Palliative Care & Pain Management: Overview of Cancer Pain

Most newly diagnosed cancer patients do not actually have pain associated with the disease. Nonetheless, pain is a symptom that many cancer patients fear at diagnosis. Pain may become more of a concern as cancer progresses — about three-quarters of patients with advanced disease have some degree of pain.

Each person experiences pain in a different way. Physical pain may be accompanied by impaired function, psychological distress with grief over loss and change, financial strains, and disruption in family relationships. At Memorial Sloan Kettering, a patient's medical team not only takes physical pain into account but also considers nonphysical stressors such as emotional, financial, and spiritual difficulties.

Looking at all the factors that may be contributing to a patient's experience of pain allows the medical team to make referrals to Memorial Sloan Kettering's support services, which include psychological consultation, counseling and support groups, help with difficult ethical decisions, and complementary therapies for symptom management.

Types of Physical Cancer Pain

There are several types of cancer-related pain, which are distinguished from one another according to cause, intensity, and/or duration.

Cancer pain may be acute (relatively short term) or chronic (continuing over several weeks or months). Both types can be of varying severity and occur as a result of tumor growth, injury, and certain treatments and procedures. Breakthrough pain is a sudden, temporary flare in pain intensity. Breakthrough pain can occur even when a patient takes the proper pain medication, and a doctor may prescribe a special dose or treatment to use when pain breaks through normal pain medication.

Causes of Pain

  • Neuropathic Pain — Neuropathic pain is caused by injury to or compression of nerves or other components of the nervous system.

  • Nociceptive Pain — Pain may also be caused by an inflammatory response to ongoing nerve-tissue damage. This pain, called nociceptive, is classified by site of origin into one of two types:

    • Visceral PainVisceral pain is caused by injury to an internal organ such as the liver. Such pain is often hard to pinpoint and can be throbbing, aching, or sharp.

    • Somatic PainSomatic pain primarily involves bone. It usually can be pinpointed to a specific site on the bone and can be throbbing, aching, or sharp.

Accurate diagnosis of the cause and type of pain is key to finding the most effective treatment for an individual patient. Neuropathic and nociceptive pain, for example, respond very differently to pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), opiods, antidepressants, and anticonvulsants.