Why is managing pain important?

When pain is controlled, quality of life improves dramatically. Uncontrolled pain, on the other hand, creates unnecessary suffering, “not only by causing immediate physical suffering, but also by increasing the anxiety level and the fear about the future and future problems.”1Strang P. Existential consequences of unrelieved cancer pain. Palliative Medicine. 1997 Jul;11(4):299-305. 

Evidence shows that pain may affect survival, body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more factors, symptoms, and side effects common among people with cancer. The way you manage stress, tension, and emotions can amplify or reduce your suffering related to pain. People often underestimate the effect that persistent pain has on quality of life, and so tend to “put up with it,” which can make things worse.

Connections to cancer survival

Cancer-related pain may increase mortality, although separating the effects of pain from the effects of advancing cancer and of pain medications on survival is difficult.

Better communication of pain and other symptoms may lead to improved survival among people with cancer.

Connections to body terrain factors

An imbalanced terrain can promote pain. Chronic inflammation, for instance, is directly related to pain processes. Pain can also affect terrain factors, such as suppressing certain immune functions and increasing risk for infection. We summarize evidence for these connections. We encourage you to work with a healthcare professional to assess terrain imbalances and create a plan to both balance terrain and manage pain.

High blood sugar and insulin resistance

Pain is linked to insulin resistance.

Hormone imbalance

Pain is linked to imbalances or disruption in stress hormones and sex hormones.

Immune function

Pain can suppress the immune system.


Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of higher systemic inflammation and poorer blood insulin levels among people with ovarian cancer with higher reported pain

Connections to symptoms and side effects

Probably no other symptom is connected to as many other cancer-related symptoms as cancer-related pain. Pain can affect your mood, your sleep, your energy, your nutritional requirements, your quality of life and ability to function, your stress, and your connection to others. In turn, many of these symptoms can affect your pain, as we illustrate in the graphic in the section “What approaches can help you manage pain?” We cannot stress enough how important it is to report all your symptoms to your doctor so they can help you manage them. You are not bothering them—you are not a complainer—you are a reporter. The very best care places improving your comfort and quality of life as important as treating your cancer.


Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of higher levels of anxiety among people with cancer experiencing pain

Body composition or cachexia

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of higher risk of needing nutritional interventions among people with newly diagnosed metastatic solid tumors and experiencing pain

Cardiovascular symptoms

Pain is linked to increased risk of cardiovascular events.


Modest evidence of a link between depression and pain among people with cancer


Modest evidence of a link between pain and fatigue among people with cancer

Quality of life and function

Modest evidence of a link between pain and worse physical function and quality of life among people with cancer

Sleep disruption

Modest evidence of more sleep disturbance among people with cancer experiencing pain

Stress or distress

Modest evidence of a link between distress or stress and pain among people with cancer

Symptoms not specific to cancer

Pain is linked to impaired gastrointestinal function.

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of higher incidence of severe sleep problems among people experiencing pain

Keep reading about pain


Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher


Wayne B. Jonas, MD

Integrative physician and CancerChoices advisor
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Dr. Wayne B. Jonas is a practicing family physician, an expert in integrative health and healthcare delivery, and a widely published scientific investigator. Dr. Jonas is the executive director of Samueli Integrative Health Programs, an effort supported by Henry and Susan Samueli to increase awareness and access to integrative health and supporting the scientific investigation of healing processes in the areas of stress, pain, and resilience. Additionally, Dr. Jonas is a retired lieutenant colonel in the Medical Corps of the United States Army. From 2001 to 2016, he was president and chief executive officer of Samueli Institute, he was the director of the Office of Alternative Medicine at the National Institutes of Health (NIH) from 1995 to 1999, and prior to that served as the director of the Medical Research Fellowship at the Walter Reed Army Institute of Research. He is a Fellow of the American Academy of Family Physicians.

Dr. Jonas’s research has appeared in peer-reviewed journals such as the Journal of the American Medical AssociationNatural MedicineThe Journal of Family PracticeThe Annals of Internal Medicine, and The Lancet. His books include the 2018 best seller How Healing Works: Get Well and Stay Well Using Your Hidden Power to Heal.

Dr. Jonas received the 2015 Pioneer Award from the Integrative Healthcare Symposium, the 2007 America’s Top Family Doctors Award, the 2003 Pioneer Award from the American Holistic Medical Association, the 2002 Physician Recognition Award of the American Medical Association, and the 2002 Meritorious Activity Prize from the International Society of Life Information Science in Chiba, Japan.

Dr. Jonas’s view: “We know so little about the mystery of life and the body that we need to consider all systems and explanations for their wisdom.”

Wayne B. Jonas, MD Integrative physician and CancerChoices advisor

Last update: May 6, 2024

Last full literature review: August 2022

We are grateful to Dr. Giovanni Elias for his review of several sections of this handbook.

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care, and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture therapies and self carelifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.