Chronic Pain: Detailed Information

Many cancer survivors experienced pain during their treatment and found ways to manage it with the help of their health care teams. For some survivors, the pain they experienced went away after their treatment ended. However, there are survivors who have to live with chronic pain. Chronic pain is pain that lasts for a long time. Chronic pain can be mild or very severe, and it can affect your quality of life after cancer.

You are experiencing chronic pain if:

• Your pain is ongoing
• Your pain has not responded to currently available treatment methods, and/or
• Your pain has interfered with your activities of daily living

It’s understandable if dealing with chronic pain upsets you or overwhelms you at times. In order to manage chronic pain successfully, you should form a strong partnership with your health care team. You should let your health care team know how this pain is affecting your life. They can help you address the physical causes of chronic pain and also address the emotional side effects of having to live with pain on a daily basis.

There are many causes for chronic pain, and each survivor may deal with chronic pain differently. If you experience chronic pain during your survivorship, there are ways to manage it and perhaps lessen how much chronic pain affects your quality of life.

Do all survivors experience chronic pain?

Not every survivor experiences chronic pain. For those who do have chronic pain, the causes can vary. Chronic pain can result from treatment of cancer or from the cancer spreading to other parts of the body. Individuals who have had breast, prostate, lung or colorectal cancer are at a higher risk of having chronic pain.

There are a few chemotherapy medicines that have a side effect called peripheral neuropathy. Peripheral neuropathy is a condition that causes tingling, burning, numbness or weakness as a result of nerve damage. It usually begins in the hands or feet. Most of the time the pain caused by peripheral neuropathy will go away when the treatment stops. However, if your nerves become permanently damaged, chronic pain can develop. Some examples of chemotherapy medicines that may cause peripheral neuropathy are Taxol, vincristine, Taxotere and cisplatin.

If you took steroids as part of your treatment for cancer, you may be at risk for chronic bone pain during your survivorship. Steroids can cause the bones to grow weaker. This can lead to osteoporosis, which may cause chronic bone pain.

Sometimes radiation therapy is used to treat cancer. Depending on where the radiation field is located, you may develop painful side effects. Most of these side effects are not long lasting and can usually be treated. Radiation therapy, however, can cause damage to bones, nerves and organs in your body that may lead to chronic pain.

When should survivors talk to their health care team about the pain they are experiencing?

Some examples of times you should talk to your health care team about your pain:

• If you experience a new pain
• If your current pain medication stops working
• If the pain changes or feels different to you
• If you develop painful swelling in the arm or leg
• If you feel pain, numbness, tingling or a burning sensation in your hands or feet

What are some pain management strategies that survivors can discuss with their health care team?

Even if you experience chronic pain, there are things your health care team can do to help reduce or eliminate how much pain you feel. Forming a strong partnership with your health care team may help you manage the pain.

Some examples of pain management strategies you may want to discuss with your health care team:

• For mild pain, a member of your health care team may prescribe a medication called nonsteroidal anti-inflammatory medications (NSAIDS). The most common types of this medication are aspirin and ibuprofen.
• For moderate pain, a member of your health care team may prescribe medication to go along with the NSAID. Two examples of this type of medication are Percocet or Vicodin.
• For severe pain a member of your health care team may use stronger pain medications like OxyContin (oxycodone) or long acting morphine.
• Your health care team may also use what are called adjuvant medications. These are medicines that have been proven to relieve pain even though that is not their primary purpose. An example is Elavil, which is primarily used as an antidepressant. Another example is Neurontin, an antiseizure medication, that can help nerve pain.
• If medication does not effectively control your pain, your health care team may suggest other methods for managing your pain. Your health care team may suggest a technique called a nerve block, where medication is injected into the spinal column to block the nerves so that you will not feel the pain.

Every survivor is different and every survivor may respond differently to pain management strategies. Open communication with your health care team can help you figure out together what strategies work best to manage your pain.

What are some suggestions for survivors who are trying to manage chronic pain?

• Use the Cancer Survivor’s Health Journal to prepare for your next visit with a member of your health care team.
• Talk to your health care team about any medication they prescribe for pain.
• Keep track of any medication you take for pain.
• Ask your health care team about complementary therapies.

This document was produced in collaboration with:
Peggy Flood, RN, MS, AOCN

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