What Causes Cancer Pain and How it is Diagnosed

Approved by the Cancer.Net Editorial Board, 03/2023

Pain is one of the most common symptoms or side effects that people with cancer experience. There are different causes and types of cancer pain. Pain can come from the cancer itself, cancer treatment, or other causes. But, nearly all cancer pain can be managed, with or without the use of medication. If you experience any pain during or after cancer treatment, tell your health care team.

Cancer-related pain can last a short time, only occur from time to time, or it may be constant and last a long time. It can make other symptoms or side effects of cancer seem worse. For example, pain can contribute to or worsen fatigue, depression, anger, and distress.

Every person with cancer should live with as little pain as possible. Talk openly with your health care team about your pain and how it affects your daily life. Relieving side effects is an important part of cancer care and treatment. This is called palliative and supportive care.

This article is about the causes of pain when you have cancer and how your health care team might diagnose and manage the cause of your pain. Learn more about how to treat pain with medication and other ways to manage pain.

What causes pain during cancer?

Pain is one of the most common symptoms or side effects for people with cancer. Sometimes, the cancer can cause pain. Other times, cancer treatment such as surgery, radiation therapy, or chemotherapy can cause pain. Any kind of pain during cancer can be treated.

Pain caused by cancer. Pain from cancer itself is often caused when a tumor grows. It can stretch or put pressure on organs, bones, and/or nerves.

Spinal cord compression is a serious complication of cancer that causes pain. This happens when a tumor spreads and grows around the nerves of the spinal cord. It puts pressure on the nerves and stops blood flow to the spinal cord. Spinal cord compression is considered an emergency. This is because it can cause paralysis if it is not treated. Call your doctor right away or go to the emergency room if you have signs of spinal cord compression. Signs of spinal cord compression can include:

  • Back or neck pain. Almost all people with spinal cord compression have back pain. The pain may be felt in other parts of the body, such as around the chest and abdomen, legs, and arms. Pain caused by spinal cord compression may get worse when you lie down.

  • Difficulty walking

  • Numbness or tingling in the arms, legs, toes, or fingers

  • Problems urinating or emptying bowels

Pain caused by cancer surgery. It is normal to experience pain after cancer surgery. Most pain after cancer surgery goes away. But some people can have pain that lasts for months or years. This long-lasting pain can be from permanent damage to the nerves. It can also be caused by scar tissue.

Pain caused by radiation therapy. Pain may develop after radiation therapy in the area targeted during treatment. This pain often goes away on its own. It can also develop months or years after radiation therapy to some parts of the body, such as the chest, breast, or spinal cord.

Pain caused by therapies using medication. Chemotherapy or other medication used to treat cancer can cause different kinds of pain, including:

Pain with other causes. People with cancer can still have pain from a cause unrelated to the cancer. These include migraines, arthritis, or chronic low back pain. Sometimes, cancer and cancer treatment can make these other types of pain worse. Let your health care team know about any pain you commonly experience before treatment begins. The treatment plan your health care team develops with you should consider these kinds of pain. Learn more about managing your treatment when cancer is not your only health concern.

How is cancer pain diagnosed?

You know your pain best. It is important to discuss any new symptoms or a change in symptoms with your doctor or a pain specialist. They can help you find medication or other pain relief methods that work for you.

To help your doctor better understand your pain, they may ask the following questions:

  • Where does it hurt?

  • When does the pain start and stop? Does anything trigger the pain? Does anything make it better or worse?

  • Is the pain constant, or does it come and go?

  • How long has the pain been there?

  • How much pain are you having on a scale of 0 to 10, with 0 being no pain and 10 being the worst possible pain?

  • What does the pain feel like? For example, is it a burning, stabbing, throbbing, or aching pain?

Based on the history of your pain, your team may examine you and order tests to understand the cause of the pain. Then, they will suggest a treatment plan.

How is cancer pain managed and treated?

Depending on the cause of the pain, your health care team may prescribe one or more methods to help manage your pain. Your pain may not go away completely, but all cancer pain can be managed. Medications can help relieve pain. Other treatment methods that do not use medication can also relieve pain. Talk with your health care team about the best treatment, or combination of treatments, for your pain.

Some people worry that pain medication can be addictive or will make them sleepy or groggy. These are concerns to talk about with your doctor. Know that there are many ways to manage and treat cancer pain, including prescription and non-prescription methods. Complementary therapies such as massage, acupuncture, and relaxation and mindfulness meditation can also help relieve pain.

Sometimes, your oncologist may adjust your cancer treatment plan to relieve severe pain. For example, they may lower the dose of chemotherapy or recommend longer time between treatments. Physical therapy and occupational therapy can also help relieve pain after cancer treatment. Ask your health care team if they recommend this for you.

Questions to ask the health care team

  • What do you think is causing my pain, based on my description?

  • Can you explain the options for managing my pain?

  • Do you recommend pain medication? Is so, which medication would you recommend?

  • Is there risk for abuse of this medication?

  • What are the side effects of the medication?

  • How can these side effects be managed?

  • How long will I get pain relief from a dose of the medication you are recommending?

  • How long will it take before I know how effective this medication will be?

  • What are other strategies for managing pain in place of or in addition to medication?

Related Resources

ASCO Answers: Managing Pain (PDF)

Treating Pain with Medication

Other Ways to Manage Pain

What is Palliative and Supportive Care?

More Information

National Cancer Institute: Cancer Pain