Pain Relief for People with Leukemia, Lymphoma, and Myeloma

Causes and Options for Pain Control with Blood Cancers

Pain causes and control with blood cancers. Istockphoto.com/Stock Photo©Antonio Guillem

Many people with blood cancers such as leukemia, lymphoma or myeloma need pain relief at some point during their disease. But while pain may be a common symptom, it is not inevitable and it is one that can usually be managed.

Why Do Blood Cancer Patients Get Pain?

There are many types of cancer pain. In some cases, people with cancer experience pain as a result of the tumor putting pressure on organs or nearby tissues.

In the case of blood cancers, where there is often not a solid mass of tumor, pain can occur for a few reasons. For example, leukemia cells can cause discomfort when they accumulate in such organs as the liver or spleen.

Leukemia patients often complain of pain in their bones and joints, which is usually caused by the overactive marrow putting pressure on the bones from the inside out.  Similarly, pain can occur when a swollen lymph node that you have from your lymphoma is near an organ or is in a location that impairs movement (such as in the groin).

Myeloma cells release chemicals into the bloodstream that cause bone to break down. These are called osteolytic lesions, and they can lead to a collapse of your spinal vertebrae or bone fractures.  Certain conditions resulting from treatment for your cancer can also lead to pain. For example, chemotherapy or even sleeping in a strange bed in the hospital can trigger mouth sores and neuropathic (nerve) pain.

What Are the Options for Pain Relief?

There are many different options available for cancer-related pain, and often it is a combination of these therapies that brings the best relief.  Finding the right plan can take patience, but be persistent.  Too commonly with cancer people try to "tough it out" or fear that talking to their doctor will make them sound whiny.

  There's no award for going through cancer treatment in pain instead of free from pain.  Don't be afraid to keep talking to your doctor until you are able to live as well as possible at this time.

Treating Cancer to Treat Pain

 In many cases, treatment of your cancer will help relieve certain types of pain. Chemotherapy and radiation therapy help reduce the burden of cancer on your body, and can relieve some of the pressure on your bones, tissues and organs.

Pain Medications

Many people who experience cancer pain will be able to manage their discomfort with the use of pain medications or analgesics. There are two main types of analgesics, non-opioid and opioid.

Non-opioid analgesics are usually tried first and are best used in people who have mild or moderate pain from their cancer. Non-opioid analgesics do not typically cause drowsiness and have few serious side effects when taken as ordered by a physician. Some common non-opioid analgesics include aspirin, acetaminophen (Tylenol), ibuprofen (Advil or Motrin) and naproxen (Aleve, Naprosyn).

Opioid analgesics (narcotics) are used if non-opioids do not seem to be doing the trick. Narcotics have gotten a bad name over the years, and people often associate them with addiction or drug trafficking. Sadly, this has lead to patients being reