Managing Cancer Related Pain
Learn the Tools to
Manage Pain
What is Cancer-Related Pain?
Cancer-related pain is complex, yet it doesn’t always mean harm.
Pain may result from:
The cancer itself (tumors pressing on nerves, bones, or organs).
Cancer treatments (surgery, chemotherapy, radiotherapy, or hormone therapy).
Reduced movement (leading to stiffness, weakness, or postural changes).
Whether it is a breast cancer related condition or side effect from other cancer treatment; pain is often part of a cancer journey. As ‘hurt’ doesn’t always mean ‘harm, pain can be thought of as a protection response, an alarm system that serves as warning before anything harmful has occurred. Yet sometimes this alarm system is too sensitive and can also interfere with daily life. Sometimes persistent pain can be evidence of bone metastasis and actual harm occurring in the body. How can a patient best manage pain? How can a patient exercise safely when having pain? Together let’s explore cancer related pain, and how you change it.
Movement Is Medicine: Exercising with Cancer
Research supports that exercising with cancer can reduce pain and improve quality of life when overseen by a cancer exercise specialist:
A meta-analysis (71 studies) found that exercise led to moderate reductions in cancer-related pain (Plinsinga et Al., 2023)
A broader meta-analysis of 76 studies showed significant pain reduction, confirming that exercise—often combining aerobic and strength training—can ease pain (Cuthbert et Al., 2023)
A landmark April 2025 review in the British Journal of Sports Medicine concluded that physical activity significantly lowered risks of postoperative complications and pain, reinforcing that movement is medicine
One of the most effective ways to manage pain is through gentle, regular activity. Research confirms that exercising with cancer is safe and beneficial when guided by a qualified cancer exercise specialist.
MOVEMENT IS MEDICINE
BE SAFE WITH GUIDANCE
Benefits of Exercise for Cancer-Related Pain:
Less stiffness and discomfort in joints and muscles.
Improved energy, mood, and sleep.
Stronger bones and better balance.
Reduced anxiety around movement.
Improved confidence with returning to work
The top priority when exercising with cancer is safety. Any cancer related condition needs to be diagnosed and considered when designing a personalized exercise plan. At times safe exercise may include monitoring of blood pressure, heart rate, white and red blood counts etc. A cancer rehab initial assessment will include a comprehensive examination to best create a plan that’s right for you. At times, some patients only start with gentle walking, while others commence a walk to run program. Others have lost too much body weight and start with body weight stability exercises prior to aerobic training. On the contrary some patients are fit to start at the gym right away. A times there can be breathlessness, mobility issues, fatigue cycling amongst many other cancer related conditions that impact exercise tolerance. Personalized exercise is important for safety and to optimize for results; each patient’s journey is very very different at the end of the day.
Manual Therapy for Cancer-Related Pain
Manual therapy may help improve pain during and after cancer treatment. Soft tissue release, or gentle joint mobilization/traction can be very helpful especially in complex conditions related to head and neck cancer, or shoulder pain associated with a breast cancer diagnosis. It however important to have a cancer specialized clinician performing this to assure it is safe. Dry needling, or other needling techniques need to be performed with caution, taking your cancer diagnosis into consideration. Chiropractic manipulations are not recommended close to any area of radiation. When working with a new clinician, assure they have taken a complete health history.
Manual Therapy Can Help Change Pain, Leading to Improved Exercise Tolerance
Cold Plunging: Can It Help with Cancer Pain?
Cold plunging—also known as cold water immersion—is gaining attention as a potential tool for recovery and pain relief. It involves immersing the body in cold water (usually between 10–15°C / 50–59°F) for short periods of time, our SAFE cancer + cold Plunge protocol provides a bit more detail on how to do this safely. No research has been completed on cancer related pain specifically but other research on a general population has shown changes do occur.
Emerging research suggests cold exposure can:
Reduce inflammation and muscle soreness.
Improve circulation and recovery after activity.
Release endorphins, which may help reduce pain perception.
Support mental wellbeing by boosting alertness and mood.
Therefor cold exposure may help with a variety of cancer related conditions involving similar symptoms to those noted above. Over time when performed as a habit, cold plunging may help decrease pain.
Considerations for People with Cancer
While promising, cold plunging is not for everyone. Some cancer treatments can affect circulation, nerve sensitivity, or immune function and cooling the core may result in too much stress on the body. Patients may feel panic at times, learning ahead of time how to best control breathing rate can be helpful. As our protocol mentions, at times it’s best to start with ‘coolish’ temperatures and decrease the temperature slowly over weeks, to assure your body has the capacity to adapt to cold plunging.
Pain Medications are Not a Failure but a Tool…
Pharmaceutical Options for Cancer-Related Pain
While exercise, manual therapy and tools like cold plunging can play a vital role in managing pain, sometimes medication is also needed. Cancer related pain is complex, and using the right medicines—at the right time—can make daily life more manageable.
Doctors often follow the World Health Organization’s (WHO) pain ladder, which guides treatment from mild to stronger options depending on need:
Mild pain: Simple analgesics like paracetamol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs).
Moderate pain: Weak opioids (such as codeine or tramadol), sometimes combined with paracetamol.
Severe pain: Strong opioids (like morphine, oxycodone, or fentanyl) remain the standard for managing higher levels of cancer-related pain. Often including fast acting options for acute pain flares and long acting for persistent pain.
Other helpful medicines may include:
Adjuvant drugs such as antidepressants or anticonvulsants, which can target nerve-related pain.
Topical treatments (creams, patches) for localized discomfort.
Steroids in specific cases to reduce inflammation and pressure around nerves.
It’s important to remember: pain medications are not a failure, but a tool—one part of a comprehensive, compassionate approach that also includes exercise, physiotherapy and other tools that are personalized to the patient. With thoughtful prescribing and monitoring, they can help restore comfort, function, and quality of life. This in turn can help patients tolerate exercise better, and often returning to more activities. At times pain management may also simply improve quality of life alone.
Whatever your journey, it is yours. Although we don’t know how this will end for you, here at the cancer physio we hope to help with some tools to assure that your pain isn’t getting the best of you.
Thank you for your interest in science and rehab.
Kindly, The Cancer Physio
