Pancreatic cancer grows in the pancreas, a small organ that sits between your stomach and spine. It can lead to severe pain around your stomach and back.
The good news is that there are ways to manage this discomfort and symptoms like nausea and constipation.
“Pain management isn't one-size-fits-all,” says Pashtoon Kasi, MD, medical director of GI medical oncology at City of Hope Orange County in Irvine, California. “The most effective approach is often multidisciplinary, bringing together specialists from different areas of care to address each patient's unique needs.”
Why Is Pancreatic Cancer Painful?
Pancreatic cancer hurts for several reasons, one of which may be the growing tumor pushing on nearby tissues. More specifically, a tumor on your pancreas can press against the celiac plexus, a bundle of nerves between your spine and stomach.
“Direct tumor growth also causes nearby tissue damage and inflammation,” says Kyle Neale, DO, a hospice and palliative care provider at Cleveland Clinic Taussig Cancer Center in Cleveland, Ohio.
Cancer cells can also grow between your nerves and the sheath (protective layer) around them. They can also invade and grow in the nerves. Other reasons for pancreatic cancer pain include:
Blocked passages. Pancreatic tumors can stop digestive enzymes from flowing through the pancreatic duct. This leads to pressure that causes pain.
Limited digestive fluid. The pancreas can’t make enough because of cancer growth.
Peripheral neuropathy. This is nerve damage that typically leads to pain in the hands and feet. Some cancer treatments can cause it.
Release of chemical messengers. Growing cancer can trigger a spike in neurotransmitters that make you more sensitive to pain.
Pressure on nearby organs. The growing cancer can push on organs such as the stomach and intestines leading to pain.
What does pancreatic cancer pain feel like?
Pain from pancreatic cancer usually feels like a dull ache or gnawing feeling. Some people describe feeling a “belt of pain” wrapped around their torso.
Where can pain show up?
It depends on where in the pancreas the cancer grows. You may feel it in your belly, back, and ribs. Tumors in one part of the pancreas cause more back pain, while tumor growth in other areas leads to more digestive symptoms, Neale says. Digestive symptoms can include nausea, vomiting, and bloating.
When Should You Tell Your Doctor About Pain?
Call your doctor if you notice these symptoms:
- New or suddenly worsening pain
- Pain that is no longer controlled by current pain medications
- A change in how the pain feels, like dull to sharp
- New neurological symptoms like weakness, numbness, or incontinence (inability to hold your urine or bowel movements)
- Pain with fever or worsening jaundice (yellowing skin and eyes)
- Swollen belly or vomiting
- Severe constipation causing pain
- New leg swelling or pain
Realistic Expectations of Pancreatic Cancer Pain Management
You may not be able to get rid of pancreatic cancer pain completely, but your care team can control it a good bit.
Who helps manage pancreatic cancer pain?
The best pain management teams include several health care providers working together, Neale says. These include:
- Oncologists
- Palliative care specialists
- Nurses
- Care coordinators
- Social workers
- Spiritual leaders
- Mental health providers
- Surgeons
- Physical therapists
- Occupational therapists
- Pharmacists
Pain Medications
Several types of medications treat pancreatic cancer pain.
Acetaminophen (Tylenol)
Your oncologist might start you on acetaminophen alone to see how well it works. It may prompt the release of pain-blocking messengers like serotonin.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs block chemicals that trigger pain and inflammation and may also be the first option your care team offers. Common NSAIDS include:
- Ibuprofen
- Ketorolac (Toradol)
- Naproxen
“While acetaminophen is a frequent initial option, many patients will require opiates such as oxycodone to effectively manage their pain,” says Daniel King, MD, PhD, a gastrointestinal medical oncologist and director of research and development at Northwell Health Cancer Institute in Lake Success, New York.
Opioids
Opioid (narcotic) medications block pain signals sent from your brain. Your pain specialist may recommend an extended-release opioid that lasts for several hours, along with an immediate-release option for any pain that still comes through.
