Cancer-Related Pain: Understanding and Relief

Cancer-Related Pain: Understanding and Relief

Cancer-related pain can be relieved through medical care, appropriate exercises, and strategies to help you resume your activities. Pain that prevents you from sleeping or enjoying time with your loved ones warrants treatment. A 2016 review estimated that 55% of adults undergoing cancer treatment experienced pain.¹ Our guide to physical therapy for cancer-related pain explains the care process.

Your healthcare team can adjust your pain management to improve your comfort and independence. Be sure to report any new or worsening pain, even if you are already taking medication.

• Pain has several causes: tumors, medical treatments, and muscle tension; each cause requires a different approach.
• Several types of care can complement one another: Medical treatment for pain can be combined with exercises, education, and physical therapy tailored to your needs.^{2, 3}

In this guide, you’ll learn about the different types of cancer-related pain, the relief options available, and how physical therapy can help you at every stage of your journey.

What is cancer-related pain?

Cancer-related pain can stem from the tumor itself, from the spread of the cancer to other parts of the body, or from cancer treatments. Metastases are cancerous growths that have developed in other parts of the body. Pain may be recent—known as acute pain—or may last for more than three months, in which case it is considered chronic pain. It can interfere with sleep, work, and relationships.

A Common Reality

A 2016 review estimated that 55% of patients experienced pain during cancer treatment and 39.3% experienced pain after curative treatment. These percentages include adults who were studied at different points in their treatment journey; they do not predict how long your pain will last.¹

Impact on Your Daily Life

Living with oncological pain affects several areas of your life:

• Disrupted Sleep: Nighttime pain prevents restorative rest
• Work-related difficulties: Reduced concentration, more frequent absences
• Social Isolation: Less energy for activities with loved ones
• Increased fatigue: Chronic pain can wear down both the body and the mind
• Increased anxiety: Uncertainty about pain causes stress

Rest assured: understanding your pain is the first step toward finding relief. To better tailor treatment, it’s helpful to know the different types of cancer-related pain.

What are the different types of cancer pain?

Cancer pain can be nociceptive—resulting from the activation of sensors that detect tissue damage—neuropathic—resulting from damage to the sensory nervous system—or mixed. Mixed pain combines both mechanisms. Assessment helps in selecting the appropriate care.

Nociceptive pain

Nociceptive pain can occur when nociceptors—nerve sensors—detect actual or potential tissue damage. These sensors transmit signals to the nervous system. The signals and the pain experienced are two distinct phenomena. There are two subtypes:

Your doctor will choose medications based on the cause of your pain and the risks associated with your treatments. Anti-inflammatory medications can relieve certain types of pain, but they are not suitable for everyone. Physical therapy can complement your treatment when pain affects your movement or daily activities.

Neuropathic pain

Neuropathic pain results from an injury or disease of the nervous system that transmits sensations. It may be accompanied by sensations such as:

• Burning or fiery sensation
• Tingling or numbness
• Electric Shocks
• Numbness
• Increased sensitivity to touch

Chemotherapy-induced peripheral neuropathy is a common example, typically affecting the hands and feet.

Mixed Pain

Mixed pain combines nociceptive and neuropathic components. It is common in advanced cancers or when a tumor invades nerve structures. Several treatment options can then be used in combination, depending on the mechanisms of the pain and your needs.

Understanding the source of your pain helps you identify the right treatments. Let's now look at the main causes of pain in cancer patients.

What are the causes of pain in cancer patients?

The tumor, cancer treatments, and their physical effects can cause or contribute to pain. A tumor may compress a nerve; surgery may leave an area sensitive to touch; and a decrease in physical activity may reduce strength. Several factors may be at play, but their impact varies from person to person.

Tumor-related pain

The tumor can cause pain in several ways:

• Compression of Nerves or Organs: A growing tumor can put pressure on surrounding structures
• Bone Invasion: Bone metastases are a common cause of pain, especially in breast, prostate, and lung cancers
• Obstruction: A tumor can block digestive or urinary tracts
• Local inflammation: The presence of the tumor triggers an inflammatory response

Treatment-Related Pain

Each type of treatment can lead to specific pains:

• Damage to the nerves in the hands or feet, known as peripheral neuropathy: According to a Staff review, 30 to 40 percent of people receiving nerve-toxic chemotherapy develop this condition⁴
• Joint and Muscle Pain
• Mucositis (inflammation of the mouth and throat)

