. Pain and cancer unfortunately travel together. In fact, pain is one of the most commonly reported symptoms of cancer affecting more than 50% of people battling cancer and 70% of people with advanced stages of cancer.1

While the experience of cancer can vary from person to person, recognizing and discussing pain with your doctor is an important part of care.  

Cancer Pain Basics

In the United States, cancer impacts one in three people. Cancer occurs when healthy cells develop mutations that cause them to divide, even when more cells aren’t needed for the body to function normally.

As these mutated cells accumulate, they can form a tumor. Tumors can grown, invade, and destroy nearby tissue and—with time—may metastasize (spread). The cancer itself, the assault on healthy tissues, and treatment regimes can all contribute to the pain experience.

Cancer pain varies depending on the following factors:2

  • The type of cancer
  • The stage of cancer
  • The location of the cancer
  • Your own history and experience with pain

What Does Pain from Cancer Feel Like?

It’s important to communicate pain experiences with your doctor so that together, you can diagnose the type of pain and best manage it. Burning pain, aching pain, and pain from headaches can be caused by cancer. Understanding the different types of pain can help you better describe it to your healthcare provider. Here's a primer:

  • Nerve or neuropathic pain is the result of a tumor (or spreading cancer) putting  pressure on nerves connected to the spinal cord. Nerve pain can also be caused by pressure on nearby tissues of peripheral nerves—the nerves outside the brain and spinal cord. Nerve pain is often described as a burning, shooting, or tingling feeling similar to the sensation of your foot falling asleep or the way hot water feels on hands made cold in snow. 
  • Bone Pain (also called somatic pain) occurs when cancer spreads to the bones and is especially painful because bone tissue has a high number of pain receptors. The sensation is usually described as aching, dull, or throbbing. 
  • Soft Tissue Pain refers to pain affecting the muscles or organs. For example, you may experience back pain caused by damage to the kidneys or pain from lesions to the liver that cause it to stretch. It can be felt near the general origin of the pain but can also be difficult to pinpoint.The pain is usually described as sharp, cramping, aching, or throbbing. Soft tissue pain is sometimes called visceral pain.
  • Phantom Pain refers to pain in part of the body that has been removed and typically occurs after surgery, such as a mastectomy (breast removal) to treat the cancer. About one third of women who have a mastectomy report phantom pain. Despite the name, this pain is very real and is often described as severe. In most people, phantom pain subsides after a few months but it can persist for a year or more.
  • Referred Pain is a pain felt in part of the body other than the origin of the cancer. This can happen when the tumor presses on nerves.
  • Breakthrough Pain is intense and can occur without warning—even if you're taking medications to control your cancer pain. Known as "breakthrough pain" it can be experienced as a pain flare and happens frequently  This type of pain is usually unpredictable and happens frequently. It typically lasts for about 30 minutes each episode and is often sharp and radiating. Episodes can be triggered by a specific activity (eg, sneezing). Researchers say that up to two-thirds of people who have cancer pain also experience breakthrough pain, often several times a day.3

How Cancer Causes Pain

There are different reasons that cancer may cause pain including:

  • The tumor itself can cause pain by growing into or destroying nearby tissues.
  • As the tumor grows (and the cancer advances), it can press on nerves, bones, and organs.
  • Tumor cells can release algesic (pain causing) compounds that excite nociceptors (pain receptors) in nearby tissues, sending a pain message to the brain.4
  • The tumor can obstruct organs, such as the colon.
  • Cancer can lead to organ failure, resulting in an accumulation of fluid. For example, kidney failure can lead to an accumulation of extra fluid in your blood.
  • Pain can also result from different cancer medications or surgery used to treat the cancer.

Cancer Pain Red Flags

If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can cause pain. However, in many instances, pain can be a warning sign that cancer has begun to spread. Sometimes we ignore pain. We want to be “tough” or we dismiss our own needs, but it’s important to always report ongoing pain to your doctor.

  • Persistent pressure in the abdomen and pelvis and/or lower back that lasts for weeks could be a sign of ovarian cancer. This pain would likely be a new pain experience and is persistent (rather than coming and going).
  • A dull belly ache that persists without relief could be a sign of colon cancer.
  • Pelvic and low abdominal pain could be a sign of rectal cancer.
  • An ongoing headache that is no alleviated by treatment could be a sign of a brain tumor.

