Page last updated: September 2024
The information on this webpage was adapted from Understanding Cancer Pain - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in September 2024.
Expert content reviewers:
This information was developed based on Australian clinical practice guidelines and with help from specialists working in pain management, oncology and palliative care, and people affected by cancer. All updated content has been clinically reviewed by:
- Professor Paul Glare, Chair of Pain Medicine, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW; and
- Dr Tim Hucker, Pain Specialist, Northern Beaches Hospital, Director, Northern Beaches Pain Management, NSW.
This edition is based on the previous edition, which was reviewed by the following panel:
- Dr Tim Hucker (see above)
- Dr Keiron Bradley, Palliative Care Consultant, Bethesda Health Care, WA
- A/Prof Anne Burke, Co-Director Psychology, Central Adelaide Local Health Network, President, Australian Pain Society, Statewide Chronic Pain Clinical Network, SA, School of Psychology, The University of Adelaide, SA
- Tumelo Dube, Accredited Pain Physiotherapist, Michael J Cousins Pain Management and Research Centre, Royal North Shore Hospital, NSW
- Prof Paul Glare (see above)
- Andrew Greig, Consumer
- Annette Lindley, Consumer
- Prof Melanie Lovell, Palliative Care Specialist HammondCare, Sydney Medical School and The University of Technology Sydney, NSW
- Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA
- Melanie Proper, Pain Management Specialist Nurse Practitioner, Royal Brisbane and Women’s Hospital, QLD
- Dr Alison White, Palliative Medicine Specialist and Director of Hospice and Palliative Care Services, St John of God Health Care, WA
Sometimes cancer pain can be difficult to relieve completely with medicines, or you may need to stop taking a pain medicine because of its side effects.
If you continue to have pain, let your health care team know. There are other ways to reduce pain that don’t involve medicine. Often a combination of treatments and therapies are more effective than just one.
Cancer treatments can sometimes reduce pain by helping to remove its cause. This will depend on the cancer, the type of pain and where the pain is.
Cancer treatment aimed at relieving pain, rather than curing the disease, is called palliation or palliative treatment.
Surgery
Whether surgery is an option depends on several factors, including your overall health and fitness. Some people may have an operation to remove part or all of a tumour from the body.
It can be a major, invasive operation or a relatively minor procedure. Surgery can improve quality of life if the pain is caused by a tumour pressing on a nerve or blocking an organ.
Examples include unblocking the bile duct to relieve jaundice (which can occur with pancreatic cancer), or removing a bowel obstruction (which can occur with ovarian or bowel cancer).
Radiation therapy
Radiation therapy uses a controlled dose of radiation, usually in the form of x-ray beams, to kill or damage cancer cells so they cannot grow, multiply or spread. This will cause tumours to shrink and stop causing discomfort.
For example, radiation therapy can relieve pain if cancer has spread to the bones, or headaches if cancer has increased the pressure in the brain.
When radiation is used for pain management, often only a short course of treatment of a few days to a week or two is required.
It can take a few days or weeks before your pain improves. You will need to keep taking your pain medicines during this time. In some cases, the pain may get worse before it gets better. Your doctor will be able to prescribe different medicines to manage this.
The dose of radiation therapy used to treat pain is low, and the treatment has very few side effects other than tiredness.
“I have an intrathecal pump, which is filled by a community nurse. I also take breakthrough medication, but some days I don’t need any. You can never tell. The pain is mysterious.” Kate
Cancer drug therapies
Drug therapies for cancer may be used to control the cancer’s growth and stop it spreading. The drugs reach cancer cells throughout the body. This is called systemic treatment, and it includes:
- chemotherapy – use of drugs to kill cancer cells or slow their growth
- hormone therapy – use of synthetic hormones to stop the body’s natural hormones from helping some cancers to grow
- targeted therapy – use of drugs to attack specific features of cancer cells to stop the cancer growing and spreading
- immunotherapy – use of the body’s own immune system to fight cancer.
In some cases, drug therapies can shrink tumours that are causing pain, such as a tumour on the spine that cannot be operated on, to help improve quality of life.
In other cases, drug therapies can reduce inflammation and relieve symptoms of advanced cancer, such as bone pain. They can also be used to prevent the cancer coming back.
Other medical procedures
Pain can sometimes be managed with other medical procedures. This can include simple options such as nerve blocks to more complex procedures such as implanted pumps.
