Pain

Pain is not a popular topic. If you are not experiencing it, you naturally would prefer not to think much about it. If you are living with acute or chronic pain, much of your energy is going to just coping. I wrote last week about the concerns around opioid use for cancer patients and survivors. That is part of the problem, but not all of it. Pain is different in every situation and for every person. For cancer patients, pain is most often related to surgical recovery or radiation or the cancer itself.

Last week, I met with several people who are dealing with pain. One woman had a mastectomy and reconstruction that has left her, several years later, with chronic pain. It is usually a dull ache, but sometimes worse. I met with another woman who has metastatic cancer to her bones and had just started a course of radiation therapy to those areas. With any luck, the radiation will be successful, and she will quickly feel much better. I have known many people who could barely walk due to bone pain and, after radiation, felt pretty well and able to move normally. I met with a third woman who had major abdominal surgery for her cancer, and continues to deal with abdominal pain. She especially worries as a similar pain was the first symptom of her cancer, so every twinge is concerning.

Cancer-related pain is treated with drugs, acupuncture, and sometimes other CAM therapies.

This article from the British Journal of Anesthesia tackles these issues. I am giving you the abstract. I am unable include a link to the article, but would be happy to share it if you email me: hhill@bidmc.harvard.edu.

Pain in cancer survivors; filling in the gaps 
M. Brown and P. Farquhar-Smith

Cancer survivorship represents a growing clinical challenge for pain clinicians. The population of cancer survivors is rapidly expanding and many of these patients experience pain as a sequelae of their disease and its treatment. The features, pathophysiology and natural history of some painful conditions observed in cancer survivors, such as direct tumour effects, cancer induced bone pain (CIBP) or chronic post-surgical pain have received extensive exposure elsewhere in the literature. 
In this narrative review, we attempt to ‘fill in the gaps’ in the knowledge, by providing a succinct outline of a range of less well known pain states encountered in the cancer survivor population. These include neuropathies as a result of graft versus host disease (GVHD), novel hemotherapeutic agents and monoclonal antibodies (mAb), and radiation induced pain states. The increasing prevalence of visceral post-surgical pain and aromatase inhibitor-induced arthralgia (AIA) is also detailed. Additionally an overview of suggested approaches to the assessment of pain in cancer survivors is provided and potential treatment strategies, with a focus on novel approaches are discussed.