For many people living with cancer, pain doesn't end when treatment does. It can linger for months or years, show up in unexpected parts of the body or appear with no clear cause at all.
Chronic pain is treatable, even if it isn’t always curable, according to mental health experts with the Simms/Mann UCLA Center for Integrative Oncology.
Clinical psychologist Jenny Tran, PhD, and psychology doctoral intern Makenna Paule offered strategies for managing chronic pain during a recent webinar presented by the Simms/Mann Center.
Why chronic pain is different
Acute pain — such as from a cut or a bruise — typically fades as the body heals. Chronic pain, which is pain that lasts for more than three months, sometimes persists long after an injury has healed and sometimes with no clear tissue damage, Paule said. It's typically managed rather than eliminated.
Cancer-related chronic pain is particularly complex: it can come from a tumor — a growth pressing on a nerve, for example — or from lasting effects of chemotherapy, radiation or surgery. The same sensation can have different causes, which is why clinicians pay close attention to how patients describe pain: such as sharp, burning, aching, or deep. Those words are diagnostic clues, she said.
There’s also phantom pain, which can occur after a mastectomy or amputation, when a person feels pain in a body part that’s no longer there. And there is referred pain, which occurs when an internal organ, such as the lungs or surrounding membrane, sends pain signals that the brain misinterprets as coming from a different part of the body, such as the back or shoulder.
Because a pain’s location doesn't always match the source, close collaboration with a provider is important for pain management, Paule said. The pain is still real. But recognizing this pattern can help separate the sensation of pain from a rush to worst-case conclusions, such as assuming new pain means a recurrence of disease. These assumptions can add distress on top of discomfort.
Distress and pain feed off each other, Dr. Tran said: pain increases distress and distress amplifies pain. That's the basis of the biopsychosocial model that considers how biological, psychological and social factors shape how much pain a person experiences, she said.
Pain management is a team effort
Because chronic pain has so many possible causes, specialists work together to treat it. A care team might include a medical oncologist, radiation oncologist, surgeon, palliative care provider, pain specialist or psychiatrist — plus complementary providers such as physical therapists, acupuncturists, massage therapists, dietitians and chaplains.
Medication options extend well beyond over-the-counter drugs or opioids, but fear of addiction and stigma — worry about being seen as "drug-seeking" — sometimes keeps patients from raising the topic, Dr. Tran said. She encourages patients to have the medication conversation anyway: physicians who prescribe opioids for cancer pain typically monitor use closely, and untreated pain is often harder to control the longer it's ignored.
There are also procedural treatment options, such as nerve blocks, injections, implanted stimulators, ablations and targeted radiation, she said.
If pain is limiting your life, tell your care team, Dr. Tran said. That conversation opens the door to referrals to medication, procedural solutions or supportive therapies.
Pain-management strategies you can try now
Beyond medical treatment, Paule and Dr. Tran pointed to proven behavioral tools that can help change how people relate to pain day to day.
Identify what opens and closes the pain gate. Notice what intensifies pain (tensing muscles without realizing it, catastrophic thinking, overexertion) and what eases it (medication, meaningful time with loved ones, moments of joy). Simply becoming aware of these patterns creates opportunities to intervene earlier, Dr. Tran said.
Catch, check, challenge. This three-step technique targets unhelpful thought patterns. When a strong emotion surfaces — frustration, sadness, anger — patients are encouraged to:
- Catch the thought running through their mind.
- Check whether it's helpful or harmful.
- Challenge it by asking what evidence supports or contradicts it, and whether there's a more balanced way to think about the situation.
Paule offered an example: after a pain flare-up while cleaning the garage, a patient might think, "This pain is killing me, I can't do anything anymore." Challenging that thought — asking what's really contributing to the flare-up and whether anything could change it — might lead to a more workable revision: "I can still do things, but I have to approach them differently. Next time I'll ask for help or break the task into smaller pieces." The emotional weight of those two thoughts is very different, even though the pain itself hasn't changed.
Notice, name, normalize. This self-compassion exercise asks patients to acknowledge a difficult moment (snapping at a loved one out of frustration, for instance), name the emotion beneath it (guilt, exhaustion), and then normalize it by asking: What would I tell a friend going through this same thing? Extending that same compassion inward — “I'm going through a hard adjustment, and anyone in my position would struggle too” — has been shown to reduce distress, which in turn can ease pain, Paule said.
Watch the shoulds. Thoughts like “I should be able to do this” add pressure, not motivation.
Keep a pain diary. Tracking pain — its location, severity on a 0-10 scale, duration, what helped, what made it worse and current medications — gives patients concrete data to bring to appointments. Research on pain diaries shows they're associated with better patient understanding of their condition and more effective communication with care teams, Dr. Tran said. The American Cancer Society offers a free template.
Pace activity instead of pushing through or avoiding it. Over-resting weakens muscles, but “white-knuckling” through pain leads to burnout, Dr. Tran said. Pacing means alternating activity with rest and building up gradually — such as a 10-minute walk that slowly grows in duration and frequency — rather than either avoiding the activity or overdoing it.
Mind body movement. Exercise triggers beta-endorphins — the body's natural painkillers, and the same chemical opioid medications mimic — while reducing inflammation and improving mood. Physical therapists who specialize in cancer-related pain can help build a realistic plan, Paule said. The key is setting achievable goals: 60 minutes of yoga may not be realistic on a hard day, for instance, but five minutes of stretching often is. Aerobic exercise, strength training, balance work and flexibility each offer distinct benefits.
Mind-body techniques — mindfulness, breathing exercises, body scans — also reduce stress and change how the brain processes pain. Even language matters; reframing pain as a "sensation" rather than "pain" can reduce its intensity, Paule said.
