I feel your pain: chronic pain in cancer survivors
Many issues can affect the life of cancer survivors after treatment. Unfortunately, they can be physically, mentally or even financially haunted by cancer treatment and its side effects. One particular side effect that is seldom acknowledged in mainstream media is chronic pain. How many cancer survivors have chronic pain after cancer treatment? What types of pain? And beyond the physical pain, what are its other effects?
A recent study suggests that up to one third of cancer survivors have chronic pain (defined as daily pain lasting more than 3 months).1 Pain in cancer survivors can be attributed to residual damage from the cancer, but is most often related to the treatment received. Pain is typically categorized into three categories: neuropathic pain, somatic pain, and visceral pain. Neuropathic pain concerns painful sensations due to abnormal nerves; feeling of “pins and needles”, numbness, tingling are frequent descriptions associated with this type of pain . Somatic pain is the type of dull aching pain that a person can easily pinpoint and typically refers to pain in muscle, bones or joints. Visceral pain is similar to somatic pain except it involves internal organs like the liver or kidneys, these painful sensations often feel more vague and are harder to localize.
Depending on the treatment they received, cancer survivors may face different types of treatment-related chronic pain. Surgery-related pain includes phenomena such as phantom limb pain, a type of neurological pain, in which pain is felt in the breast that was removed. For patients who were treated with chemotherapy, they may be affected by chemotherapy-induced peripheral neuropathy. This can occur after treatment with older intravenous chemotherapy treatments and includes symptoms such as tingling or numbness in the arms, hands, and legs.
Some factors that increase odds of chronic pain in cancer survivors include age, cancer type and invasiveness, and the type of cancer treatment.2 In some studies of breast cancer survivors, younger women were more likely to have chronic pain, this might be explained by the fact that younger women tend to have more aggressive cancers and receive more treatments as a result.3, 4 Regarding treatment, breast cancer survivors who received mastectomy were more likely to have some chronic pain compared to those who received breast-conversing surgery.4 Another recent study found that some socio-demographic factors are related with access to proper chronic cancer pain management, with minorities being more likely to encounter barriers to receiving proper management for their pain.5
Evidently, ineffective pain control can lead to worse quality-of-life, as it can disturb sleep, cause fatigue and diminish ability to carry out normal daily activities. One study found that survivors with chronic neuropathic pain were twice as likely to be unemployed five years after treatment compared to survivors with no experience of such pain.6 Depression and anxiety problems are especially common in cancer survivors who have chronic cancer pain.7
Suffice to say, chronic pain in cancer survivors has emerged as one the major issues of cancer management that cancer doctors face. Its importance is highlighted by that there are now several guidelines for clinicians to refer to, ranging from Cancer Care Ontario to the American Society of Clinical Oncology.8, 9 Nowhere in Quebec is this more evident than at the McGill University Health Centre (MUHC) Cancer Pain Clinic, where its interdisciplinary approach has made it recognized at the international level. Doctors from around the world come to train at the clinic to learn from their unique approach.10
One must not forget, however, that pain is normal. Everyone feels pain sometimes, even frequently! The challenge for cancer survivors is that pain may drum up anxiety. Specifically, anxiety due to fear that their cancer has returned, also known as the fear of recurrence, an issue we’ll explore in a future blog.
1. Bouhassira D, Luporsi E, Krakowski I. Prevalence and incidence of chronic pain with or without neuropathic characteristics in patients with cancer. Pain. 2017;158: 1118-1125.
2. Glare PA, Davies PS, Finlay E, et al. Pain in cancer survivors. J Clin Oncol. 2014;32: 1739-1747.
3. Poleshuck EL, Katz J, Andrus CH, et al. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain. 2006;7: 626-634.
4. Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat. 2018;167: 157-169.
5. Stein KD, Alcaraz KI, Kamson C, Fallon EA, Smith TG. Sociodemographic inequalities in barriers to cancer pain management: a report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II). Psychooncology. 2016;25: 1212-1221.
6. Bouhnik AD, Bendiane MK, Cortaredona S, et al. The labour market, psychosocial outcomes and health conditions in cancer survivors: protocol for a nationwide longitudinal survey 2 and 5 years after cancer diagnosis (the VICAN survey). BMJ Open. 2015;5: e005971.
7. Brown LF, Kroenke K, Theobald DE, Wu J, Tu W. The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psychooncology. 2010;19: 734-741.
8. M S, GG F, J R, J W-W, T R. Guidelines on management of pain in cancer and/or palliative care. Program in Evidence-Based Care Evidence Summary. Toronto, ON, 2017.
9. Paice JA, Portenoy R, Lacchetti C, et al. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34: 3325-3345.
10. Cancer pain, the neglected symptom. Available from URL: https://muhc.ca/our-stories/article/cancer-pain-neglected-symptom [accessed 2018-05-30.