Pain
Key Points
- When pain is controlled, the quality of life improves dramatically.
- Pain can be acute or persistent.
- Cancer pain can be managed, often with relatively simple treatments.
- Many of the common fears people have about cancer pain management are often unfounded.
- In addition to opioids, many complementary therapies can also be remarkably helpful in controlling pain.
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A uthor
Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher
Read more Ms. Pole is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation and education services for more than 30 years. View profile.  Reviewer
Nancy Hepp, MS, BCCT Project Manager
Read more Ms. Hepp is a science researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. View profile. Last updated April 13, 2021.
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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." 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.
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.
Read more
Many cancer patients fear that they will have persistent pain, but many don’t usually experience such pain except perhaps with advanced cancer.
If you have pain, first understand that cancer pain can be managed, often with relatively simple treatments such as oral pain medications. Become educated about cancer pain, how to communicate your pain, where to get help, and what to do next if you’re not satisfied.
Pain may be a side effect of many medications, such as statins. Before pursuing treatments for pain, check with your doctor or pharmacist to see if any of your prescription medications may contribute to pain and whether adjustments can be made.
Reporting Pain
Our fears are masks of old hurts and not necessarily premonitions about the future.
Benjamin Shield
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:
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- Genetic predisposition
- Certain brain characteristics such as impairments in the brain’s reward circuitry, compensation for trauma and mental health problems
- Psychological factors: stress, personality traits like high impulsivity or sensation seeking, depression, anxiety, eating disorders, personality and other psychiatric disorders
- Environmental influences: exposure to physical, sexual or emotional abuse or trauma, substance use or addiction in the family or among peers, access to an addictive substance; exposure to popular culture references that encourage substance use
- Starting alcohol, nicotine or other drug use at an early age
Nonmedical Opioid Use
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.
Read more Nonmedical use of prescription opioid analgesics is without one’s own prescription or simply for the experience or feeling the drug caused, such as euphoria. In the general population, most nonmedical use is for self-treatment of pain with opioids obtained from a friend or family member with a legitimate prescription.
The most common NMOU behavior among cancer patients was an early refill request, followed by self-directed dose escalation.
Researchers recommend these steps to reduce the risk of developing these NMOU behaviors:
- Universal screening (such as with the Screener and Opioid Assessment for Patients with Pain (SOAPP)
- Setting limits on opioid use by limiting supply
- More intense follow-up with an interdisciplinary team to provide optimal use of medications for pain and symptom management
- Providing counseling and support to patients and their family members
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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.
Read more
Many of the common fears people have about cancer pain management are often unfounded. Allow space for the probability that you will not have persistent pain, and that if you do, you will have knowledge of and access to expert help for managing your pain.
Some truths:
- Unreported, uncontrolled pain will make you weak.
- Addiction is not common if you are taking your pain medication as your doctor prescribes and you don’t have have the disease of addiction or high risk for addiction (see at right).
- The risk of opiod-related death is very low in cancer patients.
- Pain dampens your thinking abilities. When opiates effectively control pain, cognitive function usually improves over time.
- Raising the dose of opiate as needed or even switching to another opiate can achieve good pain management with minimal side effects.
- Most opiate side effects can be prevented or controlled.
- Some people with cancer misuse opioids by using without a prescription or for a reason other than as directed by a physician (such as to create euphoria). Misuse also includes using opioids in greater amounts, more often or longer than prescribed, often because of insufficient pain control.
Even though addiction is not common overall, a study of women undergoing mastectomy with reconstructive surgery as part of cancer treatment investigated use of opioids and sedative-hypnotic drugs. These women are at particularly high risk of becoming dependent on opioids following surgery, with about 13 percent of women who had not used an opioid for the year before surgery becoming a chronic user in the year following surgery. More than 6 percent of women became chronic users of sedative-hypnotic drugs. The researchers recommend women work closely with the prescribing provider to attempt to minimize risk of dependence.
