Shoulder pain can have many causes. If you or a loved one living with lung cancer experience shoulder pain, you may wonder if there’s a connection. Although shoulder pain isn’t a well-known lung cancer symptom — like shortness of breath or chest pain — it can be associated with lung cancer, resulting from lung tumors themselves or from the cancer metastasizing (spreading) to the bones.

Not only is shoulder pain uncomfortable, but it can also be worrisome if you don’t know the underlying cause. “Developed pain in my shoulder with a painful cough. I have neuroendocrine carcinoma in my right lung. It’s been stable for three months, but I’m worried,” shared a MyLungCancerTeam member.

Understanding shoulder pain with lung cancer can help you navigate the pain and uncertainty with more ease. Learn more about what causes shoulder pain with lung cancer, what it feels like, and how to manage it so that you can go about your daily life with more comfort.

What Causes Shoulder Pain in Lung Cancer?

As lung cancer progresses, complications can cause new or unexpected symptoms throughout the body, including shoulder pain. There are three potential causes of shoulder pain related to lung cancer: lung tumors, malignant pleural mesothelioma (MPM), and lung metastases.

Lung Tumors

When a lung tumor grows in size, it begins to compete for space against the surrounding bones, tissues, and nerves. Pain may develop depending on the tumor’s location and the pressure it exerts. If a lung tumor puts pressure on a nerve near the shoulder, you may experience referred shoulder pain. You can think about this shoulder pain as an alarm signaling something irregular happening in the body.

Pancoast Tumor

A Pancoast tumor (also called a superior sulcus tumor) is a rare form of non-small cell lung cancer (NSCLC), occurring in 3 percent to 5 percent of all lung cancer cases. Pancoast tumors usually do not cause respiratory issues typical of other lung cancers. Instead, they tend to cause sharp shoulder pain, among other symptoms, as they expand upward from the top of the lung and hinder the nerves around the shoulders and shoulder blades.

About 25 percent of people with Pancoast tumors experience a set of conditions referred to as “Pancoast syndrome.” As the Pancoast tumor continues to enlarge, more of the surrounding nerves become impaired, which may cause disruptions in the sympathetic nervous system. This nerve damage can also result in Horner’s syndrome — a condition that can cause decreased pupil size, drooping eyelids, and an inability to sweat. Typically, these symptoms appear on only one side of the face.

Malignant Pleural Mesothelioma

MPM is a form of lung cancer caused by exposure to asbestos. In one study, researchers found that 14.3 percent of people diagnosed with MPM said shoulder pain was their first symptom. MPM attacks the pleura (lining of the lungs) rather than the structure of the lung itself. As tumors develop on the pleura, they begin to apply pressure on the chest cavity that can cause pain in the shoulders.

Metastatic Lung Cancer

In people with metastatic lung cancer (advanced lung cancer), the cancer cells from the primary tumor spread to other areas of the body. In most cases, lung cancer cells enter the surrounding bones in a process called bone metastasis.

Physical pain from bone metastasis, including joint pain, is one of many effects of lung cancer on the body. As cancer cells begin to invade the bone, they alter its structure. Small holes, called lytic lesions, then develop on the affected bones, which can cause severe pain in the shoulders, back, and chest.

Most of the physical symptoms of lung cancer don’t show up until the tumor metastasizes. However, researchers are working every day to find new methods of early detection. By better understanding the link between lung cancer and shoulder pain, it may be possible to detect lung cancer in its early stages.

What Does Shoulder Pain From Lung Cancer Feel Like?

Shoulder pain caused by lung cancer can feel different from person to person, depending on the location and type of lung cancer. Lung cancer-related shoulder pain may be similar in intensity to the pain caused by arthritis, but there are a few differentiating characteristics.

In most cases, shoulder pain in lung cancer is more prevalent while lying down or resting. It doesn’t typically inhibit movement in the arms like arthritis can. Some people have also noted that they experience a tingling sensation racing down their arms in addition to shoulder pain, signifying nerve involvement.

Many MyLungCancerTeam members have reported shoulder pain and share their pain stories. “Very painful day,” wrote a member. “Shoulder and hand in extreme pain.”

Another said, “Been having pain in both shoulders and down the arm.”

Others mention weakness and tingling as well as pain around the arms and shoulders. Speaking of their daughter’s pain due to lung cancer, one member wrote, “She had numbness and tingling and pain in her right arm, and especially when standing or sitting up, and no strength in her right hand/arm.”

Some members note a cough alongside their shoulder pain. “Having some coughing spells today along with some shoulder pain,” one member wrote.

Managing Shoulder Pain With Lung Cancer

Managing symptoms like shoulder pain often starts with treating the lung cancer itself. If this doesn’t relieve your shoulder pain, your oncologist or health care team may recommend other options (such as over-the-counter or prescription pain relievers) to help manage pain in the shoulders.

As with any new or worsening symptoms, contact your health care team if you start experiencing shoulder pain. If you’re concerned shoulder pain could be a sign of lung cancer coming back, talk to your doctor to help you get the answers and treatment you need. Make sure to reach out if shoulder pain is causing sleep problems or hindering your everyday life.

Treating Lung Cancer

Treating the underlying cancer may help manage common symptoms like shoulder pain. One member of MyLungCancerTeam said that they “had a lot of shoulder, arm, and between-the-shoulder pain” right before their diagnosis but added that “after chemo, it went away.”

If a lung tumor is the cause of the shoulder pain, once it decreases in size, the pressure it was applying on the surrounding nerves should improve as well. In the early stages of lung cancer, it may be possible to remove the tumor surgically. If the tumor has started to spread, your doctors may suggest other treatment options, such as chemotherapy, immunotherapy, targeted therapy, or radiation.

Pain Management

If pain is affecting your quality of life, talk to your doctor about a referral to a palliative care specialist. Palliative care for lung cancer is focused on managing pain and other symptoms during any stage of the disease. There are several steps you can take to manage shoulder pain.

Medication for Pain Relief

Over-the-counter pain relievers, like nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, may help alleviate mild or moderate shoulder pain caused by lung cancer. Talk with your health care team to understand what pain relief medications you can take with your lung cancer treatment.

For more severe shoulder pain, your doctor may prescribe stronger medications, including morphine or other opioids.

Hot and Cold Treatments

Ice therapy is mainly used to treat swelling and inflammation, and heat therapy reduces tension and increases flexibility. If your shoulder pain arrives immediately without warning, first try to use cold therapy. Penn Medicine recommends applying ice for 15 minutes and then leaving the area bare for another 15 minutes. If the pain continues for more than 72 hours, try applying heat. One member of MyLungCancerTeam rests “with heat on their shoulder.”

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 12,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Have you experienced shoulder pain since your lung cancer diagnosis? How have you learned to manage it? Share your experience in the comments below, or start a conversation by posting on your Activities page.