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Pain

Some types of cancer or their treatments may cause pain, but having cancer doesn’t necessarily mean having pain. You may worry that a new ache or pain means that the cancer is getting worse or has spread. Try to keep in mind that the amount of pain is not always related to how advanced the cancer is or if treatment is working. For example, a very small tumour pressing on a nerve can be painful, while a large tumour somewhere else may not cause any pain at all.

Pain related to cancer can affect you both physically and emotionally. Pain can affect healing and cause fatigue, loss of appetite and problems sleeping. Dealing with pain also takes energy that you need to fight disease and carry out normal daily activities.

For most people, pain related to cancer or its treatment can be controlled. Your healthcare team can help you find ways to prevent, manage or relieve your pain.

Types of pain

Pain is often described based on how long it lasts.

  • Acute pain is short-term pain. It comes on quickly, lasts a relatively short time and can range from mild to severe. It is caused by tissue damage or inflammation.
  • Chronic pain is long-term pain. It may last a few weeks or months or be ongoing. It may be constant or come and go, and it can range from mild to severe. Chronic pain can start as acute pain and then stay beyond the normal expected healing time. It is also called persistent pain.
  • Breakthrough pain occurs when pain “breaks through” the regular dose of pain medicine. It can be moderate to severe. When breakthrough pain is related to activity, it is called incident pain. When it occurs as the effects of pain medicine wear off, it is called end-of-dose pain.

Pain can also be described based on the part of the body it affects.

  • Nerve pain is caused by pressure on the nerves or spinal cord, or by damage to nerves. It may be described as burning or tingling. You may have nerve pain after surgery, radiation therapy or chemotherapy.
  • Bone pain develops when cancer spreads to the bone. It may occur in one or more areas of bone. Bone pain is often aching, dull or throbbing.
  • Soft tissue pain is caused by damage to an organ or muscle. It is usually described as sharp, aching or throbbing.
  • Visceral pain is pain that starts in internal organs such as the intestine or bowel. It is often difficult to describe or find the source of the pain. It is described as colicky or vague and is often linked with other symptoms such as nausea and sweating.
  • Phantom pain is pain or changes in sensation in a body part that has been removed. For example, some people feel pain in an arm or leg that has been amputated or in the breast area after a mastectomy.
  • Referred pain is when one part of the body causes pain in another part. For example, a swollen liver can press on nerves and cause pain in the right shoulder.

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Causes of pain

Pain may be caused by the cancer itself, medical tests or procedures and cancer treatments or their side effects.

Tumours

Tumours can cause pain as they grow. They can damage parts of the body or press on organs, nerves or bones. For example, a tumour may spread to the spine and cause spinal cord compression. Tumours can also cause pain if they block organs, tubes or blood vessels.

Medical tests or procedures

Medical tests or procedures sometimes cause pain. These tests or procedures can include injections, placing an intravenous line, a lumbar puncture, a bone marrow aspiration or surgery. Whenever they do a test or procedure, the healthcare team takes measures to prevent pain as much as possible.

Cancer treatments

Cancer treatments may cause pain. For example, surgery to remove a tumour can damage tissue or nerves, and some people may develop an infection after surgery. Some chemotherapy drugs may cause vomiting, diarrhea, constipation or mouth sores, which can be painful. Radiation therapy can also cause discomfort or pain, depending on the area treated.

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Talking about pain

You can help make sure your pain is relieved or controlled by talking to your healthcare team about it. Be honest, and let them know if you have any pain or concerns about its treatment. The more you talk about it and answer the healthcare team’s questions, the better equipped they will be to help relieve or control your pain.

Try to remember that you do not have to accept pain as part of your disease. Others will not think you are weak because you admit that you have pain. You aren’t being a nuisance or making a fuss when you talk about your pain.

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Treating pain

The first step your healthcare team will take to treat your pain is to find out more about it. They will ask you questions, including where you feel pain, what it feels like, how strong it is and how long it lasts.

Different treatments can be used to relieve or control pain, including medicines, medical therapies and physical, psychological or complementary methods. Each of these treatments may be used alone or in combination. It may take a few hours or days to get your pain under control. How long it takes depends on the type, location and duration of the pain itself, the type of treatment used and if it causes side effects. Everyone responds differently to each treatment. You may need to try several before you find what works best for you.

Assessing and managing pain involves experts with different skills. Your entire healthcare team may be involved in treating pain. Some treatment centres may have pain teams that include specialized doctors and nurses. A physiotherapist or occupational therapist may show you ways to move or do things to prevent pain or keep you more comfortable. Counsellors or psychologists can help you develop skills to cope with pain and manage any worries or concerns that may make pain worse. Some hospitals and communities also have palliative care teams.

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Pain and emotions

Pain can affect your thoughts and feelings as well as your body. When you’re in pain, you may feel sad, anxious, irritable, angry or frustrated. You may feel alone even though there are others around you. Untreated pain can lead to depression, fear of living in pain and a poorer quality of life. If you are in constant pain, you may feel like you can’t focus on anything else. Your physical pain may even feel worse when you are afraid, anxious, sad, angry or tired.

Just as pain can affect your emotions, your emotions also affect your pain. Pain is more than physical. It also has psychological, social and spiritual parts. Spiritual pain may include fear of the unknown, search for meaning and purpose, loss of faith or anger at what is happening. Social pain may include financial concerns and worries about the future, losing your job or having to depend on others. Psychological pain may include anxiety, fear of suffering and depression.

Talk with your healthcare team about your feelings and how pain is affecting you. You are not alone. There are many people who can help you.

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Finding support

Try talking about your feelings with someone you feel comfortable with, such as family, friends, clergy or the healthcare team. You may also find it helpful to talk to someone who has had cancer and who understands what you are going through. Ask your healthcare team or talk with others in your community about joining a support group.

Talking about your pain can help others understand what you are going through and find ways to help you. Sometimes just having someone listen to you and acknowledge your pain can be helpful.

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