Cancer-Related Pain

What is Cancer-Related Pain?

Cancer-related pain is pain caused by the cancer itself or by cancer treatment. It is common and often under-treated: in one review, pain remained poorly controlled in about 40% of patients, and about 28% of cancer survivors had moderate to severe chronic pain.^[1]

Common symptoms

Cancer pain can be a dull ache, sharp pain, burning, or shooting pain, and many people have more than one type at once.^[2] Pain from nerve damage often feels like burning, tingling or electric shocks.

• Pain at or near the site of a tumor
• Joint or muscle pain, including stiffness after hormone-blocking treatment
• Burning or numb feet and hands after some chemotherapy
• Pain that disrupts sleep, mood, appetite and activity^[2]

Causes and risk factors

Pain may be due to the tumor pressing on or invading tissue, bone or nerves, or to treatment such as surgery, chemotherapy or radiation.^{[2, 3]} Researchers describe it as nociceptive (from tissue injury), neuropathic (from nerve injury) or mixed, with changes in how nerves and the spinal cord process pain signals adding to it over time.^{[2, 4]}

How it is diagnosed and treated conventionally

Your oncology or palliative care team assesses the pain, its type and its cause, and chooses treatment to match.^[5] Treatment is usually a combination: pain medicines including opioids, drugs for nerve pain, treatment aimed at the cause, procedures, and psychological support.^{[1, 4]}

The World Health Organization analgesic ladder, introduced in 1986, has long guided medicine choices for cancer pain.^[6] Newer thinking treats cancer pain more like other long-term pain, with an "integrative and supportive" approach aimed at quality of life.^[1] Current US guidelines also address non-drug options and the careful use of opioids.^[5]

Why Cancer-Related Pain calls for a whole-person approach

Cancer pain rarely has a single cause. Tumor effects, treatment effects, nerve sensitivity, mood and sleep can all feed one another, so reviews recommend a multimodal plan that combines medicines with non-drug approaches.^{[2, 4]}

Because of this, supportive therapies can reasonably sit next to medical care. Their role is to help with pain and the symptoms around it, not to treat the cancer.

Sensitized nerves

Over time, both peripheral nerves and the spinal cord can become more sensitive, which can make pain persist and spread.^[4] This helps explain why pain can continue after a tumor is treated.^[1]

Treatment side effects

Cancer pain may come from the treatment itself, such as nerve injury or joint pain, and not only from the tumor.^[3] Aromatase inhibitors, for example, commonly cause joint pain, and this leads some women to stop therapy.^[7]

Mood, sleep and daily function

Pain affects quality of life, emotional wellbeing and the ability to stay on treatment.^[2] In trials of acupuncture and massage in advanced cancer, fatigue, insomnia and quality of life were measured alongside pain and also improved.^[8]

Acupuncture for Cancer-Related Pain

What the research shows

Research suggests acupuncture may reduce cancer pain when added to usual care. A 2020 meta-analysis in JAMA Oncology pooled 17 trials. Seven high-quality sham-controlled trials found real acupuncture reduced pain more than sham, and acupuncture or acupressure alongside pain medicine was linked to lower pain scores and lower opioid doses. The authors graded the evidence as moderate because results varied a great deal between studies.^[9]

A 2024 meta-analysis of 16 trials with 1,124 participants also found less pain with acupuncture than with no treatment, sham acupuncture or usual care, although some trials were small or low quality and the cancers and stages differed.^[10] An overview of 51 systematic reviews concluded acupuncture may benefit cancer-related pain, but rated most of those reviews as low or very low methodological quality.^[11]

Two US trials add detail. In the PEACE trial, 360 cancer survivors with chronic musculoskeletal pain had 10 weekly sessions of electroacupuncture or auricular (ear) acupuncture. Both reduced pain more than usual care at 12 weeks, and more people stopped ear acupuncture because of side effects.^[12] In the IMPACT trial of 298 people with advanced cancer, acupuncture and massage each reduced pain over 26 weeks, with no significant difference between them.^[8]

For joint pain from aromatase inhibitors, a trial of 226 women found real acupuncture lowered pain more than sham or waiting, though the authors considered the clinical importance uncertain.^[7] A 2022 guideline from the Society for Integrative Oncology and the American Society of Clinical Oncology gave acupuncture a moderate-strength recommendation for cancer pain.^[13]

