Many people with cancer have pain during or after treatment. However, your health care team can help you manage nearly all cancer-related pain.
One important part of cancer care and treatment is to relieve side effects, including pain. Talk with your health care team about any pain that you have. This includes any new pain symptoms or a change in symptoms. Your health care team will create a plan to relieve your pain. This approach is called palliative care or supportive care. Sometimes, your health care team will consult with doctors who specialize in palliative care and pain management.
The importance of pain relief
There are several types of cancer pain. Pain may last just a short time and be caused by a procedure or a body movement. It may only occur from time to time. Or, pain may be constant and last for a long time. Pain may also increase all of a sudden even though it is being treated. This is called breakthrough pain. Breakthrough pain mostly occurs between scheduled doses of pain medicine. It is not necessarily linked to a certain movement or time of day. But you might notice certain things that cause the pain.
No matter what type of pain you have, it is crucial to tell your health care team. Some patients do not want to tell their doctor that they are having pain. They may think that the pain means that the cancer has gotten worse or spread. Others feel like pain is simply a part of living with cancer. But every patient has the right to live with as little pain as possible.
If you do not address cancer-related pain, it can make the other symptoms or side effects of cancer seem worse. For example, pain may contribute to or worsen fatigue, depression, anger, worry, and stress. It is important to find a way to relieve your pain to stay active, sleep better, and improve your appetite. It will also help you enjoy activities and time spent with your family and friends.
Common pain management concerns
Some patients worry about becoming addicted to pain medication. This is a valid concern, but it is uncommon when medication is used appropriately. Your health care team is trained to carefully monitor people taking pain medication. And they can help safely decrease your dose when you no longer need treatment. Tell your doctor if you or your family members have a history of alcohol or drug abuse. By knowing ahead of time, your doctor can help prevent a problem from developing.
It is also normal for patients with cancer to worry about the side effects of medications. Some medications cause side effects such as constipation, nausea, sleepiness, or confusion or hallucinations. This is more common with medicines used for moderate or severe pain. But not everyone who takes pain medication has side effects. Talk with your health care team if you are concerned about a specific side effect. Find out if it is manageable or if there are other pain management options that do not cause that side effect. Also, tell your health care team if a side effect does not go away. They may help relieve the side effect by changing the timing, dose, or type of medication.
Types of pain-relief strategies
After thoroughly assessing your pain, your health care team will help you create a pain-relief plan. Some hospitals have pain specialists and palliative care specialists. These experts focus on the physical and emotional side effects of cancer. They help patients who have pain that is hard to control.
Doctors can treat or manage cancer-related pain in several ways:
- Treating the source of the pain. For example, a tumor putting pressure on nerves can cause pain. Removing the tumor with surgery or shrinking it with radiation therapy, chemotherapy, or other medications could reduce or stop the pain.
- Changing the perception of pain. Some medications change how your body feels pain, making it more tolerable.
- Interfering with pain signals sent to the brain. If medication does not work, your doctor may refer you to a pain specialist for specialized medical procedures. These include spinal treatments or pain medication injected into or around a nerve to interfere with a pain signal.
Medications for pain (updated 12/2022)
One of the best ways to treat cancer-related pain is to prevent pain from developing or getting worse. When using medication to treat pain, people are usually prescribed to take it as needed for pain at regular, scheduled times. It is important to take medications prior to the pain becoming severe, which may make it harder to treat. Doctors may also use long-acting pain medicine to provide a more constant pain control, as it allows a steadier level of medicine in the body to help control pain. This is used together with your as-needed medication for breakthrough pain. Your doctor will look at the amount of medicine used for breakthrough pain at every visit and adjust your usual dose if needed.
Many different pain-relief medications, called analgesics, are available. Depending on the drug and the person’s condition, doctors give them in different ways. Some are taken by mouth, while others are injected into a vein or worn as a skin patch.
