Pain

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A cancer diagnosis does not mean that you will have pain. Still, many people with cancer do have pain at some point. Good pain control is part of proper cancer care.

Managing pain may result in better treatment outcomes, so patients should talk to their healthcare team about their pain right away. Left untreated, pain can:

Limit the ability to work, exercise, sleep, and perform everyday tasks
Weaken the immune system, making it harder to heal and fight infection
Reduce appetite
Lead to anxiety and depression
Reduce intimacy with a partner

Your doctor should assess your pain and ensure that it's managed throughout your treatment and recovery. Pain management often includes a combination of medications and nondrug options to provide relief. If you are having trouble getting your pain under control, ask to see a pain or palliative (supportive) care specialist. 

Assessing and managing pain

Pain assessment is an important part of every medical appointment. Talk about any pain you have so your healthcare team can help manage it. You play the most important role in your pain assessment. Pain cannot be measured like your weight, blood pressure, or temperature—only you can describe your pain.

Accurately telling your healthcare team about your pain will help them work with you to develop a pain management plan. Honest and direct communication with your healthcare provider is important. Be as specific and detailed as you can about your pain.

As part of your pain assessment, a member of your healthcare team will ask you to “rate” your pain. One of the most common tools is a scale on which you rate your pain by choosing a number from 0 to 10. This is called the “numeric rating scale.” A zero means you have no pain and a 10 means you have the worst pain you can imagine.

Keeping a record of your pain on a daily or weekly basis can help you and your healthcare team better understand and manage your pain.

It can be hard to remember how pain has affected your everyday life, so it helps to write it down when it happens. Some ways to keep track of your pain include using a calendar, a journal, or a computer spreadsheet. Find the way that works best for you and stick to it.

Download lists of suggested questions to ask your healthcare providers about pain and its treatment.

Types of pain

You should never accept pain as a normal part of having cancer. If you or someone you love is in pain, tell a member of your healthcare team right away. Treating pain as soon as it starts, or even stopping pain before it begins, is key. No matter when you have pain, it’s important to remember that all pain can be treated and most pain can be controlled or relieved.

Acute and chronic pain

There are two main types of pain: 

Acute pain comes on quickly and lasts a brief time; it can range from mild to severe. This pain is nature’s signal to change a harmful behavior or seek medical attention. Acute pain is due to a known cause, such as damage resulting from surgery or an injury (like a fall). You might need pain medicine to treat acute pain. But once the event is over or the injury has healed, the pain usually goes away.
Chronic pain doesn’t go away or comes back often. It lasts beyond the usual healing time or more than a few months. Chronic pain can begin suddenly, or slowly become a problem. It may be constant, come and go, or get worse over time. Left untreated, it can suppress your immune system and slow healing.

Breakthrough pain

Breakthrough pain happens even though you’re taking pain medicines on a regular schedule to control chronic pain. In other words, the pain “breaks through” your regular pain management schedule. Breakthrough pain often comes on suddenly and lasts a short time. It may happen several times a day. Many people with chronic pain also have breakthrough pain.

Disease- and treatment related pain

People with cancer can have pain caused by the cancer itself, its treatment, or both. They may also have pain caused by other health problems that are unrelated to cancer (like arthritis or diabetes).

Increased pain does not mean that the cancer is getting worse, but you should always tell your healthcare team if you have increased pain.

It’s important to remember that no matter what the cause, pain can be treated.

Disease cancer-related pain

Many people with blood cancers have pain caused by the cancer itself. For instance, cancer cells can build up in the bone marrow (the spongy tissue inside bones where blood cells are made) and form a mass. That mass may then press on nerves or joints and cause pain. Some of the ways in which specific blood cancers can cause pain are listed below. Open each section to learn more.

Some people with leukemia or myelodysplastic syndromes have bone or joint pain. This bone pain is most often felt in the long bones of the arms and legs, in the ribs, and in the breastbone. Joint pain and swelling of the large joints, like the hips and shoulders, sometimes starts several weeks after bone pain begins.

People with chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML) and hairy cell leukemia (HCL) sometimes have pain or feel full below the ribs on their left side. This happens when cancer cells build up in the spleen and cause it to swell (enlarge). The spleen is a small organ in the upper left part of the body under the ribcage. It acts primarily as a filter for your blood.

People with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) often have swollen lymph nodes. This rarely causes pain at the time of diagnosis. Sometimes, depending on where a mass of abnormal cells forms, a person can have pain in one or more places in the body where the mass is—most commonly in the chest, abdomen (belly), or bones. For instance, a mass in the abdomen can cause back or belly pain. Over time, some people with lymphoma also develop bone pain.

Many people with myeloma have pain. Back pain is often the first symptom, but because back pain is so common in our society, it might not be initially linked to myeloma.

When myeloma cells build up in the bone marrow, they release chemicals that cause an imbalance in the process called “bone remodeling” (reabsorption of old bone and formation of new bone). This imbalance causes greater bone destruction and less new bone formation, leading to bone thinning (osteoporosis) or holes in the bones (lytic lesions).