• Fibrosis of the treated tissues—that is, tissues that become stiffer and less flexible after radiation therapy
• Joint stiffness in the treated area
• Local skin or muscle pain

• Recent pain following surgery
• Scars and adhesions: tissue that remains stuck together
• Persistent pain after breast surgery, sometimes related to nerve damage
• Lymphedema, swelling caused by a buildup of lymph, the fluid that the body normally drains from the tissues

• Joint pain, particularly with aromatase inhibitors, which are medications that reduce estrogen production
• Muscle fatigue

Certain breast cancer treatments, such as aromatase inhibitors or chemotherapy-induced menopause, lower levels of estrogen, a hormone that contributes to bone health. Bone loss can increase the risk of osteoporosis—a condition characterized by brittle bones—and fractures.⁵

Pain related to the consequences of the disease

Cancer and its treatments often cause changes that can increase pain:

• Loss of physical fitness: A decline in strength or endurance can make activities more difficult
• Postures Adopted to Relieve Pain: Holding yourself in a certain way to avoid pain can cause new pain
• Anxiety and Muscle Tension: Prolonged stress can increase the sensation of muscle tension
• Fatigue and Pain: Severe fatigue can make pain harder to bear

Understanding Lymphedema

Lymphedema is a buildup of lymph fluid that causes swelling, usually in an arm or a leg.

Lymphedema can appear immediately after treatment or months, even years, later. Early detection and treatment are essential.

This swelling occurs when the lymphatic system, damaged by surgery or radiation therapy, can no longer effectively drain fluids. The affected arm or leg may feel heavy, uncomfortable, and more susceptible to infections. Lymphedema of the arm can develop after breast cancer surgery. The risk increases significantly with the removal of multiple lymph nodes from the armpit, a procedure called a lymph node dissection. Lymph nodes are small organs that filter lymph and play a role in the body’s immune defense. An analysis of 72 studies shows that the incidence of new cases is about four times higher after axillary lymph node dissection than after the removal of the first lymph node that receives lymph from the region, known as the sentinel lymph node.⁶ Radiation therapy in this area is also associated with lymphedema, although the level of evidence for this is less robust in the same review.

Risk factors include:

• Mastectomy with removal of several axillary lymph nodes
• Radiation therapy in the lymph node area
• Recurrent limb infections: an association has been suggested, although the evidence is less robust than for the extent of surgery and being overweight.⁶
• Overweight or obesity
• Reduced physical fitness: an association with risk has been observed, though this does not prove that any prescribed rest causes lymphedema

Lymphedema treatment is described in our guide on physical therapy for cancer-related pain.

Given these many causes, physical therapy offers a tailored and personalized solution. Let’s explore how it can help you in practical terms.

How does physical therapy help relieve cancer-related pain?

Physical therapy can help relieve certain cancer-related pain, improve mobility, and help you resume your activities through exercise, tailored manual therapy, and education. The program takes into account your medical treatments and your condition. Its benefits depend on the specific issue being treated.^{7, 8}

What the research says

The PROSPER study randomly assigned 392 women at high risk for arm problems following breast surgery without reconstruction. At 12 months, the exercise program added to standard care improved arm function more and reduced pain compared with standard care alone. The exercise group did not experience more complications or lymphedema.⁸

Oncology rehabilitation encompasses care that helps patients regain their functional abilities throughout their cancer journey. Before treatment begins, prehabilitation prepares patients physically and supports their psychological well-being. Silver and Baima described this preparatory process as early as 2013, while emphasizing the need to identify the most effective programs.⁹

Knowing when to see a physiotherapist is essential for optimizing your recovery.

When should you consult a physiotherapist?

A physical therapy consultation can be helpful before treatment to prepare for the necessary movements, during treatment to manage certain challenges, and after treatment to resume your activities. Your healthcare team will help you determine the best timing and precautions based on your situation.

