How Cancer Causes Pain and What to Do About It
Medically reviewed by Cristian Zanartu, MDFact checked by Sarah Scott
Many people ask, "Does cancer hurt?" The answer is not simple. There are many different types of cancer pain, and some people with cancer will have a lot of pain, whereas others experience minimal pain. Cancer causes pain in different ways, and several factors can affect the degree of pain. It's helpful to communicate with your healthcare provider about your pain so that you can get effective pain relief with the fewest side effects.
What Determines Cancer Pain Levels
When cancer is in the early stages, and especially those cancers that are detected on screening exams, pain is very uncommon. Most people with advanced cancer, however, experience moderate to severe pain at some point in their journey.
Many variables affect whether cancer or cancer treatments will cause pain, and how severe that pain will be.
The Stage of the Cancer
When cancer is in the early stages, many people do not experience pain symptoms. In fact, this is one of the reasons that some types of cancer, such as pancreatic cancer, are often diagnosed at very late stages.
It's also why surveillance is so important for some types of cancer. For example, breast cancer that's only detectable on a mammogram may not cause any discomfort, whereas stage 4 breast cancer may cause a lot of pain due to issues like bone metastases.
The Type of Cancer
Some cancers are more likely to cause pain than others, though pain can occur with most forms of cancer. Furthermore, two people with the same type and stage of cancer may have completely different pain symptoms.
This does not mean that one person has a high pain tolerance and the other a low tolerance. The variation can happen because the effects of cancer can vary significantly even among similar cancers.
Pain Threshold and Tolerance
Pain threshold is defined as the point at which a sensation becomes painful. Pain tolerance is defined as the amount of pain it takes to bother you. Pain threshold and tolerance vary between people, and your personal levels also fluctate.
Whether a sensation is interpreted as painful is determined by genetic makeup, history of pain, medical conditions, and other factors. It is not right or wrong to experience pain.
Even so, one of the reasons people forego pain medications that could improve quality of life during cancer treatment is the desire to "be a good patient" and to appear "strong."
Conditions in Addition to Cancer
Not all pain experienced by people with cancer is due to cancer or cancer treatments. Healthcare providers use the term "co-morbidities" to describe the presence of more than one medical condition.
And co-morbidities that you have alongside cancer can be a major cause of pain. For example, someone with lung cancer may also experience pain due to arthritis or degenerative disc disease.
Cancer Treatments
Many cancer treatments can cause pain, including:
Surgery
Chemotherapy
Radiation therapy
In the early stages of cancer, the pain from treatments may be worse than the pain due to cancer itself.
How Cancer Causes Pain
Cancer and its treatments can cause pain in several ways. You can have pain for one or more of these reasons at different times during your cancer care.
Some causes of cancer pain include:
Tumor growth: Cancer can cause pain by compressing organs and nerves adjacent to the tumor.
Metastases: Metastasis (spread) of cancers to other regions of the body can cause pain.
Bone metastases: The spread of cancer to bones can be very painful. Pain from bone metastases is often treated with radiation or bone-modifying medications.
Substances secreted by the tumor: Some cancers secrete proteins that lead to pain. This includes some paraneoplastic syndromes that can develop due to some types of lung cancer.
Neuropathic pain: Neuropathic (nerve) pain is usually severe and may come from nerve damage from chemotherapy or tumors putting pressure on nerves.
The interventions used to control pain can vary depending on the type of pain. For example, neuropathic pain may not improve with medications that are used to treat pain that's caused by tumor growth. And bone pain is treated with specific medications that will not reduce pain due to other causes.
Describing Cancer Pain Symptoms
Healthcare providers use several terms to describe cancer-associated pain. Learning about these descriptions, as well as how to describe and rank your pain, will help you communicate with your healthcare provider so they can have a better grasp on how to best control your pain.
Acute pain: Comes on rapidly. It may last only a few moments or go on for days at a time
Chronic pain: Ongoing; usually lasts longer than six months
Breakthrough pain: Pain you feel despite pain-relieving treatments
Referred pain: Felt away from the actual source of the pain (for example, feeling shoulder pain during a gallbladder attack); common with nerve pain.
Phantom pain: Felt in a region of the body that isn't there, such as in a leg or breast that's been removed
Providers may also ask you about the quality and nature of your pain.
Severity | Is it barely there or the worst imaginable? |
Quality | Achy, sharp, dull, gnawing, stabbing, burning |
Frequency | How often do you feel it? Is it constant? |
Location | Where does it hurt? |
Modifying factors | What makes it better or worse? |
Effect on quality of life | How impaired are you due to pain? |
Effect on sleep | Difficulty falling asleep? Staying asleep? |
Pain Scales
To understand objectively how severe your pain is and monitor how effective your pain treatments are, healthcare providers often use pain scales. The simplest ones ask you to rate your pain on a scale of 1 to 10, with 1 being pain that you barely notice, and 10 being the worst pain you can imagine.
Managing Pain
Though many people with cancer harbor fear about pain, the majority of people with cancer can experience adequate pain management throughout their treatment.
Depending on the severity of your pain, you may be given:
Over-the-counter pain relievers such as Tylenol (acetaminophen) or Advil (ibuprofen)
Opioid painkillers such as Vicodin (hydrocodone-acetaminophen) or OxyContin (oxycodone)
Strong, quick-acting painkillers for breakthrough pain, such as morphine
Other pain-management options include:
Antidepressants
Anti-seizure drugs
Corticosteroids
Nerve blocks
Epidurals
Psychological approaches to help cope with pain include:
Short-term psychotherapy
Cognitive behavioral therapy
Structured support
The first step toward pain management is letting your care team know about it.
Why Cancer Pain Is Under-Treated
Studies suggest that one-third to one-half of people with cancer do not receive adequate treatment of pain.
The reasons are many, but some include:
The dangers of narcotic pain medicines
The desire to be a "good" patient
Fear of becoming addicted to pain medication
Lack of access
Fear that if pain medication is used now, it will not be effective later when you really need it
Talk to your healthcare provider about any apprehension you have about pain management so you can get a treatment that you are comfortable with—both physically and emotionally.
A Word From Verywell
Living with pain takes a toll on your quality of life. Taking an active role in your cancer care can help you get the best possible treatment for your pain.
Frequently Asked Questions
Is cancer typically painful?
Some cancers don't cause pain while others are intensely painful. Often, the pain of cancer is caused by complications, and not the tumor itself.
What does pain from cancer feel like?
The nature of cancer pain depends on the cause. For example, bone pain may be a deep, dull ache, while nerve compression from a tumor may be burning or tingling. Pain in an organ may be throbbing.
Where do you feel cancer pain?
Cancer pain is generally felt in the area of the tumor(s). Nerve damage from cancer treatments is generally in the treatment area. If you have nerve compression, pain may radiate to other areas.
What type of cancer is most painful?
While many types of cancer can be quite painful, bone and pancreatic cancers are among the most painful types. Other especially painful tumor locations include the head, neck, prostate, uterus, esophagus, and breast.