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Types and causes of cancer pain

Coping with cancer

This page tells you about the types and causes of cancer pain. There is information about

 

Causes of cancer pain

Most cancer pain is caused by the tumour pressing on bones, nerves or other organs in your body. Sometimes pain is related to your cancer treatment. For example, some chemotherapy drugs can cause numbness and tingling in your hands and feet or a burning sensation at the place where they are injected. Radiotherapy can cause skin redness and irritation.

Remember that some pain may have nothing to do with your cancer. You may have the general aches and pains that everyone gets from time to time.

 

Acute and chronic pain

Cancer pain can be acute or chronic. Acute pain is due to damage caused by an injury and tends to only last a short time. For example, having an operation can cause acute pain. The pain goes when the wound heals. In the meantime, painkillers will usually keep it under control.

Chronic pain is pain caused by changes to nerves. Nerve changes may occur due to cancer pressing on nerves or due to chemicals produced by a tumour. It can also be caused by nerve changes due to cancer treatment. The pain continues long after the injury or treatment is over and can range from mild to severe. It can be there all the time and is also called persistent pain. Chronic pain can be difficult to treat, but painkillers or other pain control methods can successfully control it in about 95 out of every 100 people (95%).

Pain that is not well controlled can develop into chronic pain. So it is important to take painkillers that you are prescribed. Trying to put up with the pain can make it harder to control in the future.

If you have chronic cancer pain, you may have times when the pain is not controlled by the medicines you are taking. This is called breakthrough pain. If you are taking regular painkillers but still get pain at times, let your doctor or nurse know. They can prescribe extra top up doses of painkillers for you to take when you need them.

Sometimes pain can come on quickly, for example when you need to have a dressing changed or move around. This type of pain is called incident pain.

There is information about how pain can be managed on our page about treating cancer pain.

Pain can greatly affect your quality of life. Chronic pain can make it hard for you to do everyday things such as bathing, shopping, cooking, sleeping and eating. This may be hard for your close friends and relatives to understand. There is information about how your pain can affect you and your loved ones, and how to deal with this, on our page about support when you have pain.

 

Types of cancer pain

Doctors talk about and describe pain in different ways. They may talk about acute and chronic pain. Or they may talk about the body tissue your pain comes from. It is extremely important for your doctor to find out the type and cause of your pain so that they can treat it in the right way. Different types of pain need different treatment. Types of pain include

Nerve pain

Nerve pain is caused by pressure on nerves or the spinal cord, or by damage to nerves. It is also called neuropathic pain. People often describe nerve pain as burning, shooting, tingling, or as a feeling of something crawling under their skin. It can be difficult to describe exactly how it feels. It can sometimes be more difficult to treat than other types of pain.

Some people have long term nerve pain after surgery. Nerves are cut during surgery and they take a long time to heal because they grow very slowly. Some people may have pain around their scar for 2 years or more after their surgery. It does usually go eventually. Nerve pain can also occur after other cancer treatments such as radiotherapy or chemotherapy.

Bone pain

Cancer can spread into the bone and cause pain. The cancer may affect one specific area of bone or several areas. The cancer cells within the bone damage the bone tissue and cause the pain. You may also hear bone pain called somatic pain. People often describe this type of pain as aching, dull or throbbing.

Soft tissue pain

Soft tissue pain means pain from a body organ or muscle. For example, you may have pain in your back caused by tissue damage to the kidney. You can't always pinpoint this pain, but it is usually described as sharp, cramping, aching, or throbbing. Soft tissue pain is also called visceral pain.

Phantom pain

Phantom pain means pain in a part of the body that has been removed. For example, pain in an arm or leg that has been removed due to sarcoma or osteosarcoma. Or pain in the breast area after removal of the breast (mastectomy). Phantom pain is very real and people sometimes describe it as unbearable.

Doctors are still trying to understand why phantom pain happens. One theory is that the thinking part of your brain knows that you have had a part of your body removed but the feeling part of your brain can't understand this. Other possible causes of phantom pain are poor pain control at the time of surgery.

Between 6 and 7 out of 10 people (60 to 70%) who have had an arm or leg removed feel phantom pain. About one third of women who have had a breast removed to treat breast cancer feel phantom breast pain. The pain usually lessens after the first year but some people can still feel phantom pain after a year or more. In most people it will go away after a few months. It is as though your brain has to realise that part of your body has gone. It is important to let your doctor or specialist nurse know about phantom pain because it can be controlled with painkillers.

Referred pain

Sometimes pain from an organ in the body may be felt in a different part of the body. This is called referred pain. For example, a swollen liver may cause pain in the right shoulder, even though the liver is under the ribs on the right side of the body. This is because the liver presses on nerves that end in the shoulder.

 

How much pain you might have

The amount of pain you have with cancer depends on

  • The type of cancer you have
  • Where it is
  • The stage of your cancer
  • Whether the cancer or treatment has damaged any nerves

Other factors such as fear, anxiety, depression and a lack of sleep can also affect how you feel pain.

If you have pain it is very important to let your medical team know straight away. If you try to put up with the pain, this can lead to nerve changes that may make the pain harder to control in the future.

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Updated: 3 July 2013