Pain: Causes and Diagnosis

Approved by the Cancer.Net Editorial Board, 07/2016

Many patients and survivors experience pain during and after cancer treatment. It may help to know that cancer pain can be treated successfully for most patients. But it is important to focus on managing pain during all phases of cancer treatment and into survivorship. Untreated pain can make other aspects of cancer seem worse, such as fatigue, weakness, shortness of breath, nausea, constipation, sleep disturbances, depression, anxiety, and mental confusion.

To find the best pain relief strategies, you need to share the symptoms with your health care team. And, consider talking about your concerns about pain relief strategies. For example, some people may worry that the medicine is addictive or will make them sleepy or groggy. Your doctor or a pain specialist can help you find a pain relief medicine that works for you. Your health care team can also suggest other methods of pain relief in addition to medicine.

Relieving side effects is an important part of cancer care and treatment. Talk with your health care team about any symptoms of pain you may experience. This discussion should include any new symptoms or a change in symptoms. Members of your health care team will develop a plan to relieve pain and other side effects. This approach is called symptom management, supportive care, or palliative care. Sometimes, your health care team will consult with doctors who specialize in palliative care.

Causes of pain

Pain can come from the tumor itself, the cancer treatment, or other medical conditions. A good pain treatment plan will help relieve pain from all causes, including the following:

  • The tumor. A tumor growing in an organ, such as the liver, may stretch part of the organ. This stretching can cause pain. If a tumor grows and spreads to the bones or other organs, it may put pressure on nerves and damage them, causing pain. Or if a tumor spreads or grows around the spinal cord, it can compress the spinal cord, causing pain.

  • Surgery. It is normal to experience pain from cancer surgery, and most pain goes away after a while. But some people may have persistent pain for months or years from permanent damage to the nerves and/or the development of scar tissue. Find out more about the side effects of surgery.

  • Radiation therapy. Pain may develop after radiation therapy and go away on its own. It can also develop months or years after treatment, especially after radiation therapy to the chest or spinal cord. Find out more about the side effects of radiation therapy.

  • Chemotherapy. Some chemotherapy can cause pain along with numbness in the fingers and toes. This pain may go away when treatment is finished, but sometimes the damage is permanent and can continue to cause pain and/or other side effects. Learn more about the side effects of chemotherapy and peripheral neuropathy.

  • Hormonal therapy. Hormonal therapy, or endocrine therapy, may cause muscle and bone pain. In addition, these treatments can increase a person’s risk of osteoporosis and bone breaks, which also cause pain. Hormonal therapy may also cause other side effects in men and women.

  • Stem cell transplant. Stem cell transplant may also cause pain, particularly associated with a serious side effect of this treatment called graft versus host disease (GVHD). Learn more about GVHD.

  • Other causes. People with cancer can still have pain from other causes, such as migraines, arthritis, or chronic low back pain. The treatment plan your doctors develop with you should also include these kinds of pain, because any pain decreases your quality of life.

Diagnosing pain

It is important to tell your doctor if you are experiencing pain, especially if it is new or has worsened. Based on ASCO’s recommendations, your health care team should discuss your level of pain with you and your family and/or caregivers during every visit.

At these times, your doctor may ask the following questions and do a physical examination to learn more about your pain. Try to describe it as well as you can. You know your own pain best. And, knowing the details about your pain will help your doctor find the best way to manage it.

  • Where does it hurt?

  • When does the pain stop and start?

  • How long has it been there?

  • How intense is the pain?

  • What does the pain feel like, in your own words?

The doctor may also ask you to describe how much pain you are having by using a scale from 0 to 10. Or he or she may offer words that help describe the pain, such as burning, stabbing, or throbbing.

Depending on whether the pain is new or has worsened or changed, your doctor may recommend medical tests to learn more about the cause.

Talking with your doctor about managing pain

The type, intensity, and location of pain is different for everyone. Identifying the cause and finding an effective solution requires teamwork between you and your doctor. To make it easier to talk with your doctor about how you are feeling, consider keeping a pain journal. Be sure to include information about pain caused by other health conditions you may have, such as diabetes and arthritis.

To start keeping a pain journal:

  • Write down the date and time you experienced the pain and how long it lasted.

  • Note what activities you were doing when the pain started.

  • Describe where in your body the pain started and if it was specific to one area or spread to other parts of the body.

  • Give your pain a number on a scale of 0 to 10, with 10 being the highest level of pain.

  • Use words that describe the type of pain, such as “burning,” “stabbing,” or “throbbing.”

  • Track the pain control methods you tried and how effectively they worked.

Along with this information, your doctor will consider several other factors when deciding how to best manage your pain, such as: 

  • The type of cancer.

  • Where the cancer is located.

  • The stage of your cancer.

  • Your tolerance for pain.

  • Your personal preferences for treatment.

  • Previous treatments for pain and how well they worked. 

There are a variety of ways to manage and treat cancer pain, including medication and other approaches. Read about managing pain with medication and additional ways to manage pain for more information.

More Information

ASCO Answers Fact Sheet: Managing Pain (PDF)

Side Effects

Additional Resources

LIVESTRONG: Chronic Pain

National Cancer Institute: Cancer Pain