Persistent Pain: When It's a Warning Sign

Pain is one of the most common human experiences. The vast majority of pain is not cancer. But pain that is new, lasts, and has no clear cause can occasionally be a warning sign. That pattern is worth checking rather than ignoring.

For most cancers, pain shows up later, once a tumor has grown large enough to press on nerves or organs, or after cancer has spread. Pain is not usually how these cancers first announce themselves. A few cancers are different. Bone cancer often causes pain early, before any lump or swelling appears. Testicular cancer can cause a dull ache in the lower abdomen or groin, sometimes before a lump is noticed. Pain that lasts, especially without an injury to explain it, deserves attention no matter which cancer might be behind it.

Bone cancer pain often starts as pain that comes and goes. It tends to get worse at night, or worse when the bone is used, such as pain in a leg bone that flares with walking. Over time, the pain can become constant. Swelling or a lump in the area sometimes follows, but it can show up well after the pain starts. This pattern, pain first and swelling later, is part of what makes bone cancer easy to mistake for a sports injury or growing pains at first.

Injuries, arthritis, and muscle strain cause the great majority of ongoing pain. Nerve problems, poor posture, and everyday wear and tear on joints are common too. Infections can cause pain in a specific area as your body fights them off. Most pain, even pain that lasts weeks, comes from one of these causes.

Your doctor asks where the pain is, how long it has lasted, what makes it better or worse, and whether it wakes you at night. A physical exam checks the area for swelling, tenderness, or a lump. Depending on the location, an x-ray is often the first imaging test, since it is quick and can show bone changes. If the x-ray raises questions, an MRI gives a more detailed look at bone and surrounding tissue. If something concerning is found, a biopsy — removing a small tissue sample to look at under a microscope — confirms the diagnosis. Results usually take about a week.

An x-ray that looks normal is reassuring, but early bone changes can be subtle and easy to miss on a plain x-ray. If pain in one spot continues for more than a couple of weeks despite a normal x-ray, ask about an MRI rather than assuming it is nothing.

Note where the pain is, when it started, and what makes it better or worse. Write down whether it wakes you at night and whether over-the-counter pain relievers help at all. This detail helps your doctor decide how quickly to move to imaging.

• Call 911 or go to an emergency department if a bone gives way or a limb suddenly cannot bear weight after little or no injury, or if back pain arrives with new numbness, leg weakness, or loss of bladder or bowel control.
• Call your care team the same day if the pain turns severe fast, or the painful area becomes hot, red, and swollen.
• Call your care team within a day or two if pain in one spot has run past two weeks, keeps worsening, wakes you at night, or a lump is growing over it.

• Should this pain be evaluated further?
• Could it be caused by something other than cancer?
• What tests would help find the cause?
• What should prompt me to come back sooner?

• NHS — Back pain
• American Cancer Society — Signs and Symptoms of Bone Cancer
• American Cancer Society — Signs and Symptoms of Cancer