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Cancer pain

Cancer pain can come from the cancer itself, from its treatment — surgery, radiotherapy or chemotherapy — or from both. Most of it can be well controlled, and where medication alone is not enough, targeted procedures can reduce pain at its source. Referrals for cancer pain are prioritised.

Pain is one of the most feared parts of a cancer diagnosis, and one of the most treatable. It deserves the same careful assessment as any other pain — because "cancer pain" is not one thing, and working out exactly what is generating it changes what will help.

Where cancer pain comes from. The tumour itself can cause pain by pressing on or invading bone, nerves or organs. Treatment causes pain of its own: surgery can leave persistent post-surgical pain, radiotherapy can injure tissues and nerves in the treated field, and several chemotherapy agents cause painful peripheral neuropathy — burning, tingling feet and hands that can persist after treatment ends. And people with cancer still get the same back pain, joint pain and headaches as everyone else. Assessment sorts these out rather than attributing everything to the cancer, because their treatments differ — and because new pain sometimes signals something the oncology team needs to know.

Can it be controlled? For most people, substantially, using well-established approaches matched to the pain's mechanism. Medication remains the foundation of cancer pain care and is coordinated with your treating teams. The question this practice most often helps answer is what to do when medication alone is not enough, or when the doses required cause sedation, nausea or confusion that costs you the time you most want to be present for.

Where procedures fit. Targeted interventions can reduce pain at its source and allow medication to be wound back: nerve and plexus blocks for pain in a defined territory, longer-lasting neurolytic techniques for selected situations — well established for abdominal malignancy — and intrathecal approaches that deliver medication directly to the spinal fluid at a fraction of the systemic dose. These options are described in more detail on the cancer pain procedures page, and considered case by case with your team.

Timing matters. Interventional options are often considered late, after months of escalating difficulty, when they would have helped earlier. If pain is becoming hard to control — or side effects are becoming the problem — that is the right time for referral, not the last resort. Referrals for cancer pain are prioritised, and GPs, oncologists and palliative care teams are welcome to call the rooms to discuss timing.

Working with your team. Nothing here happens in isolation: assessment findings and plans go back to your oncologist, palliative care physician and GP, and the aim is always to fit the overall direction of your care and your own priorities — including when the priority is comfort, clarity and time with the people who matter.

Sources: International Association for the Study of Pain; Healthdirect Australia; Cancer Council Australia.