Before treatments: prehabilitation

Prehabilitation prepares patients physically, nutritionally, and psychologically before surgery or treatment. Carli and Scheede-Bergdahl described this preparation in 2015.¹⁰ It may include or focus on the following elements:

• Assessment of your baseline physical condition
• Preventive Strengthening Program
• Better recovery of function after cancer surgery: A 2022 review supports this benefit with moderate confidence in the results. The reduction in complications is less certain.¹¹
• Preparation for resuming activities after the procedure, with no guaranteed recovery time

During Treatments

Physical therapy during treatment helps you:

• Managing side effects such as fatigue, pain, and stiffness
• Maintain your mobility and strength
• Minimizing the Loss of Strength and Endurance
• Support your daily quality of life

After treatment

Post-treatment rehabilitation aims to:

• Regain the capabilities you need for your business
• Gradually return to your normal activities
• Managing Long-Term Aftereffects
• Learning to Identify and Manage Persistent Challenges

Signs that indicate you should consult

Talk to your healthcare team about the following difficulties; they can recommend a physical therapy evaluation and determine whether a medical evaluation is necessary:

• Pain that persists or worsens despite medication
• Swelling in an arm or leg (possible lymphedema)
• Difficulty moving a joint normally
• Fatigue that doesn't improve with rest
• Loss of balance or strength

Signs That Require Urgent Medical Attention

The following symptoms require prompt care, and some require immediate attention. Follow the instructions provided for each situation without waiting for a physical therapy session:

• Sudden, severe bone pain—especially if it occurs without a blow or fall—should prompt you to seek medical attention immediately to have the bone examined, as it may be weakened.
• New weakness, numbness, tingling, or loss of sensation; difficulty walking; pain radiating down an arm or leg; new difficulty urinating; or loss of bladder or bowel control: in a person who has or has had cancer, these signs may indicate compression of the spinal cord—the bundle of nerves that transmits messages between the brain and the body—or of the nerves in the spine. You don’t have to experience all of them at once. Seek medical attention immediately.
• If you develop a fever during chemotherapy—even if you’re not in pain—contact your care team immediately and follow their emergency instructions. An infection can progress quickly, even if you still feel relatively well. Call your care team right away if you have a temperature of 38 °C or higher, chills, or other signs of infection. A cough, pain when urinating, or redness around a catheter—a tube used to administer treatments—can also indicate an infection. Follow the emergency number and instructions provided by your care team; if they cannot be reached, go to the emergency room. The National Cancer Institute recommends urgent treatment of infections during treatment.
• New or more severe breathing difficulties than usual: seek medical advice immediately. Call 911 if you are severely short of breath, if your chest feels tight or heavy, or if your lips turn blue or very pale. Call 911 for sudden, severe shortness of breath that does not go away at rest; a new wheezing sound that makes it hard to breathe; or difficulty finishing your sentences because you can’t get enough air. Sudden, severe chest pain or pressure that lasts for several minutes or recurs also requires immediate help. The same applies to a feeling of fainting, confusion, or coughing up a significant amount of blood accompanied by shortness of breath. These warning signs are described bythe American Cancer Society.
• Sudden confusion or altered level of consciousness: Call 911.

New swelling in an arm or leg—especially if accompanied by pain or a change in color—should also be evaluated promptly to check for a blood clot. If these signs are accompanied by shortness of breath or chest pain, call 911. A red, warm, or painful area, or a fever, may indicate an infection. The lymphedema guide recommends calling immediately if these signs are present. Severe, persistent back pain, back pain that worsens, or back pain that wakes you up at night requires consultation with your cancer care team within 24 hours, even if you have no weakness. The same applies to back pain that increases when you move, cough, or strain. Localized pain when pressure is applied or leg cramps while walking also warrant consultation in this context. The neurological signs described above remain an immediate emergency.

These guidelines are based on recommendations from NICE, a British organization, regarding cancer-related spinal cord or nerve compression; from the Canadian Cancer Society regarding infections; and from the NHS, the British health service, regarding blood clots,shortness of breath, and sudden confusion.

You can see a physical therapist when pain, fatigue, or difficulty moving limits your activities, as well as before or after surgery. An evaluation as soon as you receive a diagnosis can help tailor your care to your needs. However, the urgent symptoms described above take priority over a physical therapy appointment.

Talk to your team and the physical therapist as soon as possible about the following issues:

• Coordination Challenges
• Persistent numbness or tingling

Don't wait until your symptoms become severe. An evaluation can help determine what care is needed and how to adjust your activities. Our guide to managing your pain at home while you wait to see a doctor provides general advice; it is not a substitute for cancer-specific precautions or an urgent medical consultation.

