Pain during or after cancer treatment deserves attention. It can interfere with sleep, eating, and movement. Tell your cancer care team early so treatment can address the cause and your goals. [1]
What Can Cause Cancer Related Pain
Cancer may cause pain by pressing on nerves or other tissues. Pain can also come from surgery, radiation, chemotherapy-related nerve damage, mouth sores, or other treatment effects. A person with cancer may also have an unrelated painful condition. An assessment helps your team decide what needs treatment. [1][2]
Brief flares during otherwise controlled pain are called breakthrough pain. Record when they happen. Take extra medicine only as your prescribed plan allows. [1]
How to Describe Your Pain
Describe the location, sensation, and activities affected. Record medicine use, relief, and side effects to help your team adjust treatment. [1]
You do not need to prove that your pain is severe enough to deserve help. You might say, “I can sleep for only two hours before the pain wakes me,” or “The medicine helps at rest, but I cannot get dressed comfortably.”
Treatments That May Help
Treating the Source of Pain
Sometimes treatment directed at the cancer also relieves pain. Radiation may help painful bone metastases, for example. Selected patients may benefit from a nerve block or another specialist procedure. The choice depends on the cause, expected benefit, and risks. [2]
Medicines Other Than Opioids
Acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, may help some pain. Certain antidepressants or antiseizure medicines may help nerve pain. Your team should select treatment for the specific cause. [2]
Ask before adding nonprescription medicines or supplements. Kidney problems, bleeding risk, heart disease, and interactions can affect which options are safe. [2]
Opioids for Cancer Pain
Opioids can be an important treatment for moderate to severe pain from cancer or active cancer treatment. The American Society of Clinical Oncology (ASCO) recommends offering them when appropriate, with close reassessment of relief and adverse effects. A focus on non-opioid care should never prevent someone from receiving needed cancer pain treatment. [3]
Your clinician will choose the medicine, dose, and schedule for your situation. Report inadequate relief instead of changing the dose yourself. If you have a history of substance use disorder, share it with your team so pain and addiction specialists can coordinate care when needed. [3]
Side Effects and Safety
Ask about a bowel regimen because opioids commonly cause constipation. Report nausea, troublesome drowsiness, or confusion. Physical dependence can develop with regular use; it is different from addiction. Discuss any planned reduction with your prescriber instead of stopping suddenly. [1][2]
Ask about naloxone and show someone close to you how to use it. Avoid alcohol with opioids, and have your clinician review other sedating medicines. If someone is difficult to wake or breathing slowly, call 911 and give naloxone if available. Emergency help is still needed after naloxone. [7]
Supportive Care and Palliative Care
Palliative care helps with symptoms, emotional concerns, and the practical effects of serious illness. It can begin at diagnosis and continue alongside cancer treatment. A referral does not mean that treatment is ending or that you must enter hospice. [4]
The team can also help caregivers, coordinate appointments, and discuss what matters most to you. Depending on your needs, it may include nurses, physicians, social workers, rehabilitation professionals, and other specialists. Ask your oncology team whether a referral would help. [4]
Gentle relaxation, guided imagery, or another approved complementary approach may add comfort. Check with your cancer team before starting physical treatments or supplements, particularly when bones, skin, or nerves are affected. These approaches should be part of your care plan. [2]
When to Seek Urgent Help
Possible Spinal Cord Compression
With a current or previous cancer diagnosis, new back pain accompanied by leg weakness, trouble walking, numbness, or changes in bladder or bowel control needs emergency assessment. Cancer affecting the spine can compress the spinal cord. Do not wait for a routine appointment. New severe or steadily worsening back pain also warrants prompt contact with your cancer team. [5]
Fever or Signs of Infection
During cancer treatment, contact your team immediately for fever, shaking chills, or other signs of infection. Follow the temperature threshold and emergency instructions they gave you. Infection can become serious quickly when white blood cells are low. Ask before taking medicine to lower a fever because it can hide an important warning sign. [6]
Pain That Is Not Controlled
Contact your team promptly if pain is new, worsening, or not responding to the prescribed plan, or if side effects make treatment hard to tolerate. Keep the after-hours number where you and your caregiver can find it. [1]
Questions to Bring to Your Appointment
Consider asking:
- What is the likely cause of this pain, and does it need further testing?
- What should I take for ongoing pain and for a sudden flare?
- What side effects should I report, and how will we prevent constipation?
- Could palliative care or a pain specialist help me meet my goals?
- Who should I contact at night or on weekends?
