Pain in cancer survivors; filling in the gaps

Abstract

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 chemotherapeutic 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.

Pain Management in Patients with Multiple Myeloma: An Update

“…As survival time has increased with two-, three-, and four-drug combination regimens, the number of cancer survivors presenting with chronic pain has increased as well. The concept of being a "cancer survivor" is relatively new, without a consensus on its definition, but it is usually related to a patient who lives with and beyond cancer [96].…”

Pain in older survivors of hematologic malignancies after blood or marrow transplantation: A BMTSS report

“…Our cohort of older BMT survivors had a 2.5‐fold higher risk of reporting chronic/severe pain in comparison with a sibling cohort. Current efforts are underway to increase the understanding of the underlying etiology of chronic/severe pain in cancer survivors, such as neuropathies (chemotherapy‐induced, postoperative pain syndrome), rheumatologic pain (arthralgias), skeletal pain (osteonecrosis secondary to chronic steroid use), gastrointestinal pain (gastritis), and genitourinary pain (cystitis) . Specifically in BMT patients, pain persisting after BMT has been shown to be attributable to cGVHD, chemotherapy‐induced peripheral neuropathies, chronic steroid–induced osteopenia, and opportunistic infections (eg, herpes zoster) .…”

Managing Cancer Pain, Monitoring for Cancer Recurrence, and Mitigating Risk of Opioid Use Disorders: A Team-Based, Interdisciplinary Approach to Cancer Survivorship

“…Broadly speaking, these syndromes can be due to chemotherapy and hormonal therapies (such as chemotherapy-induced peripheral neuropathy, bone complications, and joint and muscle pain), radiation therapy (such as pain related to fistulous tracks, radiation-associated cystitis and enteritis, and radiationassociated brachial plexopathy), graft-versus-host disease, and surgical procedures (such as lymphedema, phantom pain syndromes, post-thoracotomy pain, and nerve pain,). 11,16,17 The management of these cancer pain syndromes can be complicated, particularly as patients live further into survivorship. When moderate or severe cancer pain complicates active disease-directed treatments, the use of opioid analgesics and nonopioid co-analgesic medications is accepted as a crucial component of cancer care, particularly since pain is often conceptualized as secondary to the cancer itself and/or treatment toxicities.…”