Types of Pain in Cancer Survivors

Ongoing pain following the completion of cancer treatments is an issue for many cancer survivors. Types of cancer-related pain that continue or develop after treatment is completed include, but are not limited to, peripheral neuropathy, pain after radiation, lymphedema, persistent post-surgical pain, and myofascial pain.

• Peripheral neuropathy
  Peripheral neuropathy is a medical condition that involves damage to the peripheral nerves. The peripheral nervous system is the communication network that connects the central nervous system (the brain and spinal cord) to every other part of the body. It carries sensations, controls movement, and regulates involuntary bodily functions.
  
  Symptoms of peripheral neuropathy include pain in the hands, feet, or other affected parts of the body. The pain is often described as burning, stabbing or throbbing. If a tumor compresses or damages a nerve, pain can continue even after the tumor is eradicated. Peripheral neuropathy can be caused from the cancer itself or from cancer treatments. When peripheral neuropathy develops as a result of radiation treatment, it is known as radiation-induced peripheral neuropathy; when it develops as a result of chemotherapy, it is known as chemotherapy-induced peripheral neuropathy (CIPN).
• Pain after radiation
  The goal of radiation is to destroy cancer cells. However, healthy cells can be damaged as well; this is known as radiation-induced bystander effects (RIBE). RIBE can lead to pain and other symptoms.
  
  Two of the most common types of pain after radiation treatment are chronic abdominal pain and brachial plexus neuropathy (BPN). Chronic abdominal pain can develop after radiation treatment of the abdomen. BPN, which causes pain in the shoulders or arms, can develop after radiation treatment of the chest, throat or neck. Pain from radiation may develop up to 90 days after treatments are completed and may last for months or years.
• Lymphedema
  When lymph nodes are removed or damaged during surgery or radiation, the lymphatic system, which maintains fluid balance in the body, can be damaged. This can lead to lymphedema, a condition that develops when the lymphatic system is unable to adequately drain fluid. Because it is not being properly drained, the fluid accumulates in the surrounding soft tissues, causing swelling, a feeling of heaviness, and aching pain near the treatment site. Lymphedema can also lead to painful skin ulcers or infections. It can occur days, weeks, months, or even years after treatment. It is particularly common in breast cancer survivors.
• Persistent post-surgical pain
  Persistent post-surgical pain (PPSP) is pain that occurs for more than two to three months after surgery. It is caused by tissue damage that occurs during surgery. PPSP is more common after certain types of surgery, such as breast surgery and limb amputation. It is also more likely if surgery lasts longer than three hours, if a surgical drain is used, and if an extensive area of tissue is disrupted.
• Myofascial pain
  Myofascial pain, or muscle pain, can also continue or develop after cancer treatment. Some cancer survivors may develop myofascial pain syndrome, in which sensitive areas in the muscles — known as trigger points — cause pain. The pain can be felt in the muscles, or it can be referred to other parts of the body.
  
  Myofascial pain syndrome is particularly common after breast cancer surgery. Myofascial pain can also occur as a result of changes to the endocrine system due to medications, such as steroids, used during cancer treatment.

Working with a health care professional to determine the type or cause of pain can help cancer survivors receive appropriate treatment to reduce their pain as much as possible.