Bones can fracture easily, or vertebrae (the small bones making up the spinal column) may collapse. This causes severe pain and could be an emergency. Common areas of pain in people with myeloma are the back, ribs, arms, legs, hips, and shoulders.

Some people with myeloproliferative neoplasm (MPNs) have pain. Each MPN disease is different, so people with different types of myeloproliferative neoplasms can have different kinds of pain.

Essential thrombocythemia (ET) is a type of blood cancer in which the bone marrow produces too many platelets, making it difficult for the blood to flow. Some people with ET have pain in their hands and feet caused by reduced blood flow. This pain is often described as “numbness,” “tingling,” “throbbing,” or “burning.” Some people get headaches or chest pain.
Polycythemia vera (PV) is a type of blood cancer in which the bone marrow produces too many red blood cells, increasing the chance of bleeding, bruising, and blood clotting. Some people with PV develop gout, a kind of arthritis that causes painful joint swelling. PV is also linked to painful ulcers in the stomach, small intestine, and esophagus. PV might cause burning or tingling pain of the skin, most often on the arms, legs, hands, or feet.
Myelofibrosis (MF) is a type of blood cancer in which abnormal blood cells and fibers build up in the bone marrow, making it difficult for the body to produce healthy blood cells. Some people with MF feel pain or have a sensation of fullness below the ribs on their left side, where the cancer causes the spleen to swell. MF may also cause bone or joint pain.

Treatment-related pain

Pain can also be a side effect of your cancer treatment as a result of the toxic side effects of standard drug therapies or radiation therapy used to treat blood cancers. Open each section below to learn more.

Bone marrow biopsy and bone marrow aspiration can be uncomfortable and sometimes painful procedures. Talk to your healthcare team about getting medicine to help reduce any pain or discomfort during or following the procedure. Some people have mild pain for a few days at the place where the needle was inserted.

Learn more about bone marrow tests.

Chemotherapy can cause painful mouth sores, headaches, muscle aches, and stomach pains. There are treatments that help control these side effects.

Radiation therapy is linked to skin dryness and sunburn-like irritation in the parts of the body exposed to radiation. There are many ways that the side effects of radiation can be managed. 

Chemotherapy and, less commonly, radiation therapy can also cause nerve damage. This can lead to pain that tends to start in the hands or the feet and is often described as “burning” or “tingling.” This condition is called “peripheral neuropathy” (PN).

Both chemotherapy and radiation therapy weaken the immune system. This puts the body more at risk for viral infections and diseases. For instance, shingles, the painful blisters on the skin caused by a reactivation of the chickenpox virus, can develop. Shingles can also lead to post-herpetic neuralgia. This is nerve pain that lasts long after the rash and blisters from shingles have gone away. Talk to your doctor about the shingles vaccine.

Learn more about radiation therapy or chemotherapy.

Cancer treatment, or sometimes the disease itself, can cause peripheral neuropathy (PN)—damage to nerves of the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body.

Peripheral neuropathy can be caused by:

Certain chemotherapeutic agents, such as vincristine (Oncovin®), bortezomib (Velcade®), thalidomide (Thalomid®), lenalidomide (Revlimid®), cytarabine (Cytosar-U®), interferon, or methotrexate
Radiation therapy, although it may take several years for symptoms to appear
Shingles, a rash that may develop in people with weakened immune systems
Certain diseases such as myeloma

Learn more about peripheral neuropathy.

Most of the side effects of stem cell transplantation, including pain, are a result of the high-dose chemotherapy used. Common painful side effects include mouth and throat sores, stomach cramping, vomiting, and diarrhea. There are ways to manage and even help prevent these effects.

Patients will have weakened immune systems for many months after a stem cell transplant. This puts the body at higher risk for viral infections like shingles, which causes painful rashes and nerve pain.

Stem cells for transplantation may be taken from the patient (autologous transplant) or a donor’s bone marrow or blood (allogeneic transplant). People who donate stem cells from bone marrow may experience temporary soreness, bruising, and aching in the hip and lower back following the procedure. People who donate stem cells from the blood receive an injection of growth factor to stimulate the movement of stem cells into the blood. For the donor, the growth factor injection may cause mild, flu-like symptoms, temporary joint pain, bone pain, or headaches.

Learn more about stem cell transplantation. 

Pain treatment

Pain can be managed effectively in a number of ways, depending on the cause and type of pain. Do not take medications or supplements without first talking to your healthcare team. 

Treatments may include:

Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opioid analgesics, antidepressants, antiepileptics, steroids
Psychosocial interventions: Stress management, counseling, and coping mechanisms
Rehabilitation techniques: Physical therapy, exercise therapy, heat/cold therapy
Complementary therapy: Meditation, hypnosis, biofeedback, guided imagery, music therapy, massage, acupressure, acupuncture, reflexology, therapeutic touch, Reiki, yoga, tai chi, qigong (chi gong), herbs, and vitamins

Medications to treat pain

Almost all people find relief from pain by using a combination of medicines. Most pain medicines are pills that are swallowed or dissolve quickly in the mouth.

