Cancer Pain

Pain From a Cancer as It Invades Tissues or Pain From Treatments Such as Surgery and Chemotherapy

Keeping pain in check is an important part of a comprehensive treatment when you are fighting cancer. Cancer pain can decrease your appetite and affect sleep, mood, and energy levels. Controlling cancer pain early on, will help reduce the dose of strong medications that you have to take. It will help you sleep better and have more energy for chemotherapy or radiation sessions. A close working relationship with your pain specialist is needed to ensure a safe and efficient treatment for cancer pain.

What Causes Cancer Pain?

In the early stages, cancer may not cause any pain. However, once tumors grow in size, the chance of having pain increases. The return of cancer after an initial remission is yet another cause for pain. Cancer treatments help reduce tumors and decrease pain in the long run, but may cause discomfort.

Cancer-related pain results from:

Pressure from a tumor. Growing tumors destroy nearby tissues such as nerves, bones, and organs. Some tumors release chemicals that trigger pain.
Lymphedema. This painful swelling of the arm can start after radiation or a breast surgery that involves an axillary lymph node dissection.
Surgery. Surgery to remove a tumor may injure a nerve or create painful scars. People with limb or breast amputations may feel as though that body part is still there (phantom pain).
Radiation therapy. Radiation can cause skin burning, nerve damage, and muscle pain.
Chemotherapy. Anti-cancer medications may cause widespread nerve pain (neuropathy).
Complex Regional Pain Syndrome (CRPS). A nerve injury or tissue trauma in an arm or a leg can cause severe pain, swelling, and skin changes.

Cancer Pain Symptoms

Cancer pain takes many forms depending on the cancer type, how advanced it is, where the cancer grows, and a person’s pain tolerance. Long-lasting cancer pain may transition into neuropathic pain, a complex pain condition.

There are different types of pain in a person with cancer:

Nerve pain can start after chemotherapy or radiation or when a tumor presses on a nerve.

Nerve pain is:

A shock-like pain that travels in a band pattern
Tingling
Burning
Numbness

Somatic pain is intense and can be superficial (on the skin, lips, nose) or deep (in the joints, bones, muscles). Examples: headaches from brain tumors and back pain from metastases to the spine.

Somatic pain is:

Localized (easy to pinpoint where it starts)
Gnawing
Aching
Sharp

Visceral pain is common when cancer invades internal organs like the liver, bladder, prostate, or blood vessels.

Visceral pain is:

Vague (hard to pinpoint)
Aching
Squeezing

Diagnosis From a Pain Specialist

Care from a pain specialist starts with an evaluation to determine the source of pain and a physical exam. A review of X-rays, CTs, and MRIs determines what future procedures may relieve the pain. On the first visit, your pain specialist may introduce you to a cancer pain scale to help you rate pain levels throughout the day. This information helps determine the doses for your medications. During later visits, the pain specialist re-evaluates your treatment plan and makes appropriate changes.

Cancer Pain Management

Cancer patients have unique challenges:

Ongoing or severe pain that requires stronger medications, including opioids.
Difficulty swallowing pills in people with throat or esophageal cancer. Pain medications must be given through patches, in the veins, or through intrathecal pain pumps.
Cancer pain at night makes it difficult to rest leading to fatigue and stress and ultimately increasing pain levels.
A tolerance for pain medications where medications stop working at the dose that covered the pain well in the past.

Cancer pain requires a balanced treatment approach that combines medications, radiation, surgery, counseling, and alternative therapies.

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