To celebrate my mother finishing her last round of chemotherapy today, I wanted to talk about cancer pain.  When I was a fellow, I rotated through one of the major cancer centers in New York City, and was exposed to many patients being treated for cancer who also had pain.  I was surprised to see that this type of pain is extremely diverse, and doesn’t always result from pain from a tumor.

A helpful way to think of cancer pain is to divide it into pain arising from the cancer itself, pain arising from treatment, and unrelated pain (basically a separate pain condition occurring in a patient who happens to have cancer).  I’ll give some examples of each type, and then talk a little bit about treatment.

Cancer itself can cause many different types of pain, often from compression arising from a tumor, or from metastatic disease.  For example, if a tumor is growing near a nerve, when the nerve gets pressed on, it can cause burning and tingling pain in the area that the nerve is responsible for.  If cancer cells metastasize to the bones, this can also be very painful. Sometimes the metastatic disease can even weaken the bone to the point where it breaks without trauma, known as a pathologic fracture.  Treatment for this type of pain really depends on what kind of pain the patient is having. If a patient is having nerve type pain, treatment options might include nerve pain medications, and nerve block procedures.  Bony pain responds well to anti-inflammatory medications, and yes, sometimes opioids.

While necessary to help patients survive their cancer, the various treatment options can also have associated pain conditions.  For instance, sometimes chemotherapy medications can cause peripheral neuropathy, a condition where patients develop numbness and burning in their hands and feet.  Another example of treatment-related pain might be a woman who undergoes mastectomy for breast cancer, and then develops chronic pain in the area of the surgery. Our goal as pain management physicians is to help patients to cope with this type of pain so that they can continue to get the treatments that they need.  So, we employ many different types of medications and procedures depending on what the symptoms are and what cancer treatment the patient is receiving.

The last type of cancer pain is unrelated pain.  Just because a patient is undergoing treatment for cancer, it doesn’t mean that they can’t develop other medical issues at the same time.  An example might be a man undergoing treatment for prostate cancer, who then happens to develop a disc herniation in his back and is now struggling with sciatica.  Sometimes it can be hard to take the focus off the cancer and recognize that something totally separate is going on. Of course, as pain physicians, we are also always on the lookout that this seemingly unrelated pain could be the first sign of metastatic disease, and we image appropriately to check for this.  

Physical therapy is invaluable for all of these types of patients.  For example, it can help patients to get their strength back after cancer surgery or chemotherapy. Therapists can also work on balance training and fall prevention if patients have developed numbness in their feet. The rehab plan is tailored to the specific problems a patient is having, just like the treatments a pain physician would prescribe. Having a personalized rehab plan in the setting of cancer treatment also goes a long way in helping patients to get their confidence back about their functional abilities.  

Cancer pain, perhaps more than some other types of pain, truly requires a multidisciplinary approach.  This means using multiple treatment modalities to target the pain, but also working with the patient’s oncologist, surgeon, physical therapy team, and psychiatrist/psychologist, as well as many other specialists.  Everyone on the team brings a unique perspective to the case.

Helping patients with cancer to improve their quality of life and functional status is one of the most rewarding parts of my job.  If you have active cancer or a history of cancer, and are struggling with pain, I strongly recommend seeing a pain physician to see if there are treatment options available.

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