Some people with cancer will not be affected by pain, but for others, managing pain is an important part of their treatment.
The best way to manage pain associated with cancer and pain from some cancer treatments will depend on individual circumstances. These include the type of cancer and the severity of the pain.
A person's cancer care team may recommend painkilling medication called analgesics or other methods, such as TENS ( transcutaneous electrical nerve stimulation), nerve blocks, acupuncture or relaxation techniques.
Pain specialists may be consulted, as well as physiotherapists and occupational therapists.
What causes cancer pain?
There are many causes of cancer pain, but most cancer pain occurs when a tumour presses on nerves or body organs, or when cancer cells invade bones or body organs. Cancer treatments such as chemotherapy, radiotherapy or surgery also may cause pain.
What are the symptoms of cancer pain?
The amount of pain present may depend on the type of cancer, the stage or extent of the disease and the person's pain threshold or tolerance of pain.
Doctors describe types of pain as:
- Acute pain: Short term pain sometimes due to surgery for cancer or other treatment.
- Chronic pain: Pain that continues over a longer period of time, often because of the cancer itself or of continuing treatment.
- Neuropathic or nerve pain: Pain due to nerve damage may be caused by treatments or a growing tumour. This type of pain may be felt as burning, stabbing, shooting, tingling, radiating or spreading.
- Breakthrough pain: Pain triggered by a specific event or activity, or when regular painkillers wear off.
- Total pain: A term to cover all pain affecting a person and how it is affecting them.
What medications are used to treat cancer pain?
Painkillers will be prescribed using the lowest strength painkiller and lowest dose that's still effective. If the dose or treatment needs to be increased, this is a step up what's called the ’analgesic ladder’.
For mild pain, paracetamol or anti-inflammatory drugs such as ibuprofen or diclofenac sodium may be recommended.
For moderate pain, weaker opioid painkillers, such as dihydrocodeine, codeine phosphate or tramadol may be prescribed.
For severe pain, strong opioid painkillers may be prescribed, such as morphine, oxycodone, fentanyl or diamorphine.
Depending on individual circumstances, painkillers may be given as tablets, liquids injection, infusion, skin patches, under-the tongue, nasal spray, suppository or feeding tube.
How else can cancer pain be treated?
Although cancer pain is usually treated with medication, surgery to remove a tumour or radiotherapy to shrink a tumour can be used along with medication to provide additional pain relief. In most cases, doctors treat cancer pain with pain-relief drugs called analgesics, or with treatments such as physiotherapy and rehabilitation, imagery, and relaxation techniques. Other treatment options for cancer patients include nerve blocks, which involve the injection of drug into or around a nerve or the spine, and neurosurgery where pain nerves are cut to alleviate pain.