Medical advances and early screening have led to an increase in the number of cancer survivors, many of whom are able to return to their normal lives. However for some survivors, normal functioning is limited by persistent pain that requires pain relief treatments.

Research shows that breast cancer survivors, for instance, experience a 15 per cent reduction in their functional well-being. Removal of the lymph nodes in the armpits notably may increase the risk of postoperative pain, while radiotherapy has been linked to chronic nerve pain around the breast region (Tian Y, Ann Surg Oncol 2013).

“Cancer patients may continue to suffer from persistent pain even after their primary cancer has been treated,” says Dr Sng Ban Leong, Consultant, Department of Women’s Anaesthesia, KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group.

Possible Causes of Pain

Persistent pain after cancer treatment can be caused by a number of factors, including:

  • Adhesions and scarrings that form after surgery
  • Steroid use which may lead to osteoporosis and fracture
  • Chemotherapy which may cause generalised muscle pain or peripheral nerve pain in the hands and feet
  • Radiotherapy resulting in nerve pain and muscle aches
  • Recurrence of cancer in the same or other areas of the body

“There can be several reasons for having persistent pain and it is important to know the cause,” says Dr Sng. “If there is increasing pain, pain affecting daily function and new areas of pain, one should consult a doctor early.”

Cancer patients are also more likely to suffer from anxiety or depression that may be associated with heightened pain sensation. They may also have been on strong pain medications such as morphine, which can reduce their sensitivity to similar pain medications.

Cancer pain treatment

Cancer patients who develop pain after cancer treatment need to consult a pain specialist who will carry out a thorough assessment of their condition and prescribe treatment. Pain treatment for cancer survivors requires a multidisciplinary approach involving drugs as well as psychological and physical rehabilitation.

Pain treatment options include:

  • Drugs such as anti-convulsants and antidepressants to reduce the nerve pain caused by chemotherapy and radiotherapy
  • Strong opioids such as morphine to help the patient cope with aches and pains due to residual cancer in the bones
  • Nerve blocks under imaging guidance to help ensure local anaesthetics and other medications are delivered correctly to the nerves that carry strong pain signals back to the brain.

Ref: R14