Cancer-related pain is complex and involves inflammatory, neuropathic, ischemic, and compression mechanisms at multiple sites of the body. Some patients with cancer experience pain, and those whose disease has spread or recurred are more likely to have pain. The extent of the pain often depends on the type of cancer, its stage, and the patient’s individual pain threshold. This can result from a tumor pressing on the nearby bones, nerves, or organs; or it can be caused by cancer-related treatment or tests.
Pain can be acute (short-term) or chronic and persistent (long-term). Symptoms can include headaches, muscle strains, and other aches and pains. Types of pain can result from:
- Spinal cord compression: When a tumor spreads to the spine, it can press on the spinal cord. Signs of this include back and/or neck pain. Quick movements like coughing or sneezing can exacerbate the pain. This type of compression can lead to bowel and bladder dysfunction or paralysis. Treatment includes radiation therapy, steroids to shrink the tumor, or surgery to remove the portion of the tumor that is compressing the spine.
- Bone pain: This occurs when cancer spreads to the bones. Treatment includes external radiation to treat the weakened bone or radioactive medicine to make bones stronger. Bisphosphonates are other medicines that may be recommended to prevent the bones from breaking.
Pain can be assessed via a physical exam and patient-reported quality of life and pain-intensity questionnaires. Other testing like ultrasounds, magnetic resonance imaging (MRI), and computed tomography (CT) scans may be required.
Treatment can include medications like pain relievers, opioids, antidepressants, anti-seizure drugs, and steroids. A nerve block may also be recommended, which is a local anesthetic that is injected around or into a nerve to prevent pain messages from traveling along the nerve pathway. An intrathecal injection may also be used to administer medication into the fluid around the spine to relieve pain.