Pain is usually a sign that something is wrong.
There are various reasons for pain. Cancer treatments such as surgery, chemotherapy or radiotherapy can damage body tissue and sometimes nerves, causing pain. These are physical causes. Your emotions can also affect pain levels e.g. social or work pressures; feelings of anxiety or depression may make pain worse.
If you have pain, it can almost always be reduced. It is important to let a healthcare professional know as soon as possible, as the earlier treatment is started for pain, the more effective it will be.
Between 30 – 50% people with cancer will have some pain.* With advanced cancer, pain is more likely. Between 70 – 90% of people with advanced cancer will experience pain. Some people with cancer do not have pain because cancers do not have any nerves of their own. A growing tumour can press on nerves near to where it is growing and this is what causes pain.
If you have a lot of pain it can be frightening and make you think that your cancer must be growing. But the amount of pain you have does not necessarily relate to how advanced your cancer might be. A very small tumour that is pressing on a nerve or your spinal cord can be extremely painful. Yet a very large tumour somewhere else may not cause you any pain at all.
Having pain after successful treatment doesn’t necessarily mean that your cancer has come back. Some people get pain after cancer treatment such as radiotherapy or surgery. This pain can start or get worse some months or years after treatment. This is due to the nervous system repairing itself after nerves have been damaged.
It is understandable to worry, but your pain may not be related to your cancer. Sometimes it may be due to common causes of aches and pains, such as headaches, constipation or arthritis.
Types of pain
There are different types of pain:
- Acute pain starts suddenly and is short-term
- Chronic pain is felt over a longer period of time. It is usually caused by the cancer tumour
- Neuropathic (nerve) pain can come and go
- Visceral pain is felt when organs or tissues are damaged
- Breakthrough pain occurs in between regular, scheduled painkillers
- Total pain includes the emotional, social and spiritual factors that also affect somebody’s pain experience
If you have any of these types of pain, tell your healthcare team. They will be able to help control the pain with the right treatment.
How pain is felt and experienced depends on the individual. Your pain may be different from someone else who has had the same treatment or type of cancer as you. Describing your pain clearly will help your consultant find the best treatment.
It is possible to relieve all pain to some extent with the right treatment. Effective pain control should enable most people to be free of pain when they are lying down or sitting. This will also help you stay more positive and active.
Pain can be mild, moderate or severe. It can be treated using different strengths of painkiller, depending on your level of pain. To decide which type of painkiller is best, your consultant may use a tool called the analgesic ladder. The ladder shows each level of pain and the type of painkillers that are best to control it.
- Step one – mild pain, includes non-opioid drugs for example paracetamol and anti-inflammatory drugs
- Step two – moderate pain, includes weak opioid drugs for example dihydrocodeine, codeine phosphate or tramadol
- Step three – moderate to severe pain, includes strong opioid drugs for example morphine, fentanyl and oxycodone
Different painkillers do different things and are sometimes used in combination e.g. non-opioid painkillers are often used alongside weak or strong opioids. Some drugs are prescribed with painkillers to help control pain. These are often known as adjuvant drugs, which include:
- Bisphosphonates strengthen bones affected by cancer and reduce bone pain
- Denosumab injections reduce bone pain and the risk of fractures if cancer has spread to the bones
- Steroid tablets can reduce swelling and pain caused by a tumour pressing on a part of the body
- Anti-epileptic and anti-depressant drugs can reduce pain caused by nerve damage
- Antibiotics can help if pain is caused by an infection
- Muscle relaxants can be given if muscle spasms are making pain worse
Cancer treatments can help to reduce pain by shrinking a tumour and reducing pressure on nerves or surrounding tissues. If cancer treatment is given with the main aim of reducing or getting rid of symptoms rather than curing the cancer, it is referred to as palliative treatment.
- Radiotherapy treatment can give long lasting pain control for certain types of cancer pain such as bone pain. The treatment kills the cancer cells so that the tumour shrinks. The affected bone then begins to heal and strengthen itself. About 60 – 80% of people will have an improvement in their pain when treated with radiotherapy
- Chemotherapy or biological therapies can shrink many types of cancer to reduce symptoms such as pain
- Hormone treatments can shrink some types of advanced cancer such as breast, prostate, and kidney cancers
- Surgery can sometimes be used to control pain. Your surgeon may carry out an operation to take away as much of a tumour as possible. This is known as debulking and can relieve pain by relieving pressure
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