If you are not getting good pain management, report this to your physician as soon as possible rather than adjusting the dose or frequency on your own. Misusing opioids, even for what you consider a good reason, may possibly lead to mistrust between you and your doctor and less effective care.
Finally, bear in mind that complete obliteration of physical pain is not usually a realistic objective; however, 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.
Managing Pain
 Helpsy Health
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.
Read more Based on a member’s health condition, Helpsy automatically creates a whole-health care plan. This plan considers the physical, emotional, social and socio-economic needs of each member. Members also have access to Helpsy’s community chat forum with other members and advocates to support and engage them throughout their journey.
Helpsy manages 500 unique symptoms and 20,000 remedy recommendations from over 30 healthcare modalities (such as patient education or nutrition), all backed by evidence-based research and science. Members can access Helpsy’s resources library for support services (including transportation, financial assistance, lodging and more) and self-care (emotional health, lifestyle changes, diet and nutritional counseling, fitness coaching, and support services).
In a clinical study, an intervention using many of Helpsy’s features led to significantly improved quality of life, less disruption to treatment, and cost savings..
Thanks to Helpsy, patients always have nursing support, right “in their pocket.”  
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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:
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.
Read more BCCT founder Michael Lerner teaches that “suffering is the human experience of pain.” He explains that very often suffering is viewed negatively in our society. However, many of the wisdom traditions as well as our own experience teaches us that there is a dual nature to painful events—they can cause suffering as well as deliver great wisdom and growth.
Dr. Lerner says: “Suffering is in large part the story we tell ourselves about our pain. And that story can sometimes profoundly shift the experience of that pain.” Indeed, many people find that in simply telling about their pain, their pain level begins to ease. Research verifies that people’s immune systems and healing abilities improve when they write or talk about the story of their pain, whether that pain be physical, mental, emotional, social or spiritual.
Roshi Joan Halifax, PhD, has written Meditations on Transforming the Suffering of Pain, which includes meditative practices that assist with being with pain and transforming the suffering of pain.
Share the facts of your pain with your doctor; share the story of your pain with those who will receive it with love: the first may ease your pain, the second may transform your pain and ease your suffering. |
Conventional Approaches
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.
Complementary Approaches
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:
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- Massage therapy from a therapist trained in oncology massage
- Mind-body approaches including these:
- Cognitive-behavioral stress management
- Cognitive-behavioral therapy (CBT)
- Hypnosis
- Music therapy
- Relaxation training
- Support groups
- Supportive/expressive therapy
- Acupuncture
- Therapies based on a philosophy of bioenergy fields such as these:
- Medical cannabis or cannabinoids can be highly effective with fewer concerns than opiods.
- Bioelectromagnetically based therapies:
- Pulsed electromagnetic fields (PEMF): Several studies and reviews show reduced pain, opioid use and inflammation after surgery.
- Transcutaneous electrical nerve stimulation (TENS): A review and meta-analysis showed reduced blood levels of proinflammatory cytokines, and a clinical trial found reduced pain intensity, lower opioid use and fewer requests for chest radiographs after coronary artery bypass surgery. A review found improved postoperative pain in urology patients.
- Electroacupuncture: Randomized trials showed evidence of reduced pain after thoracic surgery.
- Transcutaneous electrical acupoint stimulation (TEAS): A randomized study found that TEAS use with general anesthesia led to stable blood pressure during surgery, reduced analgesic use and better pain relief compared to general anesthesia alone..
Some of these methods may relieve pain directly, while others may improve your ability to cope with the mental, emotional and spiritual discomforts that often accompany and aggravate physical pain.
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." The reason or mechanism for this association is still unknown.
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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.
Earlier bedtimes (before midnight) were also associated with less pain than later bedtimes in a group of ovarian cancer survivors.
Integrative Programs, Protocols and Medical Systems
- Programs and protocols
- Traditional systems
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View All References
More Information
- Cancer.net: Pain
- American Society of Clinical Oncology: Managing Cancer-Related Pain: A Guide for Patients, Families, and Caregivers
- SIO clinical practice guidelines:
- 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
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