How Cancer Treatment Causes Pain

Whether a hard-to-catch warning sign, an effect of chemotherapy, or simply another difficult symptom, pain is a very real part of battling cancer. To further complicate matters, some procedures used to treat cancer can be the cause of pain.

  • Chemotherapy can cause a neuropathic pain, usually felt as burning, tingling, and numbness in the hands and feet. Treatment with chemotherapy may also cause a sore mouth, anywhere from 5 to10 days after starting treatment. Regular oral hygiene will be important to prevent sores and infections of the mouth. Chemotherapy may also induce mucositis—inflamed mucus membranes that can lead to bleeding, ulcers, trouble swallowing and sometimes, infection. Some people also experienced muscle pain and tenderness, joint pain, headaches, and stomach pains. Nausea is also a common side effect of chemotherapy. Bone pain, is another potential effect of chemotherapy,
  • Postoperative Pain may occur after the removal of a tumor or tumors. The prevalence of opioid prescriptions for postoperative pain has become a matter of debate—more on that in pain treatments.
  • Radiation Treatment may cause delayed tissue damage, including mucosal inflammation (mucositis) in areas receiving radiation. A temporary worsening of pain in the treated area for bone metastases may also occur.

To compound matters, some people will experience more than one sort of pain. Usually, pain caused by the cancer itself will improve with treatments. For example, as tumor size decreases, it may alleviate pain caused by pressure on nerves or other tissues.

You may find that your pain experience changes, or that it comes and goes. Social, emotional, and psychological factors may also influence your day-to-day experience.

Cancer Pain: What to Expect When You're In Pain

Cancer is scary; there’s a reason people refer to it as the C word. There’s a Voldemor-like quality to the disease and much of it is generated by a very rational fear. This fear, anger, and feelings of doom are often unexpected and are very real components of dealing with cancer pain.

Pain associated with cancer can greatly increase a person’s emotional distress. The past decade has shown advances in our understanding of the relationship between cancer pain and our mental/emotional state. In recent studies, those who experienced pain alongside their cancer, had significantly higher levels of anxiety, depression, and anger.5

But people experiencing cancer pain should also expect some relief. The National Cancer Institute reports that pain can be controlled in most patients who have cancer. Even in advanced stages of cancer, relief is possible, but relief and care is individual. Having a support network, open communication with your care provider, and tracking your symptoms will be an important part of improving daily life.

How to Talk to Your Doctor about Your Pain

When discussing your pain, it is important to communicate the following with your healthcare provider.6

  • When did the pain start? Knowing whether the pain began before or after treatment will be important. It is also important to tract changes in pain after beginning any new treatment.
  • Where is the pain?
  • How long does the pain last? Does it come and go or is it persistent?
  • How strong is the pain? Most likely, you will be asked to rate the pain on a scale of 1-10 (10 being the most severe).
  • What makes the pain better or worse?
  • Have there been changes in when or where the pain occurs?
  • Do certain activities, moods, or medications make the pain better or worse?
  • Is the pain worse during certain times of day or night?
  • How is your mental state? Trouble sleeping and feelings of anxiety, depression, and hopelessness should be noted and reported and, by the way, are a totally part of dealing with cancer for many people. 
  • Does the pain interfere with your daily activities? If so, what activities and to what extent does the pain interfere?

It’s always important to remember that your care plan is your choice and must fit with your life and personal preferences. For most, a well-rounded care plan that includes pharmaceuticals, complementary therapies (massage, acupuncture, physical therapy) and emotional/psychological counselling will offer the best results.7

Untreated, cancer pain can interfere with your day to day life—even during remission from the cancer itself. Pain can increase your risk for anxiety and depression and it is important to share these feelings with your doctor. Anxiety and depression are not signs of weakness, but are symptoms that can be managed with the help of your care team. 

Mental Health and Cancer Pain

When talking about cancer pain, we cannot exclude existential pain, the anxiety factor.

Anxiety

When we feel fear, uncertainty, and grief, there are very real physical changes in our brains; these can increase our pain experience. The difficulty is, much of these changes are initiated by the pain itself.

Researchers can observe physical adaptations in the brains of chronic pain patients, such as changes in various neural areas that modulate pain, including the prefrontal cortex, amygdala, and hippocampus.

These changes can induce and increase negative emotions, disrupted memory, and poor thought patterns which contribute feelings of anxiety. At the same time, focusing on the pain, feelings of doom, and stress can also cause changes in neural areas. These changes can actually increase the feeling of pain by increasing pain signaling.

If this feels like a vicious circle, you’re not wrong. However, there is good news. Changing your thought pattern and behaviors (ideally by working with an experienced therapist and pain management team) can positively change neural networks, and increase “feel good” neuroendocrine signaling.

The interplay between physical pain, mental, and emotional wellbeing can feel overwhelming, but it can also be used as a tool to decrease feelings of pain and increase quality of life.

Cancer Pain Management

There are many different treatment options to quell the pain associated with cancer. Medications  include:

  • Over the counter, prescription pain relievers such as, aspirin, acetominophen (Tylenol),  ibuprofen (Advil)
  • Weak opioids (codeine)
  • Strong opioids (morphine, oxycodone)
  • Antidepressants
  • Anti-seizure drugs
  • Steroids

Specialized Treatments

  • Nerve Block is a local anesthetic that is injected around or into the nerve and prevents pain messages from reaching the brain.
  • Palliative Surgery or Radiation Therapy is performed strictly for the purposed of easing pain and discomfort associated with cancer. Therapy is used to remove bowel obstruction, reduce compression of the spinal cord or peripheral nerves, and compression of organs. Palliative Surgery is used primary for people in the advanced stages of cancer

Alternative/Natural Therapies

  • Acupuncture has shown to be effective for reducing many types of cancer pain. Acupuncture helps relieve the pain associated with cancer by releasing morphine-like substances (endorphins) in the spinal cord and brain. Acupuncture also releases serotonin, a neurotransmitter (sometimes called the happy hormone) which can relieve pain and increase feelings of wellbeing.8
  • Medicinal Marijuana has shown to be effective in reducing certain pain symptoms associated with cancer but keep in mind that there is an absence of robust research (due to it’s current drug classification). Still, marijuana (especially a balanced ratio with 1:1 THC to CBD) may help reduce neuroinflammation, pain signaling, inflammation, and anxiety.9 Dronabinol, a pharmaceutical form of THC, and a man-made cannabinoid drug called nabilone are approved by the FDA to treat some conditions.
  • CBD is an extracted marijuana cannabinoid that won’t get you high. CBD may help to relieve pain, lower inflammation, and decrease anxiety.
  • Massage can be helpful for sore and fatigued muscles. A recent meta-analysis10 found that massage therapy significantly reduced cancer pain when compared with conventional care and no massage therapy— especially for surgery-related pain.
  • Physical therapy may relieve stiffness, soreness, and help to reduce symptoms of anxiety and depression that can increase pain experiences.
  • Relaxation techniques have been shown to help some people with cancer to manage their pain. Breathing and muscle tensing involves deep breathing, while momentarily tensing and relaxing major muscle groups, such as the thighs, shoulders, and feet. It is recommended to begin at the top of your head and work down to your toes. Slow, rhythmic breathing may also help. This type of relation usually involves laying on your back while thinking of a peaceful scene. With each exhale, you can envision your muscles releasing into the ground. Imagery also works well for some people. Imagery usually works best when people think of a scene that has made them calm or happy in the past.11
  • Hypnosis has been indicated as an adjunct therapy for cancer and cancer-treatment related pain. It may be useful in managing the various symptoms that accompany plain, including anxiety and depression.12 

The type of treatment you choose will depend on your type of pain, stage and location of cancer, personal history and personal preference. As medical professionals better understand the connection between pain and our brains, many are beginning to recommend a biopsychosocial approach to pain management.

The biopsychosocial approach views chronic pain as an interaction among various biological, psychological, and social components and uses and integrative approach to manage the pain condition.

What Can I Do Right Now For Cancer Pain?

Self care can't be overstated. Just getting through the day with cancer may feel like the ultimate struggle, especially while balancing the responsibilities of modern life. Often, remembering to care for yourself (or just finding the energy) can feel impossible. Still, there are certain steps you can take (at home) to live with less pain.

