Pain and cancer

Pain is an uncomfortable, unpleasant physical sensation. It happens when parts of the body are damaged. Around 5 in 10 people who have treatment for cancer (50%) have some pain.

How people feel and experience pain is very individual. Your pain may be different from someone else’s who has had the same treatment or type of cancer as you. Remember, having more pain does not necessarily mean the cancer is worse or more advanced.

You may have pain for a number of reasons. Cancer treatments such as surgery, chemotherapy or radiotherapy can damage body tissue and sometimes nerves, causing you to feel pain. These are physical causes. Your emotions can also affect pain levels. For example, feelings of anxiety or depression may make pain worse. Social or work pressures can also exacerbate pain.

If you have pain, it can almost always be reduced. It’s important to let your doctor or nurse know as soon as you have pain. The earlier treatment is started for pain, the more effective it will be.

Who can help you manage pain

Different healthcare professionals may help to manage your pain. You’ll see some of them in the hospital and others at home or in the local community. They include:

• GPs, who can monitor your pain and suggest treatments
• district nurses, who can help you with your medicines and manage your pain at home
• physiotherapists, who can advise you on how to make moving less painful
• occupational therapists, who can arrange special equipment to make you more comfortable
• counsellors or psychologists, who can help you with worries or emotions that may worsen pain
• pharmacists, who can give advice about your pain relief and over-the-counter medicines
• specialist palliative care teams, made up of professionals who are experts in managing pain
• hospice staff, who can treat your pain when you spend time in a hospice
• Marie Curie’s nurses, who help people with advanced cancer to stay at home
• anaesthetists, some of whom are pain relief experts and treat pain with specialist techniques
• pain teams, which are based in hospitals and made up of pain experts

Different types of pain and how to describe it

Pain does not feel the same for everyone. Describing your pain clearly will help your doctor or nurse find the best treatment. Try to explain to them where the pain is, what it’s like (for example dull, sharp, burning), how bad it is and when you are in pain. It can also help to describe how the pain changes over time and what makes it better or worse.

Keeping a pain diary can help you explain your pain to your doctor or nurse, and it can help them plan the best treatment.

When cancer treatments are used for pain control

Cancer treatments can help relieve pain caused by cancer. They include surgical and medical treatments:

• surgery can be used to remove part or all of a tumour – this reduces pain by relieving pressure on organs or a nerve
• radiotherapy can be used to shrink a tumour – a special type of radiotherapy known as Radioisotope therapy can also be used to control bone pain
• chemotherapy and targeted therapies reduce pain by shrinking the tumour
• hormonal therapy may be used to treat certain cancers and help reduce pain
• nerve blocks relieve pain by blocking pain messages from getting to the brain
• radiofrequency ablation (RFA) uses heat to destroy cancer cells – it’s sometimes used to relieve bone pain caused by small secondary bone tumours

Your doctor or specialist nurse will be able to advise you about which method of pain control is most suitable for you.

Painkillers and how they are taken

Painkillers are medicines to manage pain. They are also known as analgesics. There are many types available and different ways of taking them.

Painkillers are usually taken by mouth as a tablet or capsule. If you find swallowing difficult, you can often get them in liquid form or as pills that dissolve in water.

You may be given painkillers in other ways such as skin patches, gels, nasal sprays or suppositories. Buccal and sublingual medicines dissolve in the mouth and act quickly, so they’re often used for breakthrough pain. Injections and drips can also be used. If you need strong painkillers over a period of time, a small pump called a syringe driver is used, which releases a dose of painkiller at a constant rate.

Always tell your doctor or nurse if you have pain, or if your pain gets worse.

Other types of drugs used in pain control

Some drugs are prescribed with painkillers to help control pain. These are often known as adjuvant drugs. They work in different ways. For example:

• 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

It may take a while to find the drugs that work best for you. Talk to your doctor or nurse if you are still in pain or have side effects.