Opioids used for pancreatic cancer pain management include:
| Drug Name | How You Take It | Short vs. Long Acting |
| Morphine (MS Contin, Kadian, Oramorph SR, Roxano) | Oral liquid or pill, suppository, IV, injection | Both |
| Hydromorphone (Dilaudid, Exalgo) | Oral liquid or pill, suppository, IV, injection | Both |
| Oxycodone (OxyContin, Roxicodone) | Oral liquid or pill | Both |
| Hydrocodone (Hysingla ER) | Oral liquid or pill | Both |
| Oxymorphone | Pill | Both |
| Fentanyl (Duragesic) | Skin patch, IV, injection, buccal tablet | Both |
| Tramadol (Ultram) | Oral liquid or pill | Both |
| Tapentadol (Nucynta) | Oral liquid or pill | Both |
| Buprenorphine (Butrans, Belbuca) | Skin patch or oral dissolvable film | Long acting |
| Levorphanol (Levo-Dromoran) | Oral pill or IV | Long acting |
| Methadone (Dolophine, Methadose) | Oral liquid or pill | Long acting |
You can also take some oral opioids combined with acetaminophen in one pill, like hydrocodone and acetaminophen (Vicodin).
No single opioid works best for everyone. Your pain management team may decide which one to try first based on factors like the health of your kidneys and liver.
What does opioid rotation mean and how can it help?
Opioid rotation means switching from one opioid to another. This is typically done if your pain is not controlled well with a certain opioid or if you experience unbearable side effects. In some cases, adding a long-acting opioid on a schedule to your pain management plan can better control pain.
Possible opioid side effects and how to manage them
Side effects from opioids can get better over time, but others need treatment. Here are some common ones and how your doctor may manage them:
- Nausea can be controlled with nausea medication or foods or drinks that contain ginger.
- Opioid rotation may help with fatigue.
- Daily laxatives or stool softeners can treat constipation.
If you have to take an opioid, you may worry about becoming addicted. But research shows the risk is low if you take it as prescribed for pain.
Adjuvant Medications
Some types of pancreatic cancer pain may not get better after taking opioids or over-the-counter medications. That’s where adjuvants, or adjuncts, come in. They’re drugs that weren’t created to ease pain but have been shown to boost the effects of pain relievers. They’re sometimes used alone.
“These medications need to be individualized,” Kasi says. “For example, a medicine that helps one patient may not be appropriate for another because of kidney function, liver function, fatigue, drug interactions, or other side effects.”
Adjuvant options include:
Antidepressants
Antidepressants like duloxetine (Cymbalta), a serotonin noradrenaline reuptake inhibitor (SNRI), can ease bone, muscle, and nerve pain. Nerve pain can also be treated with tricyclic antidepressants like amitriptyline.
Anticonvulsants
Anti-seizure medications (anticonvulsants) like gabapentin (Neurontin) and pregabalin (Lyrica) can help pain from nerves damaged by the cancer itself or its treatments, King says.
Corticosteroids
Corticosteroids like dexamethasone (Decadron) and prednisone (Deltasone, Rayos) lower inflammation and help manage bone pain.
Antispasmodics
Antispasmodic medications can ease abdominal belly cramping. Common antispasmodics include hyoscyamine (Anaspaz, Levsin, Levbid, NuLev), dicyclomine (Bentyl), and glycopyrrolate (Robinul).
Procedures for Pancreatic Cancer Pain
When medication isn’t enough, your doctor may suggest a medical procedure.
“These tend to be reserved for patients who, despite being given therapy, or are not a candidate for therapy, are still having severe, quality-of-life impacting pancreatic cancer pain,” King says.
Celiac plexus block
Because pancreatic cancer can press against the celiac plexus nerve bundle, your doctor can inject medicine that numbs or destroys those nerves, a procedure called a celiac plexus block.
First, you’ll get medication through an IV to help you relax. Your doctor will clean and numb the treatment area, then inject the medication. They may use imaging, like an X-ray or a CT scan, to make sure they’re injecting the right area.
Potential celiac plexus block side effects may include:
- Bruising, pain, or swelling at your injection site
- Low blood pressure
- Diarrhea
- Muscle spasms
Who can benefit: A celiac plexus block is a good option if your pancreatic cancer can’t be removed during surgery or pain medication isn’t helping. You might also benefit from this procedure if your pain meds work well but you have too many side effects, Neale says.
