Pain & Neuropathy
Pain and neuropathy are common side effects of a cancer diagnosis and treatment.
Treatment for cancer — surgery, chemotherapy, radiation therapy, and targeted therapies — can cause pain and discomfort. For example, inflammation of the mucous membranes anywhere in the body caused by certain kinds of chemotherapy or by radiation can be very painful. Or, if a nerve is damaged during treatment, it may cause burning or shooting pain.
Tumors can also cause pain when they press on a nerve, invade bones, or press on a body organ. Because cancer can cause pain, the pain can be distressing, raising concerns about recurrence. That’s why relief for pain can include addressing your fears as well.
Pain can keep you from living your life as fully as possible. Yet studies show that pain among cancer survivors is not often reported, recognized, or treated well. You do not have to suffer in silence. In most cases, treatment can help. Admitting that you are in pain is not a sign of weakness.
If you begin experiencing new pain or severe pain, it is important that you tell your doctor immediately. Not all pain you experience will be directly related to your cancer or your treatment. Your doctor may ask questions about how often you have pain and how much the pain hurts. Using a Pain Rating Scale will help your doctor better understand the pain you have and provide an appropriate course of treatment.
How to Describe Pain
You are the expert in your cancer experience, so your healthcare team will look to you to provide information regarding your pain. By talking about pain, you begin the process of controlling it. Recording details in your planner can also be helpful.
Some of the important characteristics of your pain to discuss are:
- Severity: How bad is the pain? Health care providers typically ask people to rate their pain on a scale of 0 to 10, with 0 being “no pain” and 10 being “the worst pain you have ever had.”
- Location: Where is the pain? Is it in more than one place?
- Frequency and Duration: When do you have pain? Is the pain always there or does it come and go? How long does it last? When did the pain start? Have you ever had this pain before?
- Quality: Describe the pain. Is it burning or stabbing? Sharp or dull? Cramping?
- Change: What makes the pain better (medication, a heating pad) or worse (moving, coughing)?
- Onset: Was it all of the sudden or was it gradual?
Coping With Pain
- Do not ignore pain. Track your pain, using a scale of 0–10 to rate it, then report it back to your healthcare team.
- Pain can be managed with prescription or non-prescription drugs, surgery, or nerve blocks.
- Do NOT wait until the pain is out of control to take your medication. It is easier to stop pain before it starts or prevent it from getting worse.
- Tell your doctor or nurse if your pain is worsening, if you develop side effects from pain medication, or if you experience bowel or bladder problems.
- Write down how much medication you are taking and the times you take it.
- Tell your doctor and nurse about all of the prescriptions and over-the-counter medications you are using. This will help reduce the likelihood of a potentially dangerous drug interaction.
- For some people, complementary therapy for pain may be effective. Mind-body practices such as acupuncture, breathing exercises, meditation, hypnosis, Tai Chi, or yoga may provide relief from pain.
- Physical or occupational therapy, massage, and the use of hot or cold compresses can also help to relieve pain.
- If pain remains a problem, ask for a referral to a pain specialist.
With appropriate management, most pain can be controlled, so you can return to your everyday routine. There are many pain management options. Most people are treated with medications initially, or complementary therapy like massage or acupuncture. If you would like to use a complementary therapy, talk with your doctor and nurse to make sure there are no restrictions for you. For people with advanced cancers, other pain management options may include surgery or radiation therapy.
For mild pain, over-the-counter medicines may be all that is needed. For more severe pain, prescription pain medications might be required. Other medications like steroids, anti-seizure drugs, and anti-depressants can also be used to control specific kinds of pain.
If your pain is still not well-controlled, ask your oncologist to refer you to a pain specialist. This member of the healthcare team works specifically on managing your pain, using a variety of techniques that your oncologist may be less familiar with.
Many people with cancer find it helps to have 2 different pain medicines: one that is long-acting, ensuring that there is always some pain medicine in the body, and the other short-acting for when you need an extra boost. The right amount of pain medicine is the amount that controls most or all of the pain, most or all of the time. With regular communication with your healthcare team about your pain, your pain medication can be changed accordingly.
Non-opioid drugs do not contain opioids. These include acetaminophen (Tylenol), nonsteroidal anti-inflammatory (NSAIDS), and cyclooxygenase-2 (COX-2) inhibitors that have anti-inflammatory properties.
- Examples: Aspirin, Acetaminophen, Ibuprofen
- Uses: Mild pain, anti-inflammatory response
- Most are available over-the-counter
Opioids are drugs that are widely used for treatment of pain in patients with cancer because of their safety, reliability, and effectiveness in managing many types of pain. The role of opioid therapy in severe forms of acute pain and in cancer pain is well established.
- Examples: Morphine, Oxycodone, Fentanyl
- Uses: Moderate to severe pain
- Available by prescription
Talk to your doctor or nurse before starting or taking any new medication, prescribed or over-the-counter, as some medications should not be taken together or may not be right for you.
Side Effects From Pain Medications
Opioid pain medications can cause side effects, including sedation or drowsiness, nausea and constipation. For most people, these side effects eventually subside. Short-term nausea may be treated with anti-nausea medication, but is often managed by taking the pain medication with food. Constipation can become a serious issue, so your doctor may recommend stool softeners or laxatives and an increase in the amount of fiber you eat and fluids you drink.
Sometimes switching to a different pain medication can eliminate unwanted side effects. If you are experiencing side effects from pain medication, tell your doctor, as there are a number of different medications that can be used.
Neuropathy (Nerve Problems)
Nerve damage from treatment — also called neuropathy — can cause odd sensations such as tingling or numbness in your hands, arms, feet, or legs. This type of damage raises your risk for burns and falls. For example, if your sense of touch is impaired, you can scald your skin in the shower without realizing it, and if your legs are numb, you are more likely to stumble.
Nervous system side effects can be common and can be caused from the cancer itself and/or from cancer treatments. The nervous system is made up of the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS includes the brain and spinal cord and the PNS includes nerves outside of the CNS that transport information between the body and the brain.
Peripheral neuropathy is a set of symptoms caused by damage to nerves in the PNS. The most common sensation is numbness, tingling, and burning in the fingers and toes. People with peripheral neuropathy can also experience increased sensitivity to touch or pain in their hands and feet. Peripheral neuropathy can often be managed with short breaks from treatment or medications, or changing the dose of your treatment.
Coping With Neuropathy
- Tell your doctor or nurse if you have trouble feeling the ground when you walk, or find it difficult to perform activities like picking up a penny off the table or buttoning your shirt. Usually these symptoms gradually get better after your treatment is over, other times the symptoms persist even after treatment ends.
- Avoid alcohol. Even small amounts can increase nerve damage from chemotherapy.
- If you are diabetic, control your blood sugar. High blood sugars can also cause nerve damage.
- Take safety precautions such as:
- Wear gloves when washing dishes.
- Use handrails to help avoid falls.
- Wear supportive shoes.
- Check water temperature.
- Be sure to use gloves and potholders.
- Keep rooms, outside paths, and stairs well lit.
- Clear walkways and floors.
- Use non-skid mats in showers and bathtubs.
- Ask your doctor or nurse what actions make sense for you, at home and at work.