Brief Overview: Chronic cancer-related pain is persistent pain in patients with a history of cancer, due either to the cancer itself (tumor infiltration, metastasis) or treatments (surgery, chemotherapy, radiation). It can be nociceptive, neuropathic, or mixed, and may continue long after cancer treatment is complete. Effective management is essential to maintain function, quality of life, and emotional well-being.
Prevalence:
- 30–50% of patients undergoing active cancer treatment experience pain.
- Up to 70–90% of patients with advanced cancer report significant pain.
- 1 in 3 cancer survivors report chronic pain after treatment.
- More common in older adults due to comorbidities and frailty.
Etiology: According to UpToDate, “chronic cancer-pain syndromes usually are directly related to the neoplasm itself or to antineoplastic therapy.”
Risk Factors:
- Advanced or metastatic cancer.
- Surgeries involving nerves (e.g., breast, head/neck, thoracic).
- Neurotoxic chemotherapy (platinums, taxanes, vinca alkaloids).
- Pelvic or chest radiation.
- Pre-existing chronic pain or neuropathy.
- Psychological distress (depression, anxiety).
Commonly Associated Conditions:
- Depression, anxiety, sleep disorders.
- Cancer-related fatigue.
- Malnutrition and weight loss.
- Neuropathy, lymphedema.
- Opioid-induced constipation, nausea.
Common Medications:
- Mild pain - NSAIDs, Tylenol
- Mild to moderate pain - Low-dose opioids
- Moderate to severe pain – opioids
- Others: corticosteroids, antidepressants, bisphosphonates, gabapentin/pregabalin, topical lidocaine/capsaicin, laxatives/stool softeners
Common Labs, Imaging, and Tests:
- No single test — evaluation depends on underlying cancer.
- Imaging: X-ray, CT, MRI, bone scans → assess metastasis or fractures.
- Labs: CBC, CMP, calcium, tumor markers depending on cancer type.
- Pain assessments: Numeric rating scales, quality-of-life questionnaires.
- Medication monitoring labs: renal/hepatic function for NSAIDs/opioids; ECG if on methadone.
Common Symptoms:
- Persistent pain (dull, aching, sharp, burning, or stabbing).
- Pain localized to tumor site, bone, or nerve distribution.
- Neuropathic pain (tingling, numbness, burning) after chemo or surgery.
- Pain worsens with activity or at night.
- May cause loss of appetite, fatigue, poor sleep, depression.
Common Treatments:
- Pharmacologic:
- WHO pain ladder: start with non-opioids → add weak opioids → strong opioids as needed.
- Adjuvant meds for neuropathic pain.
- Corticosteroids, bisphosphonates for bone pain.
- Non-Pharmacologic:
- Physical therapy, gentle exercise.
- Acupuncture, massage, relaxation therapy.
- Cognitive-behavioral therapy (CBT).
- Palliative care involvement.
- Interventional:
- Nerve blocks, epidural or intrathecal infusions.
- Radiation therapy for painful bone metastases.
- Surgery for stabilization (e.g., fracture risk).
Physical Findings:
- May show tenderness at tumor sites.
- Limited mobility or guarding behavior.
- Neuropathic findings: sensory loss, hypersensitivity, allodynia.
- Cachexia, fatigue, or weight loss in advanced cancer.
- Otherwise, exam may be normal despite severe pain.
Potential Complications and Contraindications:
- Complications:
- Opioid side effects: constipation, sedation, confusion, falls
- Undertreated pain → depression, immobility, functional decline
- Overuse/misuse of opioids
- Disease progression with worsening pain
- General Contraindications (always follow the guidance of your healthcare provider):
- NSAIDs: avoid in kidney disease, ulcers, uncontrolled hypertension.
- Opioids: caution in patients with history of substance use disorder; avoid abrupt discontinuation.
- Corticosteroids: avoid long-term high doses due to bone loss, diabetes, and infection risk
General Health and Lifestyle Guidance:
- Encourage open communication about pain — it should not be “suffered in silence”
- Balanced nutrition to support healing and strength.
- Gentle physical activity (walking, stretching) to reduce stiffness and improve mood.
- Stress management: meditation, support groups, counseling.
- Good sleep hygiene
- Safety planning if on opioids: fall prevention, constipation management.
- Encourage follow-up with oncology, palliative care, and pain specialists.
Suggested Questions to Ask Patients:
- How would you rate your pain today (0–10 scale)?
- Where is the pain located, and how long have you had it?
- What makes the pain better or worse?
- Are you taking pain medications? How often? Do they help?
- Have you had side effects (constipation, drowsiness, confusion)?
- How does the pain affect your sleep, appetite, or mood?
- Have you had new symptoms (numbness, weakness, weight loss, fever)?
- Do you feel your pain is being taken seriously and managed well?
Suggested Talking Points:
- Chronic cancer-related pain is common, and there are many ways to help manage it.
- Make sure to discuss balancing pain relief with safety, especially with medications like opioids, with your healthcare team.
- Non-medication strategies such as gentle exercise, relaxation, or therapy can also help.
- Constipation and drowsiness are common with pain medicine — ask your healthcare provider for advice on management of any symptoms you’re experiencing.
- Palliative care can help with pain and improve quality of life, even if you’re still receiving treatment. You may be managed by multiple providers.
Sources:
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.