Splanchnic nerve neurolysis
Splanchnic nerve neurolysis works the same way as a celiac plexus block, but it targets nerves before they join the celiac plexus.
Potential splanchnic nerve neurolysis side effects include:
- Bleeding or infection at the injection site
- Nerve inflammation
- Incontinence (inability to hold in pee or poop)
- Difficulties with sex
Who can benefit: You may benefit from splanchnic nerve neurolysis if you have moderate to severe pancreatic cancer pain. Research suggests it works best in the first three months and may lower the amount of opioids you have to take.
Intrathecal pain pumps
An intrathecal pain pump delivers pain medication straight into your spinal fluid.
First, your doctor puts a temporary catheter (very thin tube) into the space around your spinal cord – similar to getting an epidural during childbirth – to deliver the medication. If it helps, a more permanent intrathecal pump can be surgically placed under general anesthesia.
Intrathecal pain pump side effects aren’t common but can include:
- Infection where the catheter is placed
- Leakage of cerebrospinal fluid (the fluid around your spinal cord), which may lead to headaches
- Problems with the pump or tubing
- Medication side effects like drowsiness or itching
Who can benefit: People whose pain is uncontrolled with opioid therapy.
Celiac plexus radiosurgery
Celiac plexus radiosurgery targets the same nerves as a nerve block. But instead of injecting medication, radiation is used to destroy the nerve cells involved in pain.
Your doctor directs high-intensity beams of radiation – like those used in X-rays – at your celiac plexus. You don’t need anesthesia for this procedure.
As a newer treatment, side effects of radiosurgery for pancreatic cancer pain aren’t well understood. But one small study reported side effects that included:
- Belly pain
- Nausea
- Intestinal bleeding
- Liver problems
Who can benefit: Treatment guidelines now include radiosurgery as an option, but you can only get it at specialized treatment centers, Neale says. One study found radiosurgery improved pancreatic cancer pain for four months or more.
Other nerve-targeting options
Your pain management team may also recommend the following:
Spinal cord stimulation. Tiny wires are placed between your spinal cord and spine bones. These wires connect to a small power source implanted under your skin. Pulses of mild electricity flow through these wires and help your brain ignore pain messages. Similar to turning the volume down on a speaker.
Scrambler therapy. This treatment also delivers electricity to distract your nerves, but it goes through electrodes (wires attached to stickers) on your skin instead of implanted wires.
Transcutaneous electrical nerve stimulation (TENS). TENS therapy works the same as scrambler therapy, but the electrodes are placed directly over the painful area instead of above and below it. Talk with your oncologist before trying TENS therapy. Electrodes should not be placed over active tumors. And people with certain medical conditions may need to avoid TENS.
Cancer treatment for pain management
Treatments for pancreatic cancer, like chemotherapy and radiation, can also ease pain by shrinking the tumor.
“One of the first signs that a treatment is working is that the pain improves or entirely dissipates,” King says.
Supportive Pain Management Therapies
Complementary and alternative therapies also play a role when it comes to controlling pancreatic cancer pain.
“The goal is to address the physical, emotional, and practical challenges that often accompany pancreatic cancer, not just treat the cancer itself,” Kasi says.
Digestion support
Pancreatic cancer can affect digestion, appetite, and weight. “Treating constipation is especially important because pain medications can make constipation worse, which can then worsen abdominal discomfort,” Kasi says.
Acupuncture
Some research shows that acupuncture can help cancer pain. It might also improve other symptoms like nausea, vomiting, and fatigue.
Physical therapy
Physical therapy helps you get stronger or maintain the strength you already have, along with your freedom of movement. It can also improve nerve pain after chemotherapy. Najeeb Al Hallak, MD, a medical oncologist and researcher at Karmanos Cancer Institute in Detroit, Michigan, says he often recommends physical therapy, especially after surgery.
