Managing chronic pain in cancer survivors

Dr Michelle King gives beneficial advice on how to avoid chronic pain once diagnosed with cancer.

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Pain in cancer survivors can result in disability and is associated with depression, anxiety and sleep disturbances.¹ Chronic pain occurs in 45% of survivors and in 50-85% of people with advanced cancer.^1,2 The main causes of chronic pain are from the treatments that you receive, such as radiation, chemotherapy, and surgery. These treatments can cause many different pain syndromes.²

How to prevent chronic pain

• You may be so focussed on surviving cancer that the possible long-term side effects of treatment or disfigurement are brushed aside.² Survival without suffering and a good quality of life should be kept in mind. How to achieve these goals should be discussed with your treating team. 
• One of the most important things is to make sure you’re managing your pain effectively when you’re diagnosed.¹ You don’t get any awards for gritting your teeth and baring it, so please speak to your doctor or palliative care specialist to ensure your pain is well-controlled. Studies show that poorly-controlled acute pain can lead to chronic pain later on. 
• Other predisposing factors for developing chronic pain include the type of cancer you had, pre-existing pain, repeat surgery, nerve damage, catastrophising about your pain, radiation and chemotherapy, depression and anxiety.²
• If you’re going to have surgery, ask your anaesthetist about procedures which will improve your post-operative pain e.g. using pregabalin or doing a nerve block when having a mastectomy, or an epidural pre-operatively if you’re receiving a thoracotomy.² 
• Studies show that receiving physiotherapy soon after surgery for head and neck cancers can help prevent the development of chronic shoulder pain.² 

Be aware of your emotional state

• If you find that you catastrophise (can’t stop thinking) about your pain and it leads you to have feelings of hopelessness or feeling overwhelmed, this type of thinking can lead to chronic pain later on. Speaking with a therapist trained in chronic pain management can  help you develop new coping skills. 
• Studies show that cancer survivors are four times more likely to develop depression. Being clinically depressed is more than just feeling sad, it can be accompanied by feelings of hopelessness and/or guilt, thoughts of suicide (at its worst), problems sleeping, changes in appetite, loss of libido and feeling tired and not being able to concentrate. Your doctor may want to start you on an antidepressant to treat this or refer you to a psychologist. Untreated depression and anxiety will have a significant impact on your chronic pain. 
• Be aware of certain behaviours that are maladaptive. These include spending too much time in bed or being inactive, medication misuse or keeping to yourself and not socialising. These types of behaviour are going to cause your body to decondition and as a result of this, your pain will worsen. 

Explore all options

• To ‘fix’ your chronic pain, focusing on medication alone isn’t the solution. You need to explore what spiritual, emotional and social factors might be contributing to your pain. 
• It might not be possible to get complete relief from your pain but  by having a team of pain professionals to assist you can improve the quality of your life. This team may include a physiotherapist, psychologist, medical doctor, or spiritual counsellor depending on what your specific needs are. trainpainacademy.co.za has a list of practitioners trained in chronic pain management and palprac.org has a  list of practitioners with specialised training in palliative medicine.

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References

1. Green CR, Hart‐Johnson T, Loeffler DR. Cancer‐related chronic pain: examining quality of life in diverse cancer survivors. Cancer. 2011;117(9):1994-2003.
2. Burton AW, Fanciullo GJ, Beasley RD, Fisch MJ. Chronic pain in the cancer survivor: a new frontier. Pain Medicine. 2007;8(2):189-98.

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