Cancer Pain: Causes, Treatment, and Support for Cancer Pain

Cancer patients may experience tumor pain of varying intensity for a number of reasons. Causes include the cancer itself, the specific treatment, or processes unrelated to the cancer. A growing tumor can press on nerves, bones, or surrounding tissues. Metastases can also cause pain, especially when they affect bones. Pain may increase as the tumor invades healthy tissue. Tumor growth at an advanced stage can also trigger pain.

Keeping a pain diary is helpful for tracking cancer-related pain. It helps identify pain triggers early on. It also helps plan and dose medication therapy correctly. This allows you and your doctor to respond more effectively to the situation.

Using a pain diary, you can, for example, identify a connection between a hectic daily routine and an increase in pain. In that case, a change in your lifestyle might be necessary.

If the cause is unclear, imaging tests such as CT or MRI can help pinpoint changes more accurately.

There are already pre-printed forms available for pain diaries. Ask your treating doctor about them.

The following information should be recorded in the pain diary:

• How severe is the pain? (Scale of 0–10)
• Where in the body does the pain occur?
• How would you describe the pain? Here are some commonly used terms:
  • sharp,
  • stabbing,
  • burning,
  • dull,
  • pulling,
  • oppressive,
  • cramping.
• When does the pain occur?
• How does my mood affect the pain, and vice versa?
• What medications do I take, and when?
• How does the pain relate to my various daily activities?
• Is the pain constant, do you experience sudden attacks of pain, or is it constant with additional flare-ups?

This documentation is particularly valuable for patients with cancer pain; it shows whether the current treatment is sufficient or whether the dose needs to be adjusted.

The cornerstone of treatment is causal therapy, i.e., treating the cancer itself through

• surgery
• chemotherapy
• radiation therapy

The goal is to control the cancer. If this slows the tumor’s growth, it can reduce pain. 

This treatment is not always sufficient to relieve tumor-related pain. In such cases, pain medications are used. Medication is generally effective quickly and carries relatively few risks.

The type of pain you experience determines which pain medications you will receive. The duration of the medications’ effects determines the intervals at which they are taken. Medications are generally administered according to the WHO pain ladder. This is a protocol developed by the WHO (World Health Organization).

Analgesics for the Treatment of Cancer Pain

For mild to moderate pain, non-opioid pain relievers are sufficient. They are also called peripherally acting analgesics. These include, for example, the following substances

• acetylsalicylic acid (ASA)
• Ibuprofen
• Paracetamol

In addition to their pain-relieving effects, some of these analgesics also help reduce inflammation. Please never take medications (including over-the-counter ones) for an extended period without consulting your doctor. Your doctor knows which medication is right for you and can identify potential side effects early on.

Medications provide fast and reliable relief from pain © Lyudmyla V | AdobeStock

Adjuvant Medications

In addition to pain relievers, doctors may also prescribe so-called adjuvant medications. These complement pain management. They alleviate symptoms that are causally related to cancer pain or that may trigger or exacerbate it. These include:

• Tension
• Anxiety
• Depression
• Insomnia

Psychotropic medications—such as antidepressants, tranquilizers, or neuroleptics—can help with these symptoms.

Corticosteroids are also frequently used for cancer-related pain to combat pain caused by inflammatory processes. A positive side effect of this treatment is the increased appetite and improved mood caused by corticosteroids.

Talk to your doctor immediately if pain relief is unsatisfactory or if severe side effects occur. There may be another medication that is more suitable.

For conditions such as neuropathic pain and nerve pain, special medications that target irritated or damaged nerves are often used. In cases of neuropathic pain, a standard pain reliever is sometimes not enough. Similarly, a combination of different medications may be necessary for neuropathic conditions.

Opioids for the Treatment of Cancer Pain

If you are experiencing severe pain or if the pain worsens over time, opioids are often the treatment of choice. These include, for example, morphine, oxycodone, hydromorphone, and fentanyl. These medications can be administered as drops, capsules, tablets, or patches. These medications are usually taken orally whenever possible. It is important to take them regularly according to the doctor’s plan to maintain a consistent level of the active ingredient in the blood. Additional as-needed medication may be prescribed to manage breakthrough pain.

Consistent Medication Intake

Newer morphine formulations are available in extended-release form. Extended-release means that the active ingredient is released gradually and evenly. This ensures the desired pain relief over a long period of time.

Such formulations, for example, need to be taken only once or twice a day. Patients with difficulty swallowing can open the extended-release capsules and take the contents with a little liquid. However, this is only possible with certain formulations.

If the pain cannot be significantly relieved, intravenous administration of opioids may be necessary. So-called PCA pump systems have proven particularly effective in this context. These allow the patient to administer the required dose of morphine as needed without the risk of an overdose.

PCA pumps can also be used at home as a continuous infusion after consultation with a healthcare provider.

Managing Side Effects

Although the benefits of opioids for pain management outweigh the risks, their use is still subject to many misconceptions.

In particular, fears of addiction and dependence are frequently raised. However, these fears are unfounded, especially when the basic rule—regular administration according to a schedule—is followed. When the active substance is maintained at a consistently high level, the euphoric (happiness-inducing) mechanism—and thus the mechanism that triggers addiction—is eliminated.

Another unfounded prejudice: opioids have a sedative effect and thus hinder social interactions. The sedative effect, just like nausea, is present only during the first few days of treatment. It then disappears in most cases.

Another side effect of opioid therapy is constipation. However, this begins right from the start of treatment and should be addressed promptly—ideally as a preventive measure. Medications are also available for this purpose, such as laxatives.

You can also take simple steps yourself to alleviate constipation, such as

• eating fiber-rich foods (as long as you can tolerate them),
• drinking plenty of fluids, and
• getting as much exercise as you can.

Medications aren’t the only way to reduce pain. Other methods include

• physical therapies such as heat and cold treatments, 
• psychological methods such as relaxation techniques and hypnotherapy, etc.

Listing and describing them all would go beyond the scope of this guide.

Talk to your doctor and/or pain specialist about other possible treatments and ask for a detailed explanation of how they work. Health insurance often covers the costs of many of these treatments, but be sure to clarify this in advance.

Effective cancer treatment combines symptom relief, treatment of the underlying cause, medication, complementary therapies, and practical support for daily life. Take advantage of all the options that could help you.

Here are some suggestions for family members and patients to better manage pain and the disease in everyday life.

Advice for patients:

• Say “no” if you feel physically overwhelmed.
• Don’t wait until the pain is severe and unbearable.
• Be willing to accept help and ask for it.
• Seek advice from your doctor or a pain management specialist.
• Stay active; participate in life.
• Try to keep other areas of your life open to you or explore new ones, despite your illness.
• Maintain your independence as much as possible.

Advice for family members:

• Show reasonable consideration and do not overwhelm the person living with chronic pain.
• However, also challenge the person affected within the limits of their abilities.
• Take your own needs into account and make time for yourself to relax.
• It can happen that a person with cancer may lash out even at those they love. Try not to take these outbursts personally. Address the situation once it has calmed down. Discuss with your family members how to divide up tasks and ensure everyone has the personal space they need.
• If you’re unable to make progress on your own, a conversation at a psychosocial counseling center, with a psychotherapist, or with a spiritual counselor may be helpful. You can have this conversation alone or together with the person affected.

Stay active as much as you can. Participate in life and try, despite the illness, to keep other areas of life open or to explore new ones. Anyone who notices new flare-ups of pain or changes should inform the treatment team as soon as possible. Preventing cancer pain means, above all, recognizing pain early, monitoring it regularly, and adjusting treatment in a timely manner. It is not always possible to completely prevent cancer pain, but effective management can reduce many of the burdens associated with it.

What does cancer pain feel like?

The pain can be stabbing, burning, dull, pulling, pressing, or cramping.

Burning or shooting pains are more likely to indicate nerve involvement, while dull pains are more likely to indicate pressure, stretching, or inflammatory processes.

When does cancer pain occur?

Tumor-related pain can occur at any stage of cancer. It becomes more common as a tumor grows, metastases develop, or treatments such as surgery, chemotherapy, or radiation therapy cause discomfort.

What medications help with cancer pain?

Depending on the severity of the pain, non-opioid analgesics, opioids, and complementary medications may be considered. The choice depends on the cause of the pain, its severity, comorbidities, and tolerability.

What helps with severe tumor pain?

Opioids are often used for severe pain; in addition, as-needed medication may be necessary to manage sudden spikes in pain. It is important not to change the treatment on your own, but to adjust it in consultation with your doctor.

Can cancer pain disappear completely?

Yes, for many patients, symptoms can be significantly alleviated or completely controlled. A precise diagnosis, regular review of the treatment, and open communication about efficacy and side effects are crucial.