Cancer survival can mean a new lease on life. But it can also mean chronic pain that in some cases is so severe, it prevents survivors from enjoying the life they fought so hard to preserve.
Fortunately, there are ways cancer survivors can find relief, says Esmé Finlay, MD, a University of New Mexico Cancer Center physician. She was among the authors of an article published this month in the Journal of Clinical Oncology titled "Pain in Cancer Survivors."
“There are lots of ways to treat post-cancer pain,” Finlay said in a recent interview. “The intent of this paper is to educate all the different types of providers who are seeing patients after their cancer is cured.”
Finlay hopes that raising awareness about chronic pain in cancer survivors will guide more people to seek help. She also hopes that greater awareness will spur oncologists, survivorship teams and primary care physicians to better integrate their care for cancer survivors who need different kinds of help to manage pain.
“We need to help cancer survivors be functional, active participants in their lives post-treatment,” Finlay said.
Cancer survivors can have pain from surgery, especially if their surgeon had to cut nerves to remove their tumor. For example, women who undergo a lumpectomy or mastectomy may feel a shooting or burning pain in their chest wall. Many head or neck cancer patients, too, may have pain after surgeries to remove lymph nodes. The pain may persist even years after surgery.
And chemotherapy drugs may also be a source of chronic pain.“Some chemotherapies are toxic to our nerves,” Finlay said. “Over time we get cumulative damage to the nerves in our fingers and toes. People can have chronic burning, numbness or discomfort.”
Aside from nerve damage, she adds, cancer survivors may also have lymphedema, painful swelling that results when fluid builds up in tissues where it shouldn’t. Lymph drainage changes when the surgeon removes lymph nodes along with the tumor; lymph nodes may not drain like they used to. And cancer survivors might also have pain or trouble moving parts of the body that were cut to remove a tumor.
Finlay’s Journal of Clinical Oncology paper describes many of the methods she uses in her practice at the UNM Cancer Center to combat chronic pain following cancer treatments.
“I often need to use very strong pain medicines to get people through their treatment,” Finlay said. “Sometimes that means (using) opioid pain medicines. But we don’t want people to be on strong opioids for a long time if they don’t need them.” Opioid drugs like morphine or oxycodone can be addictive and have side effects and risks with long-term use. “Chronic pain specialists really try to use non-opioid strategies, whether it’s medicine or physical or psychological interventions, like acupuncture, physical therapy, or cognitive behavioral therapy, to manage pain.”
Finlay uses a non-addictive group of medicines that ease nerve pain, and she also prescribes physical therapy to ease pain and lymphedema after surgery and radiation treatment. She and her UNM Cancer Center colleagues refer patients to a physical therapist who specializes in helping cancer survivors and in lymphedema therapy. Finlay also refers some patients to the UNM Center for Life – a clinic specializing in integrative therapies, like massage and acupuncture.
Like many oncologists, Finlay follows her patients for at least five years after cancer treatment. For most patients, she says, pain subsides within the first two years. For some, though, the pain persists and can be very severe.
“With chronic pain and symptoms, it’s important that people transition to a primary care doctor who understands those pain issues,” she said, adding that if their pain is really complex, patients should visit a multidisciplinary pain clinic like the UNM Pain Center.
“Pain makes people less functional,” Finlay said. “I think the key thing people need to know is to ask for help if they have chronic pain after cancer. They need to know that there are lots of different ways to address pain. Just because the cancer is gone doesn’t mean you’re going to be 100 percent the way you were before you were treated.”