Cancer is a terrifying illness, regardless of its type or severity. One of the most feared aspects of a cancer diagnosis is the spread of pain as the disease progresses through the body – and cancer treatment also involves managing, diminishing, and hopefully eliminating that pain through various therapies and pharmacology. As a patient’s condition changes and evolves, cancer pain levels can rise and fall, accompanied by new causes and a completely different medication course. Understanding how medical professionals aim to address cancer pain helps to understand how cancer typically causes pain.
Common Types and Causes of Cancer Pain
Cancer pain, and pain in general, can be briefly divided into nociceptive pain (pain picked up by nerve receptors due to tissue damage) and neuropathic pain (pain caused by damage to the nerves themselves). Most cancer pain is neuropathic and worsens as tumors grow and spread through sensitive, innervated areas, compressing and damaging significant nerves. Typical forms of cancer pain include:
Peripheral neuropathy involves any form of pain caused by damage to the nerves in the peripheral nervous system (i.e., outside of the brain and spine). Most kinds of peripheral neuropathy are caused either by compression due to a growing tumor or the cancer treatment process (nerve damage due to chemotherapy and radiation treatment). Examples of cancers often causing peripheral neuropathy include:
- Breast cancer
- Lung cancer
- Multiple myeloma
Spinal Cord Compression
The spinal cord and the nerve roots attached to the spine can also be affected by a growing tumor, compressing and damaging the nerves directly and sending sharp pains, tingling feelings, and numbness throughout the body. Compression in the upper portion of the spine may lead to symptoms throughout the chest and arms, while compression further down along the spine can cause weakness, tingling, and pain in the legs. If left untreated, compression on the spinal cord can lead to loss of control in the bladder and bowel and paralysis. Immediate treatment is necessary to reduce the tumor’s size, usually through targeted radiation, steroid injections, or surgery.
Bone pain is a type of nociceptive cancer pain, wherein cancer spreads to and damages the body’s bones. As anyone who has ever broken a bone would know, bones are not merely pure deposits of minerals – they’re innervated with nerves and, as long as they’re in the body, count as a form of feeling and living tissue. Bone pain may be treated by focusing on medicine and treatments that strengthen the bones and weaken cancer, alongside pain medication. Some treatment types can also cause or exacerbate bone pain by stimulating the bone’s natural production of white blood cells within the marrow. This can be painful.
Depending on the type of surgery and its invasiveness, recovery can be lengthy and painful. This is also a kind of pain that is considered part of the cancer treatment process. It is usually treated with different classes of pain medication, depending on how your recovery goes.
Chemotherapy and Radiation Treatment Pain
The side effects of chemotherapy and radiation treatment are varied. They include various forms of peripheral neuropathy (with symptoms such as pain, tingling, weakness in the extremities), mouth sores, and damage in the throat or intestine. These side effects can be severe enough that patients may seek to avoid or end their treatment – if you’re experiencing side effects, it’s important to communicate them with your doctor and find an alternative or ways to manage the pain and treat radiation damage.
Following surgery, some patients may experience pain related to a missing limb or body part. While phantom pain is not entirely understood, we know that some physiological components are not purely psychological. Different therapy forms may help reduce or address phantom pains, including pain medication, brain stimulation (magnetic fields), transcutaneous electric nerve stimulation, and physical therapy.
This is a particular type of pain that occurs when cancer pain has been controlled or managed via therapies and medication for a while, and a sudden jolt or new sensation “breaks through” and causes pain where there had been done before. This typically calls for a re-evaluation of a patient’s pain management, may hint at a new or different cause of pain, or indicate that a patient is developing a greater tolerance against the current medication.
Managing and Treating Cancer Pain
When it comes to addressing cancer pain, a multimodal approach is typical. This means combining medications, therapies, and invasive and non-invasive treatments based on what any given situation calls for.
- Medication: Different drugs are used to tackle cancer pain depending on the type and cause of the pain. Opioids are the most common medication for severe cancer pain. They are far less likely to cause substance use issues when used for pain management than recreationally but may still have other side effects, such as constipation and drowsiness. Non-opioid painkillers may include over-the-counter drugs such as NSAIDs and acetaminophen, anticonvulsants following certain nerve damage types, antidepressants to help relieve pain addressing low mood, and other types of medication used to reduce swelling or block nerves, such as corticosteroids. When considering painkillers and other kinds of medication for cancer pain management, it is important to thoroughly discuss your doctor’s options and speak openly about your fears and worries. Your doctor helps you better understand how and why these drugs work and what to do in case of specific side effects.
- Surgery: Not all cancer pain can be alleviated with surgery, but in cases where it is an option, careful removal of most or all of the tumor can do a great deal to relieve pain in the long-term.
- Non-Invasive Interventions: Swelling, inflammation and tumor-related nerve damage may be addressed in cases where surgery is not an option through targeted radiation treatment (to reduce tumor size) and corticosteroid injections (to reduce tissue swelling and inflammation). Other medications may numb the nerves in an area after an acute spike in pain (nerve block).
- Nerve Stimulation: Another non-pharmacological intervention for reducing cancer pain for a while is transcutaneous electrical nerve stimulation. A low-voltage current is applied to the site via electrodes, sufficiently decreasing certain types of chronic and acute pain by activating different receptors. While its application is limited, it may work well for some patients.
Always Consult Your Doctor Before Making Changes
Cancer pain management must adapt to the situation as the disease changes and progresses. Certain medications may no longer be needed after a certain point, while others might become ineffective due to the pain changes or the body adapts.
But before making changes to the type of medication used, or the dosage, it is critical to discuss your symptoms with your doctor. Take note of when and how often you feel pain, what it feels like – whether it is tingling, burning, sharp, or dull – and how bad it is, on a scale of your choice. Information like that may help your doctor find a better way to manage your pain.