Diagnosis of Cancer Pain

Understanding what is causing the pain that you may be feeling can take some time. It may require several visits or various tests, such as x-rays or biopsies. Sometimes it can take weeks or months before the growth of a tumor shows up in an x-ray, for example, even though a patient has been complaining of pain all along. Every case is different, and depending on the type and stage of cancer, the appropriate diagnostic tests vary.

No matter what tests are done, your doctor will want to find out as much as possible about the history the pain that you have been feeling. They should also be curious about the level of anxiety or depression that you may be feeling about the pain. Your emotional and psychological health is an important part of feeling pain.

After the pain is diagnosed and treated, it is essential that you tell your doctor if the pain worsens or if there is any new pain. In this case, either the treatment will change and/or the physician will re-examine you to look for another cause of the pain.

Open and honest communication is an essential part of evaluating a patient's pain, not only with the patient but family members as well.

Cancer Pain Categories

There are five types of cancer pain, categorized on the basis of whether the pain is acute or chronic, whether it results from the tumor or the therapy, and whether the patient has had any history of chronic pain or drug addiction. Whether the pain is somatic, visceral or neuropathic is not a factor in the classification process.

Classifying the pain helps in evaluating how to manage the pain, especially with regards to how important the psychological and emotional well-being of the patient may play a role. Importantly, however, pain is a very individual experience and is difficult to measure or categorize. For any given category, there is no right treatment except for adequate treatment, and a person may not fit very neatly into any one of the following categories.

Group I Acute Cancer-Related Pain

  • Group IA Tumor-Associated Pain For these patients, the pain caused by a tumor is usually what has prompted them to visit their physician, either before they know they have cancer or, if they have already been treated for cancer, the disease is progressing. This kind of pain is best treated by trying to remove or reduce the tumor, if possible, by radiation or surgery.
  • Group IB Pain Resulting from Cancer Therapy This is pain that results from surgery, chemotherapy or radiation therapy. It is predictable and will end when the treatment ends. Physicians can manage it in various ways, although unfortunately it is something that most patients endure to some extent until their treatment ends.

Group II Chronic Cancer-Related Pain

Group II patients are people who have felt a particular pain for more than three months.

  • Group IIA Chronic Pain from Tumor Growth As a person's cancer progresses, the pain worsens. Ways to try to reduce the pain include removing or reducting the tumor, analgesic drugs (pain-relievers), anesthetic blocks (a neurosurgical pain management technique), and behavioral management. These patients usually suffer both from the actual pain and the psychological and emotional stress that happens when a person with cancer feels pain and fears death. Counseling and participating in a cancer support growth can be an important part of treatment.

  • Group IIB Chronic Pain Resulting from Cancer Therapy These are patients who feel pain following various cancer therapy procedures such as mastectomy (surgical removal of the breast) or the amputation of a limb. The psychological factors at play here are similar to the ones that a Group IIA patient feels. A growing percentage of cancer patients are considered Group IIB patients. It is estimated that about one quarter of all patients referred to pain clinics are in this category.

Group III Pre-existing Chronic Pain

These are patients who have a history of chronic, non-cancerous pain who then develop cancer. The fact that they have a history of pain complaints should in no way be used to deny them adequate treatment. Their symptoms usually escalate when they are diagnosed with cancer, and psychological counseling can play an important part of their pain management therapy.

Group IV Patients with a History of Drug Addiction

These are the patients for whom under-treatment of pain is at its worst. Too often the pain symptoms are confused with addictive behavior, and it imperative that in these cases the medical versus psychological needs of the patient be evaluated as best they can be.

Group V Dying Patients with Pain

The primary aim in the treatment of Group V patients is comfort. The relief of suffering is much more important than any risks, including addiction, that the various pain relief therapies pose.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 31 Jul 1999

Last Modified: 03 Sep 2015