Pain Management for Cancer

Pain is an unfortunate but common symptom of cancer and cancer treatment. Studies indicate that as many as 90% of cancer patients with advanced stage disease experience some degree of pain, while as many as 50% of patients have pain at the time of their diagnosis or during active treatment.

The etiology of cancer pain can reasonably be divided into two broad sources:

  1. Tumor involvement or similar pathology. As tumors grow in size they may begin to put pressure on the surrounding organs and tissues or press on nerve endings. This can lead to bone pain, headaches, and muscle pain, as well as pain from organ sites affected by tumors, such as pain in the intestines or kidneys.
  2. Response to anti-cancer treatments, procedures or interventions. Surgeries, biopsies, injections, IV or central line manipulation, lumbar puncture—many cancer-related procedures can prove painful for patients.

Pain itself can also be divided into two general categories:

  1. Nociceptive pain. Often described as 'dull' or 'throbbing', nociceptive pain occurs along the normal nerve pathways.
  2. Neuropathic pain. Often described as 'burning' or 'radiating', neuropathic pain occurs on account of damage the body's nervous system (central and peripheral).

Determining the best path for pain management

When determining the best path for effective pain management, doctors rely on the patient's description of their pain—location, severity, onset, type, etc. They also consider the patient's age, overall health, and previous history with pain medication, as well as issues regarding method of administration (oral pill, IV, topical ointment, transdermal patch) and whether the medication could have an interaction with other ongoing therapies.

With so many options for managing pain and with so much variation between them, effective pain management for cancer-related pain is best handled by a clinician with extensive experience.

Pharmacologic and Nonpharmacologic Intervention

As has been the pattern thus far, the intervention of one's medical team can best be divided into two categories: pharmacologic intervention and non-pharmacologic intervention.

Pharmacologic intervention

Oncologists use an array of medications in the pharmacologic treatment of cancer-related pain, medications that come from several different drug classes, listed below with examples.

Non-steroidal anti-inflammatory drugs (NSAIDs) and non-opioid analgesics
Acetaminophen (Tylenol), Ibuprofen (Motrin), Naproxen (Naprosyn), Aspirin
Amiltriptyline (Elavil), Desipramine (Norpramin), Nortriptyline (Pamelor)
Muscle relaxers
Baclofen, Cyclobenzaprine (Flexeril), Diazepam (Valium), Methocarbamal (Robaxin)
Gabapentin (Neurontin), Clonazepam (Klonopin)
Morphine, Codeine (Tylenol #3, #4), Hydrocodone (Vicodin, Lortab), Oxycodone (Percocet, Oxycontin), Methadone

Nonpharmacologic intervention

In the case of pain management that does not involve pharmaceuticals, doctors have a slightly smaller range of choices. They include:

Physical therapy, Massage therapy, Application of ice and heat, Acupuncture, acupressure

Furthermore, there are non-physical interventions as well that concentrate on the mental health of the patient as a treatment route:

Hypnosis, Cognitive behavioral therapy, Relaxation therapy, Psychotherapy

Side Effects

Successful pain management often will come at the cost of the side effects associated with the choice of treatment. For example, opioids can cause constipation, respiratory depression, sedation, physical dependence or tolerance, nausea, pruritis, delirium, and mental impairment; while if radiotherapy is used to reduce the size of a tumor and relieve pain, then the side effects might include fatigue, hair loss, or other such effects of that treatment.


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