Massage
Although research hasn’t proven that massage offers pain management benefits in pancreatic cancer, Al Hallak says many of his patients report meaningful short-term relief. “I find it most useful for muscle tension in the back and shoulders, stress-related pain amplification, anxiety, and insomnia,” Al Hallak says.
Cognitive behavioral therapy (CBT)
CBT with a licensed mental health provider can help your brain relearn how it responds to pain. “CBT reduces distress and can significantly reduce pain intensity and improve quality of life,” Al Hallak says.
Relaxation techniques
Relaxation techniques like progressive muscle relaxation, guided imagery, and music therapy may help lessen pain. Experiment with these to find what works best for you.
Home Remedies for Pancreatic Cancer Pain
Home remedies for pancreatic cancer pain include:
- Warm packs or electric heating pads
- Hot baths
- Cold packs or ice bags
- Distracting yourself by listening to music or watching television
Quality sleep also plays a role in pain management. Do your best to:
- Go to bed and wake up at the same time every day.
- Be physically active.
- Avoid heavy meals, alcohol, nicotine, and caffeine too close to bedtime.
You can also prevent worsened pain from constipation by drinking enough fluids every day, taking a daily walk, and eating high-fiber foods like vegetables, fruits, beans, and whole grains. Your care team can help you come up with a diet that sounds both appetizing and easy to digest.
Can Supplements and Other Alternative Approaches Help?
“It's completely understandable that patients and families look for additional ways to manage symptoms when they're facing something as challenging as pancreatic cancer,” Kasi says.
Alternative treatments you might be considering include:
- Cannabidiol (CBD)
- Tetrahydrocannabinol (THC)
- St. John’s wort
- Vitamin B12
CBD is an ingredient found in the cannabis sativa plant. Research is ongoing, but it’s thought to play a role in pain management because of its anti-inflammatory properties. It doesn’t cause the high people feel when they smoke marijuana. That’s THC, which is also found in the cannabis sativa plant.
“CBD may help some people with symptoms such as anxiety, sleep, or discomfort, but the evidence for pancreatic cancer pain specifically is limited, and products can vary widely in quality and purity,” Kasi says.
CBD is legal in many U.S. states, territories, and the District of Columbia with varying restrictions. Recreational and medical use of THC is legal in some, while others only allow medical use. A few still prohibit both recreational and medical use.
Wherever you are, it’s important to let your doctor or pharmacist know if you’re considering CBD or THC. That’s because they could affect cancer treatments or interact with medications you’re taking.
The same applies to St. John’s wort and other vitamins and herbs.
“Before starting any supplement, I encourage patients to talk with their care team so we can review the available evidence and identify the safest options for managing symptoms,” Kasi says.
Building a Layered Pain Management Plan
“A patient who needed only occasional medication at one point may later need a more structured pain plan, different medications, a procedure, radiation therapy, palliative care support, or more intensive symptom management,” Kasi says.
What to do if your pain is getting worse?
When pancreatic cancer progresses, your pain can increase or change its location or characteristics, says Al Hallak. If your cancer pain gets worse, tell your care team. They may start with a fast-acting pain medication to get you over the hump, then move on to a stepwise approach to tackle ongoing pain.
FAQs
What does pancreatic cancer pain feel like?
Pancreatic cancer pain can feel like dull, gnawing pain in your upper abdomen or mid-back. It can spread from front to back, feeling like a band of pain.
What are the signs that my pancreatic cancer is getting worse?
Symptoms of worsening pancreatic cancer include fatigue, poor appetite, weight loss, abdominal pain, dark urine, light-colored stools, and jaundice (yellowing of your skin or eyes).
What can I do when pancreatic cancer pain is unbearable?
If your cancer pain feels unbearable, tell your care team. They can change or add to your treatment to help you feel better.
Does pancreatic cancer hurt all the time?
In its early stages, pancreatic cancer may not hurt at all. Once you start feeling pain, the intensity depends on the location of your tumor and where it has spread.
How do you treat end-stage pancreatic cancer pain?
You can treat end-stage pancreatic cancer pain with opioid medications like morphine or a nerve block, a procedure that blocks nerves near your pancreas from sending pain signals.
