Managing Cancer-Related Joint Pain

CURE, Winter 2011, Volume 10, Issue 4

For many cancer patients, joint pain subsides when treatment ends.

Thanks to effective advertising, many people assume that joint pain is caused by arthritis, but it can also occur as a result of cancer treatment and, although not life-threatening, can cause serious distress.

Like arthritis, this type of joint pain is felt primarily in the hands, knees, hips, spine, shoulders and feet and is most evident after several hours of inactivity.

Treatment-related joint pain can usually be distinguished from the pain that accompanies a recurrence or spread of cancer because it is a generalized pain felt in multiple places, whereas cancer pain is usually site-specific.

The cause of treatment-related joint pain isn’t precisely known, but patients are at risk for it if they have undergone the following therapies:

Chemotherapy: Pain is a common side effect of chemotherapy, and joint pain is no exception. Although it can occur anytime during treatment, it often appears afterward and is usually resolved in weeks to months. In one study of breast cancer patients, 35 percent reported joint pain, with most saying it occurred between eight and 16 weeks post-treatment.

Hormone therapy: The growing use of aromatase inhibitors (AIs) in breast cancer treatment for postmenopausal women has led to an increased incidence of joint pain, mostly in the hands and feet, but it can also affect the knees, hips and other joints. When 200 of these patients were surveyed, 47 percent reported joint pain, and of those, 67 percent ranked it as moderate to severe. This pain is believed to affect compliance.

Radiation therapy: Radiation can cause scar tissue, nerve damage and weakness and spur pre-existing chronic pain syndromes, such as rheumatoid arthritis and fibromyalgia. For these patients, the problem is compounded because of the need for them to curtail the immunosuppressive drugs they may be taking during cancer treatment.

Although treatment-related joint pain can feel like arthritis, there are some very important differences. First, while arthritis can permanently damage the joints, treatment-related joint pain, even when severe, does not. Second, the pain will eventually subside after treatment ends.

Standard pain treatments that work in people with arthritis may or may not help. These include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), glucosamine and chondroitin, omega 3-fatty acids, probiotics, heat, transcutaneous electrical nerve stimulation, physiotherapy, massage and hypnosis.

One study of patients with post-treatment chemotherapy joint pain found that in those with evidence of inflammation, using NSAIDs and disease-modifying antirheumatic drugs (DMARDs) and low-dose oral corticosteroids helped. Another pilot study suggested that the drug Cymbalta (duloxetine) can help relieve AI-induced joint pain.

Regarding joint pain from AIs, separate studies reported patients found relief from acupuncture, weekly high doses of vitamin D (taken by women who were deficient for it) and, for women in a breast cancer study, taking 80 milligrams/day of testosterone for three months. This remains an area of active investigation.

Managing one’s weight and getting plenty of exercise may help avoid the pain that inactivity can bring.

Researchers are exploring how genetics may help identify which patients are most likely to experience joint pain as a result of certain cancer treatments so that treatment plans can be tailored to the individuals and more effective drug interventions can be developed.