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Pain, ASCO's curriculum

This section has been reviewed and approved by the PLWC Editorial Board, 05/05

Depending on the stage of disease, 30% to 75% of all patients experience pain from cancer. About 85% to 95% of cancer pain can be treated successfully. However, pain can make other aspects of cancer seem worse, such as fatigue (tiredness), weakness, sleep disturbances, and confusion.


Causes

Pain can come from the tumor itself or may be a result of cancer treatment.

Pain from the tumor. As tumors grow and spread to the bones or other organs, they can put pressure on nerves and damage them, causing pain. If cancer spreads or grows around the spinal cord, it can cause a compression of the spinal cord, which can cause severe pain or paralysis if not treated.

Pain from surgery. It is normal to experience pain from cancer surgery. Some people may have persistent pain for months or years from permanent damage to the nerves. Common procedures that cause pain afterward include the following:

  • Mastectomy (removal of the breast and, occasionally, the surrounding tissue)
  • Chest surgery
  • Neck surgery
  • Amputation of a limb

Pain from radiation therapy. Pain may develop after radiation therapy and go away on its own. It can also develop months or years after treatment, especially after radiation therapy to the chest, breast, or spinal cord.

Pain from chemotherapy. Certain chemotherapy can cause pain along with numbness in the fingers and toes. Usually this pain goes away when treatment is finished, but sometimes the damage is permanent.

Diagnosis

You know your own pain best. The doctor's job in managing pain is to listen to you, believe you, offer a solution, and keep repeating this process as long as the pain lasts. Your doctor may ask the following questions about your pain:

  • Where it hurts
  • When the pain stops and starts
  • How long it has been there
  • How intense the pain is

The doctor may also ask you to describe the pain using a scale from 1 to 10 or offer words that help describe the pain, such as burning, stabbing, or throbbing.

Managing pain

Doctors can treat pain in several ways:

  • Fixing the source of pain, such as treating the tumor or reducing inflammation
  • Changing the perception of pain, usually with pain-killing medications
  • Interfering with pain signals sent to the brain, through spinal treatments or nerve blocks

Depending on the source of the pain and the patient's health, there are many different combinations of medications and ways to give them. Most doctors know how to manage most pain, most of the time. Sometimes, pain and palliative care specialists (specialists who care for the physical, spiritual, psychological, and social needs of a person with cancer) are available as a resource to help patients manage more intense pain.

Pain medications

ASCO recommends the use of the pain treatment ladder developed by the World Health Organization (WHO). Using this system, mild to moderate pain is treated with mild painkillers (analgesics), and if the pain increases to moderate or severe, it is treated with opioid drugs, such as morphine. Pain medicines can be given in different ways, depending on the drug and the patient's overall condition:

  • By mouth (oral)
  • Under the tongue or inside the cheek
  • Under the skin
  • Into the veins (intravenous or IV)
  • Into the spine or area around the spine
  • By rectum

Often doctors will give patients a device where they can control the release of medicine into their own body, called patient-controlled analgesia (PCA). Pain medications are often given around the clock, with appropriate "rescue" doses for pain that surges suddenly through regular pain medications (called breakthrough pain).

Side effects. Pain medication, especially opioids, can cause constipation, nausea, sleepiness, confusion, or hallucinations. Many side effects can be treated, either with other medications, supplements, or by switching to another drug.

Managing pain without medication
Many people have found that other methods besides medication help control pain. Your doctor may be able to help you manage pain using more than one method. Make sure you share with your doctor what methods have previously worked for you.

  • Physical therapy or occupational therapy can help you use devices, such as prostheses, splints, or braces, to help ease pain.
  • Relaxation, distraction, hypnosis, or biofeedback
  • Nutritional support
  • Acupuncture

Your doctor or a pain specialist can help you learn more about these methods for controlling pain.

More Information

PLWC Feature: Cancer Pain

PLWC: Managing Side Effects

Cancersymptoms.org: Pain

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