What is Cancer Pain?
Cancer pain explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors.
Cancer pain is the pain associated with cancer and its treatments. It can range from dull aches to intense, very severe pain. Short-term, or acute, cancer pain is generally associated with the procedures surrounding the cancer. Enduring, or chronic, cancer pain is largely the result of the condition itself.
For patients with chronic cancer pain, their continuous pain may be punctuated by instances of “flare ups,” or sharp rises in the intensity of the pain. Additionally, chronic cancer pain patients may also experience intermittent periods of being pain-free.
Causes of Cancer Pain
In terms of cancer pain that is associated with the illness itself, the pain is generally experienced within the region of the cancer. However, in some cases, the pain can be experienced in other places on the body. Prostate cancer, breast cancer, and most bone cancers are well-known as among the most painful cancer conditions. Pain that emerges as a result of these conditions can be caused by pressure being placed on the nerves, or a chemical stimulation of the nerves.
Cancer pain can also emerge as a result of the procedure used to treat the cancer. For instance, chemotherapy can be associated with pain and inflammation of the mucous membranes, pain in the muscles and joints, abdominal pain, and peripheral neuropathy. Pain associated with chemotherapy can also cause patients to experience a painful sensitivity to cold, which begins in the outer extremities, such as the hands and feet, and can progress into the arms and legs.
Radiotherapy treatment for cancer can also be associated with significant pain. In general, this procedure can affect the connective tissue surrounding nerves, and may cause damage to the spinal cord and white and grey matter that comprises the brain. Patients with radiotherapy-related pain generally describe painful tingling (i.e. “pins and needles”), as well as numbness and weakening of the affected area. Interestingly, damage to the spinal cord as the result of radiotherapy may not emerge until several months following the procedure. In most cases, however, this pain will resolve on its own without long-term effects.
In rare instances, tissue itself can become cancerous, as in the case of gliomas. These can be a significant source of pain, as the tumors place pressure on surrounding pain-sensing tissue and are likely to cause significant tissue damage. Brain tumors are one example of cancerous tissue. The pain associated with this condition is generally the result of increased compression on blood vessels within the brain, pressure on the outer coverings of the brain (i.e., meninges), and by spreading to other nearby tissue and causing damage. Cancerous cells that spread to the bone are particularly associated with significant pain.
Procedures targeted to reduce or remove the cancerous tissue may also be the primary source of cancer pain. This pain is generally the result of tissue and nerve damage sustained during the surgical procedures performed on the tumors. Tissue inflammation following these surgical procedures can also put pressure on the nerves within the affected area causing the patient to experience pain.
Treatment for Cancer Pain
Given that the spinal cord is primarily responsible for transmitting pain signals to the brain, successful pain management strategies are those that target this area. Pharmacological interventions are available, such as opioid medications that target this pain signaling system. Opioids such as codeine, morphine, or fentanyl act on the opioid receptors within the spine to block the signaling of pain. Opioids are a common pain medication prescribed to cancer patients, either in oral form or intravenously. Opioids are ideal for the management of acute cancer pain. Indeed, however, there are risks associated with the use of opioids. Prolonged reliance on opioids for pain management increases the potential for drug dependence, abuse, and possible overdose. Patients receiving opioid treatment as part of their pain management plan should be closely monitored.
As an alternative to pain management through the use of opioids, spinal nerve injections may be recommended for treating cancer pain. For this procedure, pain-relieving compounds known as anesthetics are injected into the space near the affected spinal nerve or nerve bundle. Examples of common anesthetics used for this procedure include lidocaine, bupivacaine, or mepivacaine. This procedure prevents the transmission of pain signals to the brain. This procedure is ideal, as targeted treatment is possible by injecting the anesthetic directly into the area that is most affected. Alternatively, for the long-term management of cancer pain, an intrathecal pump may be recommended. This involves inserting a device that delivers pain-relieving medication directly into the epidural space over long periods of time.
These procedures are relatively brief and can be done on an outpatient basis. Some patients have reported almost immediate pain relief following the injection.
There is some risk involved in these procedures though, which includes possible nerve damage and incorrect placement of the injection that can lead to numbness or discomfort, respiratory depression, and, in severe cases, paralysis. Other minor risks from the injection itself include minor bleeding, infections, and headaches. Some patients experience a reaction to the medication itself.
Cancer can be associated with significant degrees of pain. This occurs as the result of tissue damage, nerve damage, irritation, and inflammation caused by the spreading tumor. As tumors continue to grow and spread, they may induce pain in other regions of the body. Procedures associated with diagnosing and treating cancer also may cause pain.
There are many treatment options available to help cancer patients in managing their symptoms of pain. Most commonly, cancer patients are prescribed opioid medications. Other treatments are available and have fewer risks, including corticosteroid injections. Similar treatments are also available for the long-term management of cancer pain.
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