Side Effect Management - Pain from Treatments

Not all cancer patients experience pain as a result of their treatments. However, if you have pain from either the cancer itself or the treatments, you know that it affects every aspect of your life.

You may find:

  • Normal daily activities, such as sitting, standing, walking, getting to the bathroom, getting dressed, and other common movements may be challenging.
  • It can be difficult to sleep or find a comfortable position.
  • Eating and/or drinking may be difficult.
  • You feel depressed and/or have less interest in participating in daily activities.

It’s important to recognize how you are experiencing pain.  It can be different for each patient and be expressed through different sensations:

  • Dull
  • Aching
  • Sharp/stabbing
  • Burning

Pain intensity is often assessed using a numeric rating scale (NRS) of 0 to 10. According to the National Cancer Institute, the pain scale is as follows: 

  • 0 indicates no pain
  • 1 to 3 indicates mild pain
  • 4 to 6 indicates moderate pain
  • 7 to 10 indicates severe pain

Don’t be afraid to tell your oncologist or your oncology nurses about the pain you’re experiencing, even though it may be in between appointments or at night. When you talk with them, they’ll want to know if your pain is mild, moderate, or severe. They may also want to know when it started and how long it has been happening. Your cancer care team will work with you to develop a pain management plan that is based on the type of pain you are experiencing.

Causes of cancer pain

Cancer pain is often a result that comes from the tumor itself, the cancer treatment, or both. A good pain treatment plan can help improve your quality of life all through your cancer treatment and after it ends.

Pain from the tumor or cancer growth

Most cancer pain occurs when a tumor presses on nerves or spreads to the bones.

If cancer grows or spreads, it can put pressure on nerves and damage them, causing pain. If cancer has spread to the bones, the bones can become weak or brittle, resulting in pain. If a tumor spreads or grows around the spinal cord, it can compress the spinal cord. This is called spinal cord compression.

Pain as a result of cancer treatments

Surgical pain

Surgery is often part of the treatment for cancers that grow as solid tumors; therefore, patients can expect some amount of pain depending on the kind of surgery they have. The amount of time that the pain lasts can vary from days to weeks and is likely to change over the course of the healing process. If your pain level changes suddenly or is accompanied by a fever, you need to contact your physician immediately.

Phantom pain, as it is referred to, is usually felt by patients who have had the removal of a body part such as an arm, leg, or breast. These unusual or unpleasant feelings that linger seem to be coming from the absent (phantom) body part. Phantom pain is real and should be talked about with your oncologist if you are experiencing it.

Chemotherapy & supportive therapies

Some patients may experience pain at the site where chemo is administered. Many patients have a port, where chemo drugs are given. Other than a few days following a port insertion, a port shouldn’t remain painful. If it becomes painful, it could be due to a complication such as a clot or infection and you should notify your health care provider immediately.

Infections may occur on the skin around where the catheter goes into the port. Signs of infection usually include red and swollen skin in addition to pain or burning in the area. Some drugs can cause pain through a peripheral IV, if you note any redness, pain, streaking near your IV site contact your care team.

If a clot forms, the port is typically removed immediately so it can be treated. Symptoms of a clot include redness and painful swelling of the arm or neck on the same side of the body where the port is located.

Chemo or supportive treatments may cause headaches in some patients. A headache is usually described as a throbbing, sharp, steady, or dull pain in the head.

Other medications given during treatment or after treatment can sometimes cause pain. This can include drugs given to counteract neutropenia, or a low white blood cell count. Patients can experience bone aching or pain as the bones work to generate more infection-fighting blood cells.

Radiation therapy

The act of having radiation delivered is a painless process. The side effects of radiation treatment can sometimes cause pain. Mouth sores (stomatitis or mucositis) and peripheral neuropathy (a set of symptoms caused by damage to nerves that control the sensations and movements of the arms and legs) are two examples of pain caused by cancer treatment.

Many patients may also feel pain from skin irritation. Skin treated with radiation may be rough to the touch, red in color, and a little swollen. Your healthcare team may suggest special creams that can help ease any discomfort.

Patients receiving radiation to the brain may also experience painful headaches.

If not managed, pain can even cause some people to stop treatment. It is important to talk to your cancer care team about any pain, especially before it becomes unbearable.

Pain from other causes

Sometimes, patients may experience pain from something other than cancer treatment. This may include pain from migraines, arthritis, or chronic low back pain. While they aren’t necessarily related to your cancer, they can still impact your mood and ability to concentrate on other things. Be sure to speak with your cancer care team so they can include these kinds of pain in your treatment plan. Having all kinds of pain resolved is an important part of the healing process and your overall wellbeing.

Pain can also be caused by cancer-related tests. Patients may experience pain during or after tests used to diagnose cancer as well as tests that check to see how cancer treatment is working. Don’t let concern about pain keep you from having procedures. Any pain you have during and after your procedure can usually be relieved. Ask someone from your cancer care team for pain medicine if you feel like you need it.

Ways to manage cancer pain

Below are some steps you can take as you work with your health care team to prevent, treat, or lessen pain:

Keep track of your pain levels. 

It is important to be as specific as possible regarding the pain you feel so it can be addressed with the most appropriate pain treatment plan. Some helpful questions to answer that can better help you describe the pain to your oncologist or nurse may include:

  • What part of your body feels painful?
  • What does the pain feel like (sharp, aching, burning, shooting, or throbbing) and where do you feel the pain?
  • When does the pain start and how long does it last?
  • Does the pain interfere with daily activities such as eating or sleeping?
  • What makes the pain feel better or worse (exercise, medicines, ice or heating pads)?
  • If you take pain medicine, how much do you take and how often do you take it?
  • On a scale of 1 to 10 (1 being mild and 10 being severe) how bad is the pain?

Don’t skip or delay doses of pain medicine

Take the right amount of medicine(s) at the right time. Do not wait until your pain comes back or gets too severe before taking pain medicine. Waiting to take your medicine could make it take longer for the pain to go away or increase the amount of medicine needed to lower pain. This sometimes means that you need to set an alarm to wake up and take medicines in the night. This is much better than waking up to intense pain caused by skipping a dose of medicine.

Do not stop taking the pain medicine unless your doctor advises you to. Tell your doctor or nurse if the medicine is not effective, or if you are in pain, but it’s not yet time to take the pain medicine. There are many medications and combinations available and they will work to find something that’s best for you.

A good way to ensure safe medication use is to keep track of all the pain pills you take. This information should include the name of the pill, the dosage, and the time of day it was taken. There are many medicine-tracking apps available; however, a written log on paper works just as well. Just make sure your log is something that can easily be shown to your doctors or caretakers if needed.

Opioids and Your Safety Patient Education Sheet

Ask about integrative medicine

Integrative medicine, sometimes called complementary therapy, is a method of therapy that combines practices and treatments from alternative medicine with conventional medicine. Acupuncture, biofeedback, hypnosis, massage therapy, and physical therapy are treatments that may also be used in addition to medications to treat pain.

Talk with your oncologist about pain

While pain is a common side effect of cancer and cancer treatment, you don’t have to suffer through it. Be open and honest with your healthcare team about any major or minor pain you are experiencing.

Talk with your cancer care team about pain, especially if:

  • The pain isn’t getting better or going away with pain medicine
  • The pain comes on quickly
  • The pain makes it hard to eat, sleep, or perform your normal activities
  • You feel new pain
  • You have side effects from the pain medicine such as sleepiness, nausea, or constipation
  •  You also have a fever

You know your pain best and discussing any new symptoms or a change in symptoms with your oncologist is an important part of getting it under control. They can help you find a medication or other pain relief method that works for you.