At Physioactif

When scheduling an appointment at Physioactif, please specify your type of cancer, your treatments, and the challenges that led you to seek care. Ask which professional has the experience best suited to your needs. Topics to discuss include:

• The Cancer Care Professional's Experience and Approach to Managing Persistent Pain
• Your abilities, your fatigue, your pain, and the activities that are important to you
• Essential Communication with Your Cancer Care Team
• Any accommodations needed for your travel or medical care

To find one of our clinics in the Greater Montreal area, visit our pages:

• Physioactif Ahuntsic and Villeray
• Physioactif Blainville South and Rosemère
• Physioactif Chomedey
• Physioactif St-Eustache
• Physioactif Vaudreuil-Dorion

You probably still have questions. Here are the answers to the most frequently asked ones.

What are the most frequently asked questions about cancer-related pain?

The most common questions about cancer-related pain concern the duration of the pain and the role of oncology rehabilitation.

How long does pain last after cancer treatments?

The duration of pain depends on the treatment, its cause, and your progress. Recent pain following surgery may subside as you heal. However, nerve damage or lymphedema may persist for months or years. Persistent pain does not automatically mean that the cancer is progressing, but any new or worsening pain should be reported to your healthcare team. Physical therapy can help manage certain types of pain and their impact on daily activities.

After breast cancer surgery, some pain that lasts longer than three months is related to nerve damage. It may be part of post-mastectomy pain syndrome. This mechanism does not explain all cases of persistent pain following breast surgery.¹²

What is oncology rehabilitation?

Oncology rehabilitation encompasses care that helps people with cancer maintain or regain their functional abilities and quality of life. It may include physical therapy, occupational therapy for daily activities, nutrition, and other tailored services. The goal is to enable you to participate in the activities that are important to you.

In summary

Cancer-related pain is common, but it doesn't have to be. With the right support, you can find relief and significantly improve your quality of life.

• Cancer pain can be relieved through several complementary approaches
• Physical therapy can help before, during, and after treatment, provided the appropriate precautions are taken
• Adapted exercise improves quality of life even during active treatments
• An early assessment helps determine the appropriate care and identify issues that require medical consultation

You can ask for help with pain, fatigue, and difficulty moving. Talk to your healthcare team about it. At Physioactif, describe your needs when you make an appointment so we can find a professional with the right experience for your situation.

References

1. van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on the Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2016;51(6):1070-1090.e9. ↩ Back to text: 1st, 2nd citations
2. Pergolizzi JV, Gharibo C, Ho KY. Treatment Considerations for Cancer Pain: A Global Perspective. Pain Pract. 2015;15(8):778-92. ↩ Back to text
3. Swarm RA, Youngwerth JM, Agne JL, Anitescu M, Are M, Buga S, et al. Adult Cancer Pain, Version 2.2025, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2025;23(7). ↩ Back to text
4. Staff NP, Grisold A, Grisold W, Windebank AJ. Chemotherapy-induced peripheral neuropathy: A current review. Ann Neurol. 2017;81(6):772-781. ↩ Back to text
5. Suskin J, Shapiro CL. Osteoporosis and musculoskeletal complications related to breast cancer therapy. Gland Surg. 2018;7(4):411-423. ↩ Back to text
6. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500-15. ↩ Back to text: 1st, 2nd citations
7. Stout NL, Baima J, Swisher AK, Winters-Stone KM, Welsh J. A Systematic Review of Exercise Systematic Reviews in the Cancer Literature (2005–2017). PM R. 2017;9(9S2):S347–S384. ↩ Back to text
8. Bruce J, Mazuquin B, Canaway A, Hossain A, Williamson E, Mistry P, et al. Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): a multicenter randomized controlled trial and economic evaluation. BMJ. 2021;375:e066542. ↩ Back to text: 1st, 2nd citations
9. Silver JK, Baima J. Cancer prehabilitation: an opportunity to reduce treatment-related morbidity, expand cancer treatment options, and improve physical and psychological health outcomes. Am J Phys Med Rehabil. 2013;92(8):715-27. ↩ Back to text
10. Carli F, Scheede-Bergdahl C. Prehabilitation to Enhance Perioperative Care. Anesthesiol Clin. 2015;33(1):17-33. ↩ Back to text
11. McIsaac DI, Gill M, Boland L, Hutton B, Branje K, Shaw J, et al. Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews. Br J Anaesth. 2022;128(2):244-257. ↩ Back to text
12. Yuksel SS, Chappell AG, Jackson BT, Wescott AB, Ellis MF. "Post-Mastectomy Pain Syndrome: A Systematic Review of Prevention Modalities." JPRAS Open. 2022;31:32-49. ↩ Back to text