  • Take your vitamins. Calcium and vitamin D are especially useful for people undergoing hormone therapy (for cancers such as breast, or prostrate).13
  • Consume a healthy diet. We really are what we eat, and a balanced (think lots of colorful plants) diet can help to improve your mood and your body’s defenses. Some treatments may cause nausea and decrease appetite. Taking comfort in the healthiest version of your favorite foods (minimally processed) can do the body (and the mind) good. Foods that are rich in omega-3 fats (flaxseeds, walnuts, fatty fish) may be especially beneficial.14
  • Get rest and practice good sleep hygiene. Cancer, and cancer-treatments can interfere with your sleep, which can make you feel worse. To get more rest, try to go to sleep and wake up at the same time every day (even if you had a restless night). Put electronics away two hours before bedtime. If you cannot fall asleep after 20-30 minutes in bed, get out of bed and try an activity such as reading a book (non-digita).15

What Can I Do Right Now?

Having continuous conversations with your doctor and care team is crucial to managing and improving your pain. You’re a warrior, battling cancer and doing your best every day, and part of that involves open communication with your medical team. Doctors don’t always ask about pain, and the initial conversation can be difficult. You’re not alone. The majority of people living with cancer report pain as a significant symptom. Prepare to discuss your pain by writing down the specifics of your experience. Ask for treatment options that include a pain management team and an individualized plan.

Remember that your mental health is as important as your physical health (they are one in the same). Pain, anxiety and depression do not make you weak; asking for help can make you stronger. Treating pain is a process and it involves an individual and comprehensive approach.

Yes, cancer comes with a bundle of symptoms and painful realities; there are many practiced and new therapies to help manage your pain and improve your day-to-day life.

FAQs

What does the pain feel like when you have cancer?

The pain you feel with cancer will differ from person to person. The pain experience will depend on: the type of cancer, the stage of cancer, the location of the cancer, your own history and experience with pain. Different cancers will affect different parts of your body.

Pain that is neuropathic often presents as a burning, shooting, or tingling feeling. Bone pain is usually described as aching, dull, or throbbing. Soft tissue pain is usually described as sharp, cramping, aching, or throbbing. Phantom pain can happen when a surgery removes a body part with tumors (such as breast removal). Breakthrough Pain is an intense increase in pain (called flares) that occurs without warning—even if you’re taking medications to control your cancer pain.

Some cancers (such as colon cancer) present with a dull ache in the lower belly, or lower back. For some, this may feel less like an obvious pain, and more like a discomfort. Bellyaches that persist should not be ignored, as they can be a warning sign of a more serious problem.

How does cancer cause pain?

Cancer can cause pain in a variety of ways. The tumor itself can cause pain by growing into or destroying nearby tissues. As the tumor grows (and the cancer advances), it can press on nerves, bones, and organs. Tumor cells can release algesic (pain causing) compounds that excite nociceptors (pain receptors) in nearby tissues, sending a pain message to the brain. The tumor can obstruct organs, such as the colon.

Cancer can lead to organ failure, resulting in an accumulation of fluid. For example, kidney failure can lead to an accumulation of extra fluid in your blood. Pain can also result from different cancer medications or surgery used to treat the cancer.

What type of cancers can cause joint pain?

Bone cancer can cause joint pain if it causes swelling around the joint. Blood cancers, such as leukemia, lymphoma, and myeloma can cause joint pain by crowding the bone marrow with cancer cells. Certain types of chemotherapy and radiation therapy may also cause joint pain.

What medications help with cancer pain?

There are a variety of medications that can help with cancer pain.

  • Over the counter, prescription pain relievers such as, aspirin, Tylenol, ibuprofen
  • Weak opioids (codeine)
  • Strong opioids (morphine, oxycodone)
  • Antidepressants
  • Anti seizure drugs
  • Steroids

Specialized treatments include:

  • Nerve Block is a local anesthetic that is injected around or into the nerve and prevents pain messages from reaching the brain.
  • Palliative Surgery or Radiation Therapy is performed strictly for the purposed of easing pain and discomfort associated with cancer.Therapy is used to remove bowel obstruction, reduce compression of the spinal cord or peripheral nerves, and compression of organs. Palliative Surgery is used primary for people in the advanced stages of cancer
Updated on: 06/17/21
Continue Reading:
The Empowered Pain Patient’s Guide to Medical Marijuana
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