Managing Chronic Pain After Cancer

Treating chronic pain requires flexibility, persistence.

Harriet Canfield ruefully calls breast cancer “the gift that keeps on giving.” That “gift” for Canfield: chronic pain. 

She experiences pain from lymphedema, which sometimes radiates from her right chest all the way to her fingers. She has back pain from breast reconstructive surgery, which involved a muscle from her upper back. And she feels a deep bone ache from the hormone therapy that keeps her estrogen-positive cancer at bay.

“I’m fortunate, really,” Canfield says. “There are a lot of soldiers who have experienced things worse than I have.” Although she received excellent care for her cancer and surgeries, she says, she’s often had to do her own research and seek out other experts to get help for her chronic pain. 

Many cancer patients and survivors experience pain as a result of their treatment or because their cancer has metastasized. It may be persistent, intermittent or breakthrough pain, and often subsides when treatment ends. But about one-third of cancer survivors continue dealing with pain long after their treatments have ended. For them, chronic pain can be a daily struggle. Chronic pain may be mild, moderate or severe, and can last several months to many years.

This kind of “pain assessment” is the essential first step in controlling pain, and it’s often the hardest, Baker says. Assessment often starts formally, with doctors asking patients to rate pain on a scale of 0-10 and report whether it is intermittent or constant. Care providers will also ask about the nature of pain (is it sharp, burning, etc.), possible triggers, and the times of day when pain occurs. Some may ask patients to keep a pain journal to help identify nonobvious patterns. 

“Pain assessment is hard because it’s all about communication,” says Michael Fisch, MD, chairman of the department of general oncology at M.D. Anderson Cancer Center in Houston and a researcher in the field of pain management. “And communication between patients and doctors about pain isn’t easy and hasn’t gotten easier in 20 years. In some ways, it’s more challenging because there’s more to talk about in less time,” Fisch says, referring to studies that show visits for cancer patients last, on average, 22.9 minutes.

In 2010, the National Comprehensive Cancer Network (NCCN) published an update of its clinical practice guidelines for adult cancer pain. The guidelines detail the multiple medicines in every category, outline dosing and discuss types of delivery—tablet, patch and intravenous, for example. The guidelines also discuss emotional and spiritual pain, depression and use of other pain medications, including seizure medications, such as gabapentin, now used for serious nerve pain, referred to as neuropathic pain. 

Effective pain management involves knowledge, skill and, sometimes, a willingness to try new things, Baker says. “We are now using things for pain that are used for treating other disorders,” she says. “We use anticonvulsants for neuropathic pain; and for bone pain, we find that bisphosphonates, sometimes used for bone mineral loss or bone metasteses, can help. Antidepressants can help with neuropathic pain.” 

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