Chronic Pain After Cancer Treatment

This page is for people who still have pain after cancer treatment has ended, and for the people who care for them. It explains where the pain comes from, how it is treated, and when it needs urgent care.

Pain that outlasts treatment is common, and it is often treated as though it were nothing. The National Cancer Institute defines chronic pain, also called persistent pain, as pain that usually lasts more than three months. MedlinePlus adds another marker: longer than the time in which you should have healed.

Once you are past the healing window, the pain is no longer a signal that something is mending. It is a problem in its own right, and it needs its own plan.

Most chronic pain after cancer is not an emergency. Some is. Go to the emergency department, or call 911, if you have:

• Back pain that is severe and not relieved by pain medicine, and that gets worse when lying down or when you cough or sneeze.
• New muscle weakness in the legs, falls, or difficulty walking that is getting worse.
• Loss of feeling, especially in the legs.
• Loss of bowel control, or bladder leakage.

These can mean pressure on the spinal cord. The faster the symptoms come on, the sooner treatment is needed to prevent permanent injury.

Call your care team right away if a swollen limb becomes red, warm to the touch, or painful, or if you have a fever. NCI says to contact your doctor immediately for fever or warm, red skin in a swollen area. This can be cellulitis, a bacterial skin infection that NCI says is common in people with lymphedema.

If chemotherapy is still part of your treatment, call your care team right away, day or night, for a temperature of 100.4°F (38°C) or higher. The CDC says to call your doctor immediately at that temperature. It says fever may be the only sign of infection, and an infection during chemotherapy can be life-threatening. Also call right away for chills, a sore throat, mouth sores, burning when you urinate, redness at a catheter site, or any other sign of infection, even with a normal temperature. A normal temperature is not a reason to wait. Go to an emergency department if you cannot reach anyone.

If none of those warning signs apply, the next step is to work out where the pain is coming from. It can come from the treatment or from the cancer itself.

Surgery. Cutting through tissue can injure nerves. NCI's clinician summary notes that pain can persist in the chest wall after breast or chest surgery.

Chemotherapy nerve damage. Some chemotherapy drugs injure the small nerves in the hands and feet. The National Cancer Institute describes tingling, numbness, or a pins-and-needles feeling in the feet and hands. It also describes an inability to feel pain, such as from a cut or sore on the foot.

Radiation. NCI's clinician summary lists nerve injury from radiation as a cause of persistent pain.

Lymphedema. When surgery or radiation blocks the flow of lymph fluid, fluid builds up. The early signs are a heavy, full, or tight feeling in the area where you had surgery or radiation. Aching, tingling, pain, or numbness can occur too.

Hormone therapy. If a hormone therapy drug seems to cause joint or muscle pain, tell your care team. Do not stop it on your own.

The cancer itself. A tumor pressing on nerves or other structures causes pain. This must be ruled out before pain is called a late effect.

NCI's clinician summary separates pain caused by tissue injury from neuropathic pain, which comes from injured nerves. NCI's patient page describes nerve damage from chemotherapy as tingling, numbness, or a pins-and-needles feeling in the feet and hands.

The same summary lists gabapentin, duloxetine, and tricyclic antidepressants among medicines used for neuropathic pain. Ask your team which kind of pain you have and which medicine fits it.

Tell the team the location, quality, frequency, duration, and intensity of the pain. Intensity is rated 1 to 10, where 10 is the most pain and 1 the least.

Keep a record. Write down your pain levels and the medicine you took, in a notebook, a chart, or a pain app.

Say what the pain stops you doing. NCI asks how pain affects your daily activities and mood.

Medicines. Options range from over-the-counter pain relievers to prescription medicines, including antidepressants and muscle relaxants. Opioids, also called narcotics, are used for moderate to severe cancer pain.

NCI lists antidepressants among medicines used for pain. Ask the prescriber to explain the reason, and expect a clear answer.

Physical approaches. Physical therapy is a core treatment, not an optional extra. For lymphedema specifically, treatment includes compression garments, manual lymphatic drainage massage, and complete decongestive therapy given by a certified lymphedema therapist.

Integrative approaches. The National Cancer Institute lists acupuncture, biofeedback, guided imagery, hypnosis, and meditation. For neuropathy, acupuncture, massage, physical therapy, and yoga may be advised to lower pain.

Mental health support. MedlinePlus says depression or stress may make chronic pain worse.

NCI says nerve damage can make it hard to sense temperature or pain.

• NCI says nerve damage can cause weakness that affects balance. It advises making changes at home to prevent falls.
• NCI advises protecting your hands and feet from injury, using potholders, and checking water temperature.
• NCI advises getting up slowly to avoid dizziness.
• Tell your doctor or nurse about new numbness, tingling or weakness.

The National Cancer Institute advises telling your health care team about:

• New pain.
• Pain that is not relieved enough by your current treatment.
• Side effects from pain medicine.
• How the pain affects your daily activities and your mental health.

Two more things are worth saying. Tell them if you are cutting doses to make a prescription last, and tell them if you are afraid of becoming dependent. They can work with you on both.

Ask your team to set goals with you, such as sleeping through the night or walking to the shop. Goals like these give you both a way to tell whether treatment is working.

• Is this pain from the cancer, from the treatment, or from something unrelated? What was done to check?
• Is my pain neuropathic, and how does that change the medicine?
• Should I be referred to a pain specialist, a palliative care team, or a lymphedema therapist?
• What is the goal we are aiming for, and how will we know if it is working?
• If this medicine does not help within a set time, what is next?

Palliative care is specialist symptom management. Ask your care team whether it could help with your pain.

• Cancer Pain — NCI
• Cancer Pain (PDQ), health professional version — NCI
• Nerve Problems (Peripheral Neuropathy) — NCI
• Lymphedema — NCI
• Chronic Pain — MedlinePlus
• Spinal Tumor — MedlinePlus