These options are not suitable for everyone, but can be particularly useful for treating nerve pain or pain that has been difficult to control with other medicines.
Talk to your doctor about referring you to a pain specialist. The specialist can explain the risks and benefits of each procedure.
Nerve block
A nerve block numbs the nerve sending pain signals to the brain. It is usually an injection of local anaesthetic, similar to when a dentist numbs a painful tooth. Sometimes an x-ray or ultrasound machine is used to help guide the needle.
In most cases, the numbing effect lasts for a few hours, but it sometimes lasts for days.
A nerve block is generally used to provide short-term pain relief or to help diagnose which nerve is sending the pain signals. This can be used to help with pain after an operation.
RFA or pulsed radiofrequency
Radiofrequency ablation (RFA) or pulsed radiofrequency can be used after some nerve blocks to provide longer-lasting pain relief.
Pulsed RFA applies electric pulses to change how the brain senses the pain signal. Thermal RFA uses heat to damage the nerve and block it from sending pain signals to the brain.
Your treating pain specialist will let you know what type of radiofrequency is most suitable.
Relief from RFA is instant for some people, but for others may take up to two months to work. It can last for nine months to more than two years.
Epidural
This is an injection of local anaesthetic and sometimes other pain medicines near the nerves in the back. The pain relief can last for up to two weeks.
An epidural can also be used to see if a spinal procedure is likely to help. It is sometimes offered to help with pain after an operation.
Spinal catheter with port or pump
If longer-term pain control is needed, a small tube (epidural catheter) may be placed a little deeper in the back. This is connected to an opening (port), which allows pain medicine to be dripped in continuously.
If pain is likely to last longer than six months, the catheter is attached to a small pump under the skin of the abdomen (known as an intrathecal pump). This pump is refilled about every three months with pain medicine.
The pump can be adjusted depending on how much pain relief you need.
Spinal cord stimulator
This is a long-lasting procedure to treat nerve pain problems. A device is implanted into the spine, and a remote control is used to send low levels of electricity. It causes tingling against the nerves in the back or neck, which reduces the amount of pain felt.
The procedure is done in two steps, with the first step as a trial to see if it provides relief. If pain relief is above 60%, the second step is to permanently implant the device.
Other ways to control pain
Pain medicines are often used along with other therapies to ease the discomfort of pain. These may include exercise, physical therapy, talk therapy and a range of complementary therapies.
These treatments are offered by allied health professionals, such as physiotherapists, psychologists and exercise physiologists.
Practitioners are usually part of your hospital multidisciplinary team (MDT), or your GP can refer you to private practitioners.
Physiotherapy and exercise techniques
An accredited physiotherapist or accredited exercise physiologist can develop a program to improve muscle strength and help you get back to some activities.
Specialised physiotherapy can help reprogram the brain to manage issues such as phantom limb pain after an amputation.
Occupational therapy
An occupational therapist can provide equipment and other devices to make you more comfortable. For example, special cushions for when you are sitting or lying down.
Psychological support
Professionals such as psychologists and counsellors can provide therapies such as cognitive behaviour therapy, acceptance and commitment therapy, and mindfulness-based cognitive therapy.
These professionals help you understand how your thoughts and emotions affect your response to pain or identify any worries that are making the pain worse.
They can help you build new coping skills and get you back to your usual activities as much as possible.
A psychologist can teach you to use techniques such as desensitisation. This involves focusing on the pain and relaxing at the same time.
Desensitisation is sometimes used for neuropathic pain (e.g. numbness or tingling). Other ways to temporarily focus on something other than the pain include counting, drawing and reading.
Complementary therapies
Complementary therapies are designed to be used alongside conventional treatments.
They may help you cope better with pain, increase your sense of control, decrease anxiety, and improve your quality of life.
Examples include acupuncture, hypnotherapy, reflexology, and mindful meditation, among others.
Let your doctor know about any complementary therapies you are using or thinking about trying, as some may cause reactions or unwanted side effects.
You should also tell the complementary therapist about your cancer diagnosis, as some therapies may need to be adjusted.
Alternative therapies are used instead of conventional medical treatments. They are unlikely to be scientifically tested, may prevent successful treatment of cancer-related pain and can be harmful.
Cancer Council does not recommend the use of alternative therapies for cancer pain.
