Cancer Pain

Pain is a complex symptom with a distressing feeling and it can affect us physically, mentally, psychologically, socially, emotionally and spiritually. It hampers our daily activity.

What is cancer?

Cancer is a condition in which the body’s cells start growing in an uncontrolled manner and it can affect any part of the body. It can affect us in many ways and pain is one of the debilitating manifestations of cancer.

Pain due to different cancers can be broadly divided into two types:

• Acute cancer pain – can be due to immediate organ damage. For example a fracture from a weakened bone.
• Chronic cancer pain – it is usually because of the cancer itself or as a side effect of medicines/procedures used for its treatment. For example, if a mass in the liver grows too big it puts pressure on the lining of the liver and gives pain.

Acute Cancer Pain

• Directly related to cancer – acute pain in the patients having cancer must be taken seriously and you must consult your doctor as most of the time it needs immediate treatment. Few examples are
• Bleeding – it can occur in any type of cancer but commonly with soft parts of the body for example liver, lung etc. Bleeding into the liver due to cancer can cause severe pain in the right side of your abdomen along with dizziness and lethargy. Immediate medical care is required.
• Fracture (breaking of bone) – it occurs either due to spread of cancer to the bone from any other part of body (metastatic deposits) or cancer of the bone itself. It is a painful condition that can happen with or without antecedent trauma to the bone. Common examples are fracture of vertebral column presenting with back pain. Long bones in the arms, hip or legs may also fracture. Once again medical advice must be sought immediately and your doctor will carry out the scan (x-rays) of the painful part of your body, relieve the pain either with medicine or refer you for operation depending on the severity. Radiation (radiotherapy) is also used to control pain over a longer period of time.
• Obstruction or leaking (perforation/rupture) of hollow organs like gut, urinary channels/tubes (ureters) or bile duct (tube containing a yellow substance from the gall bladder to the gut) – it occurs because of abdominal or pelvic cancer when a huge mass usually obstructs or ruptures the delicate hollow organs and causes pain. It is an emergency that warrants surgery in most cases.
• Pain related to cancer treatment – this occurs because of medicines, hormones and radiation used for the treatment of cancer.
• Ulcers and inflammation in mouth – These lesions occur because of medicine as well as radiation used for the treatment of cancer. A painful condition can hamper talking, eating and swallowing. It usually starts in the first week of treatment and good oral hygiene is mandatory to avoid secondary infections. Common examples are; methotrexate, doxorubicin and fluorouracil. Radiation for head and neck cancer is are also causes of ulcers.
• Effects on the nerve roots (origin of nerves) and the nerve – Pain or tingling can occur when nerves going into the extremities are compressed. Hearing or vision loss, difficulty in swallowing or breathing and hoarseness of the voice, because of involvement of the nerves in the head and neck can also occur because of medicines used for cancer treatment. Common examples of medicines are; vincristine, paclitaxel, oxaliplatin and thalidomide. Another problem that can occur especially after radiation treatment for cancer is acute pain, tingling and weakness of either of the shoulders, arms and hands. It is usually a self-limiting condition.
• Involvement of the gut and back passage – it usually occurs a few hours after radiation or may develop slowly in a week’s time. It can cause nausea, vomiting, abdominal cramps, and diarrhea with or without blood/ mucus, and pain on passing stool.
• Bone pain usually occurs due to spread of cancer to almost any bone of the body. Cancers commonly spreading to bony parts of body are of lung, breast and prostate. They usually cause pain by direct spread, fracture or damage of soft tissue adjacent to the bones. Blood cancer involving the bone marrow does not cause bone pain. In rare cancers like of muscle bone pain is caused by release of chemicals causing damage to the bone. Vertebral column is the most common site for bone pain due to cancer; it can come only as pain or other serious problems like compression of the spinal cord leading to numbness and weak of lower limbs and it is an emergency to be reported to your doctor at the earliest. Other commonly involved bony sites are the hip bone and skull. Treatment by radiation (radiotherapy) is the best treatment for bone pain due to cancer and your doctor will refer you to the concerned specialist.
• Soft tissue pain – common types of soft tissue in the body are muscles, fat, tissues lining different organs (pleura, peritoneum etc.). Cancer of the soft tissue itself or spread from any other cancer can cause soft tissue pain. Common examples are; muscle pain due to sarcoma (cancer of the muscle) or cancer spread from other site (rare). Muscle cramps can occur due to abnormalities in the balance of electrolytes like calcium and sodium in the body. Chest pain caused by lung cancer is an example of soft tissue pain that can be due to involvement of the ribs, muscles lying in between the ribs or the lining of the lungs (pleura).
• Cancer related visceral pain originates from the organs lying deep in the body but the pain is manifested superficially. Hollow organs of the body like gut, lining of the liver (capsule), lining of lungs (pleura) and gut (peritoneum) give visceral pain. This type of pain is associated with abdominal and gynecologic cancers and the common cause is either obstruction of the gut and other hollow organs, or stretch put on the lining of the organs like liver, lung etc. due to increase in size of the cancer.
• Pain due to involvement of lining of the brain and spinal cord from cancers spreading to the lining of the brain (meninges). Certain cancers second spread into the brain and spinal cord are lung, breast, cancer of lymph glands (lymphoma) and white blood cells (leukemia). Common symptoms are headache with nausea or vomiting, neck stiffness and backache. Severe involvement can cause fits, weakness and numbness of any part of body and impaired thinking. If you have such symptoms at all you must see your doctor who will be interested in getting the scan of your brain (MRI).
• Para neoplastic syndromes – it is a disorder occurring in cancer patients because of release of substances from the cancer that act on different parts of body.

Certain treatments can cause pain. The following are a few examples.

• Nerve related pain manifesting as tingling of feet and legs followed by involvement of hands as well. Pain of the fingers and toes due to narrowing of the arteries (Raynaud’s phenomenon) can also occur due to cancer medicine. Common causes are cisplatin and vincristine.
• Steroid induced bone complications – it causes damage to shoulder and hip joint by compromising the blood supply and causes hip and shoulder pain. Moreover, they can cause osteoporosis and lead to fracture of vertebral column causing severe backache.
• Breast enlargement and pain can occur in men due to medicine used for prostate cancer. This medicine suppresses the male hormone, testosterone and causes enlargement of breast and pain.

To summarize, there are several types of pain that can occur due to cancer and if you feel any unusual or out of proportion pain you must visit your doctor to rule out any underlying serious cause.

Here at Elite Pain Management we take a multidisciplinary approach to help patient’s suffering with pain. Contact us  for more details.