Non-opioid pain relievers. These may be options for mild or moderate pain. Doctors also sometimes prescribe them along with other pain medicines for severe pain. These include:
Non-steroidal anti-inflammatories (NSAIDS), which includes ibuprofen (such as Advil and Motrin)
Acetaminophen (such as Tylenol)
Medications commonly used for other conditions. Some medications used for other health conditions may help relieve pain, particularly nerve pain. These include:
Some antidepressants, such as duloxetine (Cymbalta)
Medications to prevent seizures, such as gabapentin (Gralise, Neurontin) and pregabalin (Lyrica)
Opioids, also called narcotics. They are often taken along with non-opioid medications. If you are taking an opioid, you may continue taking other non-opioid pain medications, such as NSAIDs, if they are helpful. However, always talk with your doctor about potential drug interactions or contraindications before starting any new medication. Opioids include the following, each of which has multiple brand names:
In recent years, the epidemic of people dying from opioid addiction and overdose has become a major concern. This has led to national efforts to limit opioid prescriptions, including general recommendations from the Center for Disease Control and Prevention (CDC) on when opioids should be used for chronic pain. However, the CDC clarified that these recommendations do not apply to people receiving cancer care. Learn more in this joint news release from the American Society of Clinical Oncology (ASCO), National Comprehensive Cancer Network, and the American Society of Hematology. Please note that this link will take you to a separate ASCO website.
Doctors may consider prescribing opioids to some people with cancer when other options have not worked. ASCO recommends that opioids be offered to people with moderate to severe cancer-related pain unless there is a personal or medical reason they should not receive opioid medication.
Before starting an opioid medication, your doctor will first talk with you to determine whether this treatment is right for you. They will also discuss with you and your caregiver the goals and expectations of the medication, as well as address any concerns you may have about the drug being prescribed. Your doctor may work with palliative care or pain specialists to help create a personalized pain treatment plan. Your doctor will also discuss with you the potential side effects of the medication and ways to prevent those side effects before you start the medication.
If you are taking an opioid medication, your doctor will check in with you to assess whether the medication is helping manage your pain, monitor and address any side effects, and adjust your dose as needed. If the medication prescribed for you is not relieving the pain or is causing unmanageable side effects, or you have other concerns about the drug, your doctor may recommend a different opioid medication.
There is a risk of opioid abuse by the patient or those close to them. Because of this, doctors will likely ask about potential risks in your situation. If you have a substance use disorder or history of one, your doctor will work with palliative care, pain, and/or substance use disorder specialists to determine the best approach for managing your pain.
It is very important that patients and caregivers store opioid medications securely in a locked box or cabinet so other people cannot get them. If someone uses them without a medical reason, serious side effects and even overdose can happen. If you do not use all of a medication for any reason, dispose of it in a safe manner. Learn more about safe storage and disposal of medications.
This information is based on the ASCO guideline, “Use of Opioids for Adults with Pain from Cancer or Cancer Treatment.” Please note that this link takes you to another ASCO website.
- Medical cannabis (marijuana) or cannabinoids. Several states have approved the use of cannabis and cannabinoids for chronic pain. Currently, there is not enough evidence for ASCO to recommend cannabis as an initial option. But if it is legal in your state, it may be an option along with other methods to reduce pain.
Medication is not the only option for controlling pain. Interventional procedures, such as nerve blocks, can provide additional relief in selected situations. Some patients also find physical therapy or talking to a counselor helpful in reducing pain. Other methods are also available, including integrative and complementary therapies. These include different techniques and methods to help ease the discomfort of many physical and emotional symptoms. These methods include meditation, acupuncture, and yoga. The most complete and potentially successful approach to pain control often combines several methods.
When Pain Persists During or After Cancer
Additional Ways to Manage Pain
Podcast: Pain and Opioids in Cancer Care
ASCO Answers: Managing Pain (PDF)
National Cancer Institute: Pain Control—Support for People with Cancer