Chronic Pain

Causes of Chronic Pain

The causes for chronic pain vary, and not all survivors experience it. Chronic pain can result from cancer treatment or because the cancer has spread to other parts of the body.

• Bone metastasis: Survivors who have had breast, prostate, lung, kidney or colorectal cancer may have pain because cancer has spread (or metastasized) to the bones. This is the most common cause of pain in advanced cancer.
• Peripheral neuropathy: Injury to nerves can result from chemotherapy, surgery or radiation treatments. Peripheral neuropathy can cause pain, tingling, burning, numbness or weakness that often begins in the hands or feet. The symptoms could go away when cancer treatment stops. However, if the nerves become permanently damaged, peripheral neuropathy may persist. Chemotherapy medications, such as Taxol, Vincristine, Taxotere, Oxaliplatin and Cisplatin, may cause peripheral neuropathy. Talk with your health care provider if you have concerns about possible side effects with your medication.
• Steroids: Taken as part of cancer treatment, steroids can lead to chronic bone pain. Steroids can cause bones to weaken, leading to thinning of the bones (osteoporosis), and even painful bones. Talk with your health care team if you took steroids during your cancer treatment to find out if you might be at risk for chronic pain.
• Radiation therapy and surgery: These treatments can lead to a variety of acute (rapid onset, severe and short term) and chronic pain. Studies have shown that inadequately treated pain immediately following surgery may cause delayed recovery and the development of chronic pain problems.

Talk to Your Health Care Team

Contact your health care team right away if you have new or worsening pain, numbness, tingling or a burning sensation in your hands or feet. In addition, let them know if your current pain medications stop working or aren’t working as well. Also, let them know as soon as possible if you develop painful swelling (lymphedema) in an arm or leg.

It’s important to get the best possible treatment for pain. If your pain becomes severe, it can be more difficult to manage. Your provider needs enough information to correctly assess your pain. Many providers ask patients to rate their level of pain using a pain scale: a rating of zero means no pain, and a rating of 10 stands for the highest level of pain.

Pain can affect your ability to sleep, eat, work and spend time with loved ones and friends. Tell your health care team how the pain is affecting your life. Your health care team should listen to you and ask questions about the nature and frequency of your pain. Tests may need to be done to identify the cause of the problem. It may take several methods to find what works best to relieve your pain.

You deserve to receive good pain care. Be certain that your health care provider has the experience and skills to treat your specific condition. Some nurses and doctors specialize in managing pain, such as physiatrists and anesthesiologists. If you think your provider is not able to effectively manage your pain, ask for a referral to a pain specialist.

Medications for Treating Pain

Cancer pain is often treated with one or more medications. If you have concerns about taking certain medication, discuss this with your health care provider and pharmacist. Ask about long-term medication usage and side effects, such as allergies, constipation, sedation, memory impairment or other reactions.

• For mild pain: Medications such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) may provide relief. Some of these drugs, such as ibuprofen or naproxen, can be purchased without a prescription.
• For moderate pain: Medications that combine an opioid (sometimes called a narcotic) such as hydrocodone or oxycodone with acetaminophen or aspirin may be needed. Vicodin and Percocet are examples.
• For severe pain: Medications that contain an opioid only (sometimes called a narcotic) such as morphine, oxycodone, fentanyl or methadone are usually needed. These narcotic medications may be given orally or intravenously (or sometimes both).
• For bone pain: When associated with metastatic cancer, treatment for bone pain can include bone-strengthening steroid medication known as bisphosphonates. (Radiation therapy and surgery may also be very effective in relieving symptoms.)
• Antidepressants medications: Amitriptyline and duloxetine, for example, can be very helpful in managing chronic pain.
• Gabapentin and pregabalin: Originally developed to treat epilepsy, these can also be used for chronic pain, including neuropathic pain caused by nerve injury.
• Topical anesthetics: Lidocaine pain patches, for example, may be helpful in some cases.

Complementary Pain Relief Options

Complementary (also called alternative or holistic medicine) treatments include massage, acupuncture, meditation, biofeedback or hypnosis. For some types of pain, heating pads, hot or cold packs and massage may be soothing and can help to reduce pain.

A health care provider may recommend counseling to help a patient cope with their pain or other distressing symptoms. Stress can make pain worse. It can also lessen the effect of pain management medications.

To learn more about these types of therapies, contact the National Cancer Institute. Talk with your health care team if you are interested in adding a complementary method of treatment. Let them know about supplements and herbs you want to try. Some types of complementary treatments can interfere with treatments prescribed by your provider.

Other Pain Treatment Options

Biofeedback is a method that uses the mind to help with pain. Breathing exercises, relaxation techniques, yoga, tai chi, qigong, visualization, meditation or guided imagery exercises may also be effective. Sometimes, talking with friends, laughing or listening to music can offer a helpful distraction from pain.

For severe pain, a technique called a nerve block is sometimes considered. This procedure may involve injecting a substance directly into or around a nerve or around the spinal cord. These procedures block damaged nerves from sending pain signals to the brain so that the pain will not be felt. Nerve blocks may work to control pain for people who have advanced cancer or very painful nerve conditions. However, there can be serious complications associated with these procedures.

Talk with your health care provider about the benefits and risks before any treatment to decide what is best for your situation. Every survivor responds differently to pain management strategies. Open communication with your health care team can help you decide together what will work best to manage your pain.

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Works Cited

NCCN. Clinical Practice Guidelines in Oncology. Adult Cancer Pain.V.2.2011. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp

American Cancer Society. A Guide to Pain Control. Atlanta: American Cancer Society, 2001.

Cherny, Nathan. "Cancer Pain: Principles of Assessment and Syndromes". Principles & Practice of Palliative Care & Supportive Oncology 2nd Edition. Ed. Ann M. Burger, Russell K. Portenoy, David E. Weissman. Philadelphia: Lippincott Williams & Wilkins, 2002.

Dillard, J., N., The Chronic Pain Solution, Your Personal Path to Pain Relief. New York: Bantam, 2002.

McCaffery, Margo, Pasero, Chris. Pain: Clinical Manual 2nd Edition. St. Louis: Mosby, 1999.

Rosenfeld, A. The Truth about Chronic Pain, Patients and Professionals on How to Face it, Understand It, Overcome It. New York: Basic Books, 2003.