Some also come in liquid form. If you’re unable to take medicine by mouth, pain medicines can also be given intravenously, rectally (as a suppository), as a shot, or as a cream or patch. Your healthcare team will consult with you and together you’ll decide which medicine you need, how to take it, how much you need (the dose), and how often you should take it. 

Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter (OTC) medicines like acetaminophen (Tylenol®) and NSAIDs (aspirin, Advil®, and Aleve®) can work very well for treating mild to moderate pain. These drugs are good pain relievers, but they can be harmful if you take more than the recommended amount. If you’re taking acetaminophen or an NSAID, be sure to follow the package instructions carefully.

Some people should not take acetaminophen or NSAIDs, so talk to your healthcare team before using these medicines. Even drugs you can buy without a prescription can be dangerous if not taken correctly.

Opioids: These are medicines that can work very well to treat moderate to severe pain. You need a written prescription to get these drugs. Be sure to follow your doctor's directions very carefully. There are many types of opioids. Morphine is the opioid that’s most often used to manage cancer pain. Others that are commonly used include: hydromorphone (Dilaudid® or Exalgo®), oxycodone, hydrocodone (Hysingla® or Zohydro ER®), codeine, fentanyl, and methadone.

Some opioids are combined with acetaminophen or an NSAID in one pill. Examples include Percocet® (a combination of oxycodone and acetaminophen), Vicodin® or Norco® (a combination of hydrocodone and acetaminophen), and Vicoprofen® (a combination of hydrocodone and ibuprofen).

Antidepressants and antiepileptics: Antidepressants are medicines most often used to treat depression. Antiepileptics are medicines used to help prevent seizures. Both antidepressants and antiepileptics can also be used to manage pain in people with cancer. They are very good for treating nerve or neuropathy-related pain. Taking these medications to help manage cancer pain does not mean that you are depressed or that you are going to have seizures.

Steroids: These are a type of medicine that can relieve pain caused by swelling or inflammation. Prednisone and dexamethasone are often used to manage pain in people with cancer.

Many times, a combination of medicines is needed to control pain. Your doctor will work with you to find the right combination of treatments to control your pain.

Addiction risk

Some people worry about the risk of addiction when using opioids for pain control. People with chronic pain who need prolonged opioid therapy and take these medicines as directed have little to no risk of becoming addicted to these drugs. Make sure you understand the instructions for taking your medicine (such as proper dosage and timing) and take only the amount that is prescribed.

Still, there are people who might be at risk for addiction. These people tend to have a current or past history of substance misuse, a family history of addictive disease (alcohol, illegal drugs or prescription drugs), or a history of mental illness. Talk with your healthcare team about whether you’re at risk for developing an addictive disease. This does not mean that you cannot use opioids to treat your pain, but you may need additional support and monitoring.

Managing your pain medicines

Remember to tell your healthcare provider and other members of your treatment team about all of the medicines you are taking, including over-the-counter drugs, supplements, and herbal remedies. Also tell them if you are using alcohol, marijuana or CBD, or illegal drugs in any form. Sometimes there can be serious interactions. Your healthcare team can provide helpful guidance.

If you’re using medicines to manage your pain, it’s your responsibility to keep all your drugs in a safe place. It’s best if they’re locked up. These drugs should not be within the reach of children, friends, pets, or visitors. They could be stolen if left out in the open. They can be dangerous if taken incorrectly.

Side effects of pain medication 

Many pain medicines have side effects. Talk with your healthcare provider right away about any side effects that you experience. There are often things you can do to treat and even help prevent them. Side effects can include:

Some other side effects of opioids to watch for include itchiness, dry mouth, sneezing, sweating, feeling irritable, dizziness, confusion, memory changes, vision changes, and trouble passing urine.

Your healthcare provider will talk with you about the side effects linked to your pain management plan. Be sure you know what to expect, what to do to help with side effects, and when to call your provider.

Other options to control pain

Some other options doctors provide that can help control pain include:

Nerve blocks—injections of anesthetic into the affected area
Nerve ablation—destruction or removal of nerve tissue
Epidural injections—medicine is injected into an area of the spinal cord
Implanted devices, such as:
Intrathecal pump—a device that delivers pain medication directly into the spinal fluid
Spinal cord stimulation—a device that sends mild electrical currents to the spine
Surgical procedures, such as:
Vertebroplasty—chemical cement is inserted into damaged bone or vertebra through a catheter to add strength and improve stability
Kyphoplasty—a balloon is inserted and then inflated in the vertebra to get it into its normal position before stabilizing the area with chemical cement

Non-drug treatments for pain

While medicines are most commonly used to manage pain, many people with cancer also use non-drug and integrative therapies to find relief. These therapies, especially when used along with pain medicines, can result in better pain relief with fewer side effects. Mind-body practices can help relieve anxiety, sleep disturbances, and mood changes commonly associated with pain. 

It's important for you and your doctor to discuss the type(s) of nondrug approaches that may be most appropriate for your condition. Tell your doctor if you're using any complementary or alternative treatments, as some natural products can change the way your body reacts to prescribed medications.

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