Cancer pain affects one in three people with cancer. If patients are in late-stage cancer or have experienced metastasis or a recurrence of cancer, the chances of experiencing cancer pain are even higher. Cancer pain has many different causes, each one of which may respond differently to treatment.
Cause #1: The cancer itself
Cancerous tumors that are growing in the body can place tremendous pressure on surrounding tissues, organs, muscles, and bones. Over time, this pressure can become painful, especially if the tumor is not responding quickly to treatment. One common type of this cause of pain is spinal cord compression. Tumors growing close to the spine can pinch nerves, causing debilitating pain.
Cancer that moves into the bones can also cause deep, difficult-to-treat pain.
Additionally, late-stage cancers can put out chemicals that cause aching joints and muscles. This type of pain can be difficult to diagnose, as the cause is discreet and difficult to detect in the body.
Cause #2: Cancer treatment
It is an unfortunate paradox that treatment for cancer can cause tremendous pain for the patient. In addition to the chronic pain that can arise as a result of surgical removal of tumors, including mastectomy for breast cancer, surgery for a cancer patient can be difficult to recover from. The body’s immunity is already compromised, and post-operative infections can cause pain and other complications.
Other treatments like radiation can cause burns on the skin that can be severe. Chemotherapy is a cocktail of chemicals that can also cause pain for some patients. Another type of pain that can be caused by chemotherapy is peripheral neuropathy. This occurs when chemotherapy destroys nerves and results in burning, tingling, or shooting pain, usually from the extremities.
Both chemotherapy and radiation can cause painful mouth sores.
Cause #3: Concurrent physical conditions
Cancer patients may have a pre-existing pain condition such as arthritis, low back pain, or migraines that may worsen with a decrease in activity due to the side effects of cancer treatment. Although patients may have had a successful treatment plan in place, this type of pain needs to be accounted for and potentially modified in the face of a cancer treatment plan.
Cancer pain is not always consistent. Acute pain is pain that is short-lived and responds well to treatment. Chronic or persistent pain lasts for longer than three months and is not typically resolved easily. Finally, breakthrough pain is sharp, intermittent, and independent of other types of pain in that it can occur even when other pain has been successfully treated. Breakthrough pain is short-lived but intense and often debilitating.
Diagnosis and treatment
Diagnosis of cancer pain often involves a patient interview using a pain scale (0-10). The doctor may ask about the location, duration, and sensation of pain (sharp, stabbing, aching, etc.). She will also carefully examine current treatments for cancer (medications, chemotherapy, etc.) and ask general health questions regarding diet and activity levels.
Once the doctor determines what type of cancer pain is present and the potential cause, a treatment plan will be put in place. Potential treatments for cancer pain include:
- Over-the-counter (OTC) medications: These can include analgesics, such as ibuprofen and acetaminophen. Some OTC medications will help address inflammation that may be caused by chemicals being emitted from tumors or from post-operative inflammation.
- Weak opioids: Codeine may be prescribed for more persistent (but not chronic) pain.
- Strong opioids: Although opioids are not indicated as a successful treatment for chronic pain, they may be prescribed for acute or breakthrough pain. These can include morphine (Avinza, Ms Contin, others), oxycodone (Oxycontin, Roxicodone, others), hydromorphone (Dilaudid, Exalgo), fentanyl (Actiq, Fentora, others), methadone (Dolophine, Methadose), or oxymorphone (Opana).
- Complementary therapies: There is growing evidence that complementary therapies are an important part of a cancer treatment plan. Acupuncture has been shown to dramatically relieve breakthrough cancer pain quickly with few side effects. Yoga, hypnotherapy, t’ai chi, and aromatherapy have proven successful in reducing stress, anxiety, and depression in cancer patients. These reductions contribute to a significant improvement in a cancer patient’s quality of life.
- Supplementation: Vitamin D has been shown to help with cancer pain experienced by women as a result of mastectomy to treat breast cancer. Deficiency of the “sunshine vitamin” has been linked to a variety of conditions, including joint and muscle pain as well as leukemia, so this treatment for cancer pain makes sense.
- Counseling: While talking about pain may not make it go away, counseling, whether one-on-one or in a supportive group, can help cancer patients to better deal with symptoms when they do arise. Battling a life-threatening illness can be very isolating, and as hard as they try, family members may not be able to fully understand a cancer patient’s experience. Finding a positive, informative group or therapist can help you to develop strategies and coping mechanisms for cancer pain.
Cancer pain can affect every aspect of a patient’s life. Mood and outlook can be drastically influenced by levels of pain. Because of this, it is important to talk to your doctor about any pain you may be experiencing.
You may feel that pain is part of cancer treatment, but this is not necessarily the case. While some pain is associated with surgery and is to be expected with radiation, chemotherapy, and the growth of tumors, this does not mean that it should not be part of your overall cancer treatment plan. Do not hesitate to talk with your doctor or reach out to a qualified pain specialist when appropriate.
For more on cancer pain, including managing pain and an online class to help develop coping strategies, visit the American Cancer Society’s page on cancer pain.