Pain is a common experience in cancer. As many as 50 percent of patients undergoing treatment experience some type of pain, increasing to 70 to 90 percent of those with advanced disease. The pain may be caused by the cancer itself or be a side effect of treatment, and often doesn’t resolve even after treatment has ended.
The type and severity of pain vary significantly by cancer location and stage, as well as by treatment. But, it can include pain from tumors pressing on organs, tissue, and bone; from tumor invasion of bone or organs increasing pressure from within; from nerve damage caused by tumors themselves; or as a direct result of surgery, neurotoxic chemotherapy, or radiation. Surgery can be a direct cause of pain, both at the incision site and due to nerve injury. And surgical complications, such as infection or the development of thick scar tissue, also can contribute to discomfort. So can the swelling and lymphedema that sometimes result from surgery.
Radiation can cause swelling, tenderness, and skin burns, all of which hurt. Chemo and immunotherapy can cause a variety of ailments, including damage to mucus membranes (typically experienced as mouth sores), gastrointestinal distress, general muscle and bone achiness, and headache. And let’s not forget the frequent needle sticks and injections and even lumbar punctures for monitoring the disease and administering treatment. When all goes well, they last but a moment, but it’s not unusual, particularly after repeated treatments, for the care team to struggle to find a vein or to place a venous catheter, resulting in chemo drugs leaking into sensitive tissue.
Many patients experience multiple types of pain in one or more locations. For instance, a tumor on an ovary may put pressure on the spine and be felt as a dull backache. One pressing on the intestine may cause severe stomach cramps. At the same time, the chemo cocktail used to treat ovarian (and many other types of) cancer may induce peripheral neuropathy, which is experienced as a numbness and tingling or even burning pain in the hands and feet.
In addition to the physical sensations caused by the presence of a tumor, its growth can change the chemical balance in tissue surrounding the tumor, increasing the release of histamines, cytokines, prostaglandins, and other mediators of pain. This turns up the body’s sensitivity to the physical presence of the tumor, and increases pain. It also contributes to fatigue, another multiplier of pain.
Dealing with this pain becomes part of the cancer ordeal, heightening the anxiety about treatment and adding to the trauma of the experience. With each recurrence or new diagnosis, patients anticipate the recurrence of pain, initiating a stress reaction that further heightens their sensitivity to pain. This pain and the anxiety it causes have a significant impact on patients, compromising quality of life while undergoing treatment and thereafter. Unfortunately, it also can interfere with the completion of treatment. Women stop taking their aromatase inhibitors due to bone pain, despite recommendations to continue for five or even ten years. Patients discontinue immunotherapy regimens when their mouth sores interfere with their ability to eat.
Less Pain, More Living
In most cases, patients can achieve substantial relief from pain if they voice their concerns. Doses can be adjusted. Pain medication and complementary therapies can be added to the regimen, and treatment plans can be changed. But not all doctors seem receptive to hearing about pain. And patients often feel that they should just “suck it up” and suffer through it. Forty percent of patients being treated in community-based hospitals don’t feel they receive the desired advice and help for their pain. While many large hospitals and cancer centers have supportive-care practices that include pain management, particularly for inpatient care, outpatient supportive care is less common, and smaller hospitals may not provide this service at all.
Reducing your physical pain can improve your quality of life and help you cope with your disease and treatment. Talk to your doctor about your pain and other symp- toms. Your oncologist may be able to address your needs directly or refer you to supportive-care colleagues on her team. If not, patients in most communities can access pain-management and supportive-care services through external providers. (The Center to Advance Palliative Care— getpallativecare.org—has a provider directory organized by zip code. Note: palliative care does not mean hospice care. It means making it better. To palliate is to alleviate or ease, and does not mean giving up on treatment, a common misperception.)
And check with your insurance plan regard- ing coverage. Most insurance plans, including Medicare and Medicaid, will pay for management of pain and other symp- toms, although Medicaid varies by state. Your hospital social worker or financial counselor may also be able to help you access symptom-management care if funding is an issue.
(Excerpt from TheBig Ordeal: Understanding and Managing The Psychological Turmoil of Cancer.)