Chronic Pain After Cancer Treatment

Pain that outlasts treatment is common, and it is often treated as though it were nothing. The National Cancer Institute defines chronic pain, also called persistent pain, as pain that usually lasts more than three months. MedlinePlus adds another marker: longer than the time in which you should have healed.

Once you are past the healing window, the pain is no longer a signal that something is mending. It is a problem in its own right, and it needs its own plan.

Most chronic pain after cancer is not an emergency. Some is. Go to the emergency department, or call 911, if you have:

• Back pain that is severe and not relieved by pain medicine, and that gets worse when lying down or when you cough or sneeze.
• New muscle weakness in the legs, falls, or difficulty walking that is getting worse.
• Loss of feeling, especially in the legs.
• Loss of bowel control, or bladder leakage.

These can mean pressure on the spinal cord. The faster the symptoms come on, the sooner treatment is needed to prevent permanent injury.

Call your team the same day if a swollen limb becomes red, hot, or painful, or if you have a fever with swelling. That can be cellulitis, a bacterial skin infection, which is more likely in a limb with lymphedema.

If chemotherapy is still part of your treatment, a fever is handled differently. The CDC treats it as a medical emergency, so call your oncology team immediately at any hour rather than waiting out the day, and go to an emergency department if you cannot reach anyone.

Surgery. Cutting through tissue can injure nerves. Pain can persist in the chest wall, armpit, or arm after breast surgery, and along the ribs after chest surgery.

Chemotherapy nerve damage. Some chemotherapy drugs injure the small nerves in the hands and feet. The National Cancer Institute describes tingling, numbness, or a pins-and-needles feeling in the feet and hands, and an inability to feel pain, such as from a cut or sore on the foot.

Radiation. Radiation causes scar tissue. Scarred tissue is stiffer and less mobile, and it can pull on nerves and joints.

Lymphedema. When surgery or radiation blocks the flow of lymph fluid, fluid builds up. The early signs are a heavy, full, or tight feeling in the area where you had surgery or radiation. Aching, tingling, pain, or numbness can occur too.

Hormone therapy. Aromatase inhibitors cause musculoskeletal symptoms, osteoporotic fractures, arthralgias (joint pain), and myalgias (muscle pain). This is one of the most common reasons people stop taking them, so tell the team rather than stopping.

The cancer itself. A tumor pressing on nerves or other structures causes pain. This must be ruled out before pain is called a late effect.

Clinicians sort pain three ways, and the labels matter.

Somatic pain comes from skin, muscle, and bone. It is usually well localized: you can point at it.

Visceral pain comes from internal organs. It is deeper, harder to place, and often described as pressure or cramping.

Neuropathic pain comes from injured nerves. It burns, shoots, tingles, or feels electric. It often appears in a glove-and-stocking pattern in the hands and feet after chemotherapy.

Neuropathic pain often responds poorly to ordinary painkillers. It usually needs medicines that act on nerve signaling instead. If your pain is burning or electric and acetaminophen does nothing, that is information, not failure.

Tell the team the location, quality, frequency, duration, and intensity of the pain. Intensity is rated 1 to 10, where 10 is the most pain and 1 the least.

Keep a record. Write down your pain levels and the medicine you took, in a notebook, a chart, or a pain app. A pattern across two weeks is far more useful than a single number in a clinic room.

Say what the pain stops you doing. Pain that prevents sleep, walking, or work is a different clinical problem from pain that does not, even at the same score.

Medicines. Options range from over-the-counter pain relievers to prescription medicines, including antidepressants and muscle relaxants. Opioids, also called narcotics, are used for moderate to severe cancer pain.

The World Health Organization three-step pain relief ladder is the framework many teams use. It sorts pain by severity and matches the strength of the medicine to it.

Antidepressants here are not prescribed because anyone thinks the pain is imaginary. Certain ones change how nerve pain signals travel. Ask the prescriber to explain the reason, and expect a clear answer.

Physical approaches. Physical therapy is a core treatment, not an optional extra. For lymphedema specifically, treatment includes compression garments, manual lymphatic drainage massage, and complete decongestive therapy given by a certified lymphedema therapist. Exercise acts as a natural pump for the lymph system.

Integrative approaches. The National Cancer Institute lists acupuncture, biofeedback, guided imagery, hypnosis, meditation, and distraction. For neuropathy, acupuncture, massage, physical therapy, and yoga may be advised to lower pain.

Mental health support. Depression and stress can intensify chronic pain, and pain can affect mood, sleep, and relationships. Treating one without the other rarely works.

Numb feet cause injuries in two ways. You cannot feel damage, and you cannot feel the floor.

• Weak or aching muscles may cause you to lose your balance and trip easily. Clear rugs and cables, and use good lighting on stairs.
• Take extra care in the kitchen and shower. You may not feel a burn.
• Check your feet daily for cuts and sores, because you may not feel them.
• Ask about a physical therapy assessment for balance and gait.

The National Cancer Institute advises telling your health care team about:

• New pain.
• Pain that is not relieved enough by your current treatment.
• Side effects from pain medicine.
• How the pain affects your daily activities and your mental health.

Add two more. Say if you are cutting doses to make a prescription last, and say if you are afraid of becoming dependent. Both are common, both change what should be prescribed, and neither is held against you.

Treatment may not get rid of chronic pain, but it can help with your symptoms.

A plan aimed at zero pain often fails, and leaves people feeling they have failed too. A plan aimed at sleeping through the night, walking to the shop, or holding a grandchild is usually achievable, and it gives everyone a way to tell whether the treatment is working.

• Is this pain from the cancer, from the treatment, or from something unrelated? What was done to check?
• Is my pain somatic, visceral, or neuropathic, and how does that change the medicine?
• Should I be referred to a pain specialist, a palliative care team, or a lymphedema therapist?
• What is the goal we are aiming for, and how will we know if it is working?
• If this medicine does not help within a set time, what is next?

Palliative care is specialist symptom management, and it can be given alongside treatment aimed at cure. It is not only for end-of-life care, and asking for it does not change your treatment plan.

• Cancer Pain — NCI
• Cancer Pain (PDQ), health professional version — NCI
• Nerve Problems (Peripheral Neuropathy) — NCI
• Lymphedema — NCI
• Chronic Pain — MedlinePlus
• Spinal Tumor — MedlinePlus