Treatment and the treatment process

Pain control

Pain can happen with leukemia and its treatment. It can be assessed and, in most cases, well controlled.

Last updated: 14 October 2026~2 min read

On a dark navy background, a red pulse along a nerve path from shoulder to brain fades into teal and gold light. — **Figure 1.**Treatment weakens the pain signal.

01Short answer

Pain in leukemia has several possible causes: an expanding bone marrow and bone pain, inflammation of the mouth lining (mucositis), procedures (bone marrow biopsy, lumbar puncture), infections, side effects of growth factors, or nerve damage. Pain is assessed regularly — usually on a 0–10 scale. Following the World Health Organization approach, medicines are chosen to match the strength of the pain: non-opioid painkillers, opioids when needed, and supporting medicines. In leukemia some painkillers (such as aspirin and other NSAIDs) are usually avoided because of bleeding risk when platelets are low, so agree every medicine with your team.

02Simple explanation

Pain is a signal. It tells you something in the body is wrong.

Measure it. Rating pain from 0 to 10 helps the team.

A plan. Medicines and methods are matched to how strong the pain is.

Speak up. Don’t hide pain — controlling it is part of treatment.

03Scientific explanation

Mechanisms: nociceptive pain (bone, mucosa, tissue injury) differs from neuropathic pain (for example, peripheral neuropathy linked to vincristine or bortezomib), and they are treated differently.

A stepwise approach: the WHO pain ladder and ESMO guidance combine non-opioids, opioids and adjuvants (such as anticonvulsants for neuropathic pain) according to pain intensity; for constant pain, medicines are given "by the clock" plus a "rescue" dose.

Leukemia specifics: NSAIDs are avoided in thrombocytopenia, paracetamol can mask fever, opioids cause constipation and drowsiness, and in kidney failure the choice of opioid changes. For mucositis, local treatments and sometimes infused pain relief are used.

04What happens in the body?

Where does pain come from?

The pain signal travels from injured tissue along nerves to the brain. Treatment aims to weaken that signal according to its cause, and to remove the cause itself.

How is pain assessed?

You will be asked about strength, place and character (aching, burning, stabbing) and what makes it better or worse. Children use scales with faces.

An elegant abstract dial shading from red to teal with a gold pointer resting low. — **Figure 2.**Rating pain on a scale helps the team.

Methods without medicines

A warm or cold compress (if your team allows), a comfortable position, breathing exercises, music and distraction add well to medicines but do not replace them.

A folded warm compress and a soft pillow on a neatly made hospital bed in gentle lamplight. — **Figure 3.**Methods without medicines add to pain relief.

05A pain control plan

A simplified outline.

1AssessmentStrength, place, character.

2Medicine planRegular and rescue medicines.

3Extra methodsComfort and rest.

4ReviewIf it doesn’t help — change.

Pain easesPossible in most cases.

Cause looked forNew pain is checked.

On timeBefore pain builds.

06Common causes of pain in leukemia

Cause	How it feels	What is usually done
Bone pain	Dull, deep ache, especially legs and back	Painkillers, main treatment
Mucositis	Burning mouth, hard to swallow	Mouth care, local treatments
Procedures	Short-lived pain	Local anaesthetic, sometimes sedation
Neuropathy	Burning, numbness, tingling	Specific medicines, protocol changes
Infection	New local pain, fever	Urgent check

* Only your treating doctor chooses the medicines, doses and combinations.

07Key terms

Pain scale: A way to rate pain from 0 to 10.
Opioid: A group of strong painkillers.
NSAID: Non-steroidal anti-inflammatory drug; usually avoided when platelets are low.
Neuropathic pain: Burning or stabbing pain from nerve damage.
Mucositis: Inflammation of the mouth and gut lining.
Rescue dose: An extra medicine given when pain flares.

08Key points

You don’t have to put up with pain.
Rate your pain regularly and tell the team.
Medicines are matched to pain strength.
Don’t take aspirin or similar medicines on your own.
Opioids can cause constipation — this is prevented too.
New or severe pain needs checking.

09Frequently asked questions

Will I become addicted to opioids?

When used for pain under medical supervision this risk is low; discuss any worries openly with your team.

Which painkiller can I take at home?

Only the one your team recommends. Some everyday medicines raise bleeding risk or can hide a fever.

The pain is worse at night — what should I do?

Tell your team: the timing and type of medicines can be changed.

How can we tell if a child is in pain?

Picture scales and watching behaviour are used; parents’ observations are very valuable.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

Will I become addicted to opioids?
Which painkiller can I take at home?
The pain is worse at night — what should I do?
How can we tell if a child is in pain?

My questions

12Sources

National Cancer Institute (NCI). Cancer Pain (PDQ) – Patient Version
National Cancer Institute (NCI). Pain and Cancer Treatment
Macmillan Cancer Support. Pain
Cancer Research UK. Cancer and pain control
National Cancer Institute (NCI). Stem Cell Transplants in Cancer Treatment
National Cancer Institute (NCI). CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers
National Cancer Institute (NCI). Chemotherapy to Treat Cancer
National Cancer Institute (NCI). Questions to Ask about Cancer Treatment
National Cancer Institute (NCI). Female Fertility and Cancer Treatment
National Cancer Institute (NCI). Male Fertility and Cancer Treatment

Medical disclaimerThis information is for educational purposes only and does not replace medical advice.

Last updated: 14 October 2026← Back to the list

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