How acupuncture may work

Researchers propose that acupuncture changes how the nervous system handles pain. Laboratory and human studies point to activation of the body's own opioid and other pain-modulating pathways, stronger descending pain inhibition, and lower levels of inflammatory chemicals near the needle.^[14] These are proposed explanations, not settled facts, and most come from non-cancer pain research.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points chosen for you, usually left in for about 20 to 40 minutes. The trials above used about 10 weekly sessions, and we reassess after a short course of visits.^{[8, 12]}

Side effects are usually minor. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000.^[15] Bruising occurred in about 6.5% of patients in the advanced cancer trial.^[8]

Tell the practitioner first if you have a low platelet count or low white blood cell count, a bleeding disorder, take blood thinners, have lymphedema in a limb, are pregnant, or have a pacemaker (relevant to electroacupuncture). Your oncology team should be consulted when your blood counts or treatment may make needling risky.

Ayurvedic medicine for Cancer-Related Pain

The Ayurvedic view

In Ayurveda, pain is classically linked to aggravated Vata, the principle said to govern movement and the nerves, and cancer-related pain would be understood in terms of the person's overall constitution and the state of their tissues. Ayurvedic texts describe cancer itself in terms of imbalance of the doshas and weak body tissues.^[16] These are traditional frameworks, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and is gentle in this setting:

• Diet and daily routine aimed at regular meals, rest and steady sleep
• Warm oil massage, if your oncology team agrees it is suitable for your skin and treatment area
• Individually prescribed herbs, reviewed against your cancer treatment and medicines

Panchakarma is not appropriate during pregnancy, acute illness, frailty or active chemotherapy, and in cancer care it should not be used without your oncology team's agreement. Transdermal medication therapy, an herbal preparation applied to the skin, may be discussed where it is relevant, but we make no claim that it relieves cancer pain.

What the research shows

We found no clinical trials and no systematic reviews of Ayurvedic treatments for cancer-related pain in PubMed. The Ayurvedic literature we found on cancer is about traditional concepts of how disease develops, not tested pain treatments.^[16] Any benefit for cancer pain is therefore unknown, and Ayurvedic care here is offered for general comfort, sleep and stress, not as a proven pain treatment.

Herbal medicine for Cancer-Related Pain

Herbs and formulas that have been studied

Research on herbs for cancer pain has mostly tested traditional herbal medicine used together with conventional treatment.^[17] The abstract of the main review does not name individual herbs or formulas, so none is singled out here.

What the research shows

The evidence is limited. A systematic review of 24 randomized trials with 4,889 patients found that traditional herbal medicine combined with conventional therapy was associated with less cancer pain in some of the trials (for example, 4 studies of 1,696 patients reported a lower degree of pain), but the authors called for larger, better-designed trials.^[17] A US guideline on integrative therapies in breast cancer found no strong evidence that ingested dietary supplements help manage treatment side effects.^[18]

Safety and herb-drug interactions

Herbs are active substances, and in people with cancer the cautions matter more. Herbs can interact with prescribed drugs. Case reports describe bleeding when warfarin was combined with herbs including dang gui, dan shen, ginger, ginseng and Boswellia.^[19] Tell us about every medicine you take, including chemotherapy, targeted therapy, opioids and blood thinners, and let your oncologist know about any herb before you start it.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or have surgery or radiation planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine describes pain as blocked flow of qi and blood in the channels, and acupuncture aims to free it. Researchers studying acupuncture analgesia instead measure nerve signaling, the body's opioid pathways and local inflammation.^[14]

Ayurveda's aggravated Vata describes pain that is sharp, moving or nerve-like. No study has shown that a dosha corresponds to a specific biological process.

How this care fits with your medical care

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Integrative care is added to, never substituted for, your oncology and pain management. Do not stop or change prescribed medicines, including opioids, without your prescriber.

We do not diagnose the cause of cancer pain or treat the cancer. Please bring your diagnosis, current treatment plan, a full list of medicines and supplements, and recent blood counts. New or changing pain should be reported to your oncology team.

When to seek urgent medical care

Some cancer pain symptoms can signal an emergency that needs immediate treatment.

• New back pain with leg weakness, numbness, or loss of bladder or bowel control
• Sudden severe pain, or pain that suddenly becomes much worse
• Fever or chills, especially during chemotherapy
• Confusion, severe drowsiness or slowed breathing after taking pain medicine
• Bone pain with a new fracture or inability to bear weight
• Chest pain, shortness of breath, or a swollen, painful leg

If any of these occur, call 911 or go to the nearest emergency department.