Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher
Nancy Hepp, MS, BCCT Project Manager
Last updated August 31, 2021
Pain, which can range from mild to severe, is the most common symptom leading people to seek medical attention. Both our experience and research tell us that when pain is controlled, quality of life improves dramatically. Uncontrolled pain, on the other hand, creates unnecessary suffering, "not only by causing immediate physical suffering, but also by increasing the anxiety level and the fear about the future and future problems."1 Pain may even shorten life. Reported pain in a group of ovarian cancer survivors was associated with markers of inflammation, a known driver of cancer and other diseases.2
Types of Pain
Pain can be acute or persistent:
- Acute pain is short-term and usually ends after the source of the pain is addressed and the painful area heals—for example, incision pain after surgery.
- Persistent pain is present frequently or constantly most of the day and persists beyond the period of time when the painful area is expected to heal. In persistent pain, the cause of the pain may not be able to be addressed.
Our fears are masks of old hurts and not necessarily premonitions about the future.
A critical step is reporting pain to your doctor. To learn how to talk with your doctor about pain, see NCI’s booklet: Pain Control. If your doctor is not trained in cancer pain management and is unable to help you relieve your pain satisfactorily, consider asking for a referral to a healthcare professional trained in managing cancer-related pain. These professionals often have a point of view that pain is an “emergency”, encouraging patients to report unmanaged pain promptly. In addition to medical oncologists (who are usually very knowledgeable about cancer pain management), doctors and nurses trained in palliative care are experts in helping people manage symptoms related to chronic illnesses such as cancer. These palliative care specialists often work in hospice or palliative care programs.
Myths and Truths about Pain
For Health Professionals
Addiction Risk Factors
As with other diseases, risk factors are associated with higher likelihood of addiction:3
Among cancer patients receiving long-term opioid treatment for pain, 19 percent developed behaviors of nonmedical opioid use (NMOU) within a median duration of 8 weeks, researchers reported.4
Fears about pain and pain treatment are common. Perhaps your fears come from experience with someone with cancer whose pain caused suffering, and you are afraid that will happen to you. Many people are also afraid that if they take opiates such as morphine, they will become addicted or will be confused, incoherent or “out of it” all the time. Many may fear that if they take an opiate now, it won’t work later if the pain gets worse.
A realistic goal is to manage the pain so that it is tolerable and frees you up to achieve your own goals of living well.
Even when people are getting the best of cancer treatment, they often feel like they need more help with organizing their care and managing symptoms and side effects. Helpsy empowers members to take control of their health through a real-time virtual nurse support service. This service is available via mobile devices, a Helpsy website and automated phone calls.
Clinical Practice Guidelines
The 2016 American Society of Clinical Oncology clinical practice guideline for management of chronic pain in survivors of adult cancers makes these recommendations regarding complementary approaches:10
|An individualized exercise program||
|Acupuncture, massage or music therapy||
|Cognitive behavioral therapy, mindfulness, relaxation, distraction, or guided imagery||
Pain and Suffering
Unrelieved physical pain can cause unnecessary suffering. In addition to physical pain, people also experience emotional, mental, social and spiritual pain. These types of pain may also lead to suffering.
Opiates are currently the mainstay of treating moderate to severe cancer pain. The non-opioid analgesic acetaminophen/paracetamol (brand name Tylenol in the US) can be effective against mild to moderate pain. Non-steroidal anti-inflammatory drugs (NSAIDs) including aspirin can reduce pain caused by inflammation. Your doctor may prescribe both acetaminophen and an NSAID for mild to moderate pain if inflammation is involved. Advil Dual Action combines analgesic and anti-inflammatory effects in one pill, but a similar effect can be achieved by alternating an analgesic (acetaminophen/paracetamol) with an NSAID, with the added benefit of tailoring the NSAID to your specific needs and condition (see Aspirin and Other Non-steroidal Anti-inflammatory Drugs (NSAIDs) for cautions related to each type of NSAID). Because each type of pain reliever carries risks of adverse reactions and interactions with other therapies, we encourage you to consult your physician before use.
We can often further manage pain with other kinds of medication, such as anticonvulsants and antidepressants. Chemotherapy, surgery or radiation therapy may also be part of your pain-treatment plan.
Pharmacologic treatment of pain does not always meet patients’ needs and may produce difficult side effects.
Many non-drug techniques—complementary therapies—can also be remarkably helpful in controlling your pain. Persistent pain often is best managed with an integrative approach, combining conventional medications and treatments with complementary approaches. The Society for Integrative Oncology clinical practice guidelines list integrative therapies with evidence for addressing pain:12
Smoking and Pain
A 2020 study found that daily smokers and former daily smokers "reported higher levels of bodily pain compared with never daily smokers at all ages."21 The reason or mechanism for this association is still unknown.
Research shows that mind-body interventions can reduce or relieve pain in cancer patients, whether from the disease itself or from side effects of treatments, and allow patients to participate in their own care.22
Earlier bedtimes (before midnight) were also associated with less pain than later bedtimes in a group of ovarian cancer survivors.23
Integrative Programs, Protocols and Medical Systems
|For more information about programs and protocols, see our Integrative Programs and Protocols page.|
- Programs and protocols
- Traditional systems
- Cancer.net: Pain
- American Society of Clinical Oncology: Managing Cancer-Related Pain: A Guide for Patients, Families, and Caregivers
- Body of Wonder podcast: Mind-Body Approaches to Understanding and Healing Chronic Pain with Howard Schubiner, MD
- SIO clinical practice guidelines:
- Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
- Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S.
- Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232.
- Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology
- University of Arizona Andrew Weil Center for Integrative Medicine: Integrative Pain Management Series
- Helpsy Inc.: Helpsy Health
- Dawn Lemanne and Victoria Maizes: Advising Women Undergoing Treatment for Breast Cancer
- Translational Behavioral Medicine: Frontiers in Mindfulness and other Complementary & Integrative Approaches in Behavioral Medicine
- Integrative Cancer Review
- Martin L. Rossman, MD: Fighting Cancer from Within
- Belleruth Naparstek: Guided Meditations to Promote Successful Surgery
- Mala Cunningham, PhD: Before and After Surgery
- National Cancer Institute: Cancer Pain Control: Support for People with Cancer
- September 2018 Issue of the Journal of Alternative and Complementary Medicine
- Wayne Jonas, MD: Your Healing Journey: A Patient’s Guide to Integrative Breast Cancer Care
- United Patients Group: Informative Videos on Medical Cannabis & Marijuana
- University of Arizona: Arizona Center for Integrative Medicine Online Courses
- American Society of Clinical Oncology: Cancer.Net
- Raymond Chang, MD: Beyond the Magic Bullet: The Anti-Cancer Cocktail
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
- Jonathan Simon: Acupuncture in Cancer Care
- Michele Schuman: The Benefits of Medical Massage
- Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer