Understanding Physical Pain
By Dr. Alison Krause Zavodny
Pain is a familiar symptom in people with cancer, though not everyone will experience pain. Whether you’re living with cancer or caring for someone who is, pain can be all-consuming — physically, emotionally, and spiritually. You might wonder: What causes cancer pain? Will it get worse? Can anything help? Why?
These questions are real, and so is the suffering. Palliative care specialists can help to ease the pain. They are experts in adjusting pain medications and will use multiple modalities to treat all symptoms that intertwine with pain. You don’t have to “tough it out” and suffer in silence.
Why Does Cancer Cause Pain?
Cancer pain, and pain in general, isn’t just “one kind” of pain. It comes in many forms and can change over time. Understanding the reasons behind it can help you feel more in control and able to work with your physician to improve it.
- Pain from the cancer itself — As tumors grow, they can press on nearby organs, bones, nerves, or blood vessels. For example:
- A tumor in the lung might rub against the lung’s lining, causing pain when breathing.
- A cancer in the abdomen might block the bowel.
- Bone metastases (cancer that has spread into the bones) can be intense and are often described as deep and aching.
- Pain from cancer treatments — Ironically, the very treatments that fight cancer can also cause pain:
- Surgery can lead to post-operative pain, scar tissue, or long-term nerve sensitivity.
- Chemotherapy might cause neuropathy—numbness, tingling, or burning in the hands and feet.
- Radiation therapy can lead to skin irritation, fibrosis (stiffening of tissues), or nerve damage over time.
- Pain from related problems
Some people develop pressure sores from inactivity or from muscle strain caused by changes in how they walk or move. Others experience headaches or abdominal cramping from unrelated but overlapping conditions.
Not everyone with cancer will have pain, but many will at some point. It’s not a sign that something is “going wrong”—it’s a signal that your body needs attention and care.
What Does Physical Pain Feel Like?
Pain is deeply personal. Two people with the same diagnosis might describe pain in entirely different ways.
Some common descriptions include:
- Aching, pressure, or throbbing—often linked to bone or soft tissue involvement.
- Burning, stabbing, or shooting—classic signs of nerve pain (neuropathic pain).
- Cramping or squeezing—common with abdominal cancers or bowel issues.
- Tingling or numbness—seen with nerve involvement, especially from chemo-induced neuropathy.
Pain can also be constant or come and go. It may flare up with specific movements or times of day. Some people feel most pain at night, while others are bothered most when trying to eat, walk, or sleep.
And then there’s emotional pain. Fear, sadness, and frustration—all of these can amplify how we experience physical pain. When you or someone you love is dealing with serious illness, stress can make pain feel sharper, more intense, or more unrelenting.
Caregivers, take note: If your loved one has trouble describing their pain, you can help. Watch for signs like:
- Grimacing or guarding a part of the body
- Changes in movement, appetite, or sleep
- Mood shifts, withdrawal, or irritability
Pain is not just a number on a scale—it’s a story. And your voice helps tell it.
How is Cancer Pain Treated?
Pain is real—but so is relief. In almost every case, pain is manageable with the right combination of approaches. First, stay active! Aerobic exercise helps decrease pain intensity. Training for a marathon isn’t required; you’re already in one, but aerobic activity will help.
Medications: Finding the Right Match
Medications are often the first step in treating cancer pain. These include:
- Non-opioids: Acetaminophen (Tylenol) and NSAIDs like ibuprofen can work well for mild to moderate pain, especially from inflammation.
- Opioids: Physicians often prescribe medications like morphine, oxycodone, hydromorphone, and fentanyl patches for treating severe pain.
- Adjuvant medications: These are not painkillers per se but help manage specific types of pain. For example, Gabapentin or pregabalin can help with nerve pain. Antidepressants like duloxetine or amitriptyline also help in treating nerve pain. Muscle relaxants can relieve muscle tightness or cramping, and steroids can help with their anti-inflammatory properties.
Non-Medication Approaches
Pain management isn’t just about pills. Sometimes what helps most is something else:
- Radiation therapy can shrink tumors that are pressing on bones or nerves.
- Nerve blocks or spinal injections can offer targeted relief.
- Physical therapy can improve movement and reduce stiffness.
- Massage, acupuncture, and relaxation techniques (like guided imagery or meditation) may help ease tension and improve sleep.
Palliative care teams specialize in managing pain and symptoms alongside your cancer treatment. If pain isn’t improving—or you’re not sure where to start—ask for a palliative care referral. They are an extra layer of support for both you and your oncologist.
When to Speak Up About Pain
One of the most powerful things you can do is tell your care team when you’re in pain. The sooner they know, the sooner they can help.
- Don’t wait until pain becomes unbearable.
- Don’t downplay it out of fear, guilt, or worry about being a “bother.”
- Don’t assume it’s “just part of cancer.”
Your comfort matters. Pain isn’t a test of strength. It’s a symptom—and symptoms deserve attention. Caregivers, you can advocate too. If you see your loved one suffering, or if their pain seems to be dismissed or misunderstood, speak up. You are part of the care team.
You Deserve Relief
If you take just one message from this, let it be this: You do not have to suffer. Pain is not something to endure in silence. It’s something to name, describe, and treat. Whether your pain is physical, emotional, or spiritual—or all three—there are ways to find relief. You deserve that.
Living with cancer is hard enough. Pain shouldn’t be part of what makes it more challenging. Speak up, ask questions, and don’t settle for “just living with it.” Relief is possible—and you are not alone.