Cancer Pain
Cancer Pain: Causes, Types, and Management
Cancer pain is a common and often disabling symptom experienced by people with cancer, affecting both those undergoing active treatment and survivors. Its causes are diverse and its management requires a tailored, multidisciplinary approach.
Causes of Cancer Pain
- Tumor-Related: Most cancer pain is caused by the tumor pressing on bones, nerves, or other organs. Tumor growth can lead to inflammation, ischemia, and compression of tissues126.
- Treatment-Related: Surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, and hormone therapy can all cause pain. For example, chemotherapy may lead to peripheral neuropathy, radiotherapy can cause skin or organ irritation, and some immunotherapies can cause joint pain125.
- Diagnostic and Supportive Care Procedures: Some tests and supportive treatments may also result in pain1.
- Comorbidities: Not all pain in cancer patients is directly related to cancer; general aches and pains or other chronic conditions may also contribute2.
Types of Cancer Pain
- Acute Pain: Usually short-term, caused by injury or procedures (e.g., surgery), and resolves as healing occurs12.
- Chronic (Persistent) Pain: Lasts longer than normal healing, often due to nerve changes from tumor pressure or treatment. This pain can be constant and range from mild to severe125.
- Breakthrough Pain: Sudden, intense pain that “breaks through” regular pain control, often triggered by movement or procedures1.
- Incidental Pain: Brought on by specific activities, such as changing position or dressing changes2.
- Neuropathic Pain: Caused by nerve damage from the tumor or its treatment. It is present in 20–40% of cancer patients and may be under-treated56.
Impact and Prevalence
- Pain is reported in up to 59% of patients receiving anticancer treatment and in 33% of those after curative treatment1.
- Chronic pain is common even among cancer survivors, with about 47% reporting some chronic pain and 28% experiencing moderate to severe pain5.
- Poorly controlled pain is linked to lower quality of life, psychological distress, and may even affect survival5.
Management Principles
- Assessment: Comprehensive pain assessment is essential, including pain type, intensity, impact on function, and quality of life36.
- Medications: The foundation of cancer pain management is regular medication, including non-opioid analgesics (paracetamol, NSAIDs) and opioid drugs. Adjuvant medications (e.g., antidepressants, anticonvulsants) are used for neuropathic pain345.
- Combination Therapy: Medications are often combined for maximum benefit and to minimize side effects4.
- Non-Pharmacological Approaches: Techniques such as relaxation therapies, massage, acupuncture, and psychological support can help4.
- Interventional Treatments: Radiotherapy, surgery, or nerve blocks may relieve pain by reducing tumor size or blocking pain pathways4.
- Regular Reassessment: Ongoing evaluation and adjustment of pain management strategies are crucial for optimal control36.
Summary Table
| Aspect | Details |
|---|---|
| Main Causes | Tumor pressure, treatments (surgery, chemo, radiation), procedures, comorbidities |
| Types | Acute, chronic, breakthrough, incidental, neuropathic |
| Prevalence | 59% (on treatment), 33% (post-treatment), 47% (survivors with chronic pain) |
| Management | Medications (non-opioid, opioid, adjuvant), non-drug therapies, interventional, reassessment |
| Impact | Affects quality of life, function, and psychological health |
References:1 National Cancer Institute (NCI)2 Cancer Research UK3 NCCN Clinical Practice Guidelines4 Better Health Channel5 PMC10378332: Cancer Pain Management Review6 CDC
Cancer pain is complex and multifactorial, but with comprehensive assessment and individualized treatment-including both medication and supportive therapies-most people can achieve significant relief and improved quality of life.
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