Dr. Neal Rakesh helps patients cope with pain both during and after cancer treatment.
Many people with cancer expect that their lives will go back to normal once their treatment has ended. That’s not always the case, unfortunately. There can be complex issues surrounding cancer survivorship, from the psychological impact of diagnosis and treatment — even when it results in a cure — to long-term physical side effects.
Cancer survivors can experience pain anywhere in the body. But no matter where it starts, all pain ultimately involves the nerves. “Our nerves are essentially information highways,” says pain management specialist Neal Rakesh, MD, of Memorial Sloan Kettering Cancer Center (MSK). “If something disrupts their signals, that can manifest as pain.”
That pain, whether short-term or chronic, can severely impact a person’s quality of life. “I often come across patients who are afraid to tell their doctors that they have pain,” Dr. Rakesh says. “They don’t want to appear ungrateful. Or they may believe that dealing with pain is their ‘new normal.’ ” But it’s important for patients to know that most pain can be managed.
Dr. Rakesh answers common questions about pain after cancer treatment and walks through the various kinds of pain relief that are available through MSK’s pain management program.
What causes pain after cancer treatment?
The way we experience pain is highly individual. Some of us are more prone to it than others. But every cancer treatment has the potential to cause side effects, and every patient can experience pain at one point or another during treatment. Even when pain is short term, Dr. Rakesh notes, pain-management interventions may be needed to help in the recovery process.
Pain From Cancer Surgery
Some patients experience long-term pain following surgery. Surgery often involves cutting into the muscle, which can disrupt the connections between the muscles and nerves.
When muscles heal, the resulting scar tissue can cause a sensation of tightness. Even for patients who have had minimally invasive surgery, the small incisions where the instruments are inserted (called ports) can be painful.
Pain From Other Cancer Treatments
- Chemotherapy drugs can damage nerves and lead to peripheral neuropathy — pain, tingling, and numbness, especially in the hands and feet.
- Radiation therapy can damage nerves or skin and lead to pain.
- Immunotherapy can cause a condition similar to rheumatoid arthritis, which results in pain and swelling in the joints, as well as peripheral neuropathy.
MSK offers effective treatments and tools for coping with all forms of post-treatment pain through its pain management program.
What are the options for relieving pain after cancer treatment?
Cancer pain is treated with a combination of approaches.
- Pain caused by tight muscles may be relieved with physical therapy and doing regular stretching exercises at home. Acupuncture, heat, and therapeutic massage may also help some patients.
- Doctors in MSK’s Integrative Medicine Service may prescribe medical marijuana.
- Skin-based pain, such as tightness around scars, and even some muscle-based pain can be treated with creams and ointments that contain numbing agents and anti-inflammatories.
- Deeper muscle pain can be treated with muscle relaxant pills.
- Nerve-based pain can be treated with neuropathic medications like gabapentin, a drug that is also taken in pill form.
- Injections, which usually contain a combination of an anesthetic medication, such as lidocaine, and a steroid, can provide long-lasting relief for many people. “Most of my patients can go several months between treatments,” says Dr. Rakesh. “We use imaging to guide the placement of these injections and ensure they are providing the most benefit.”
- For those with severe pain that is not alleviated by any other methods, implanted nerve stimulators or pain pumps can provide relief.
What are the options for patients with post-mastectomy pain?
“Pain after having a mastectomy is common, and something that a lot of my patients experience,” says Dr. Rakesh. “They often describe a sensation of being squeezed around the chest, a feeling that may be described as an ‘iron corset’ or an ‘iron bra.’ ”
Post-mastectomy pain is caused primarily by the cuts made to the muscles in the chest, though many patients also experience pain in the armpits, when lymph nodes are removed.
Patients who have had surgery for lung cancer may have similar pain, which often occurs in the chest but can also be felt in the sides and the back. Sometimes this pain can affect the way a person breathes.
For patients experiencing this type of pain, a combination of the approaches mentioned above, especially physical therapy, medications, and injections, can be very effective.
Will I have to take opioids to treat my cancer pain?
Some people with cancer experience severe pain during and after treatment. “This is what opioids are there for,” Dr. Rakesh says. “They can help make you more comfortable and functional, even if they don’t completely eliminate the pain.”
Many patients have concerns about becoming dependent on (or addicted to) these drugs, and Dr. Rakesh counsels them on how to prevent dependency.
“Some patients stay on these drugs and take them preemptively, before the pain even starts, because they are afraid of getting behind the pain,” Dr. Rakesh says. “But if they do that, they will never know if the pain is resolved or even exists. One of my main goals is to work with patients who are taking these drugs to progressively decrease their doses.”
Implanted pumps, which deliver opioids directly to the area where the pain originates in the spine, are another option for patients with severe long-term cancer-based pain and can help prevent some of the side effects of taking these drugs systemically.
Is pain something that cancer survivors have to accept as normal?
“Pain is important from an evolutionary standpoint,” Dr. Rakesh explains. “It’s your body’s way of telling you that something is wrong. I tell my patients that even though pain may be unavoidable for some, the suffering does not have be inevitable.”
Everyone will experience pain at some point in their lives, whether it’s from a major cancer surgery or the normal muscle and joint pains that come with aging.
What’s important is to know is that there are many ways to help alleviate pain. If you are an MSK patient or cancer survivor who is experiencing pain, you can talk to your doctor about getting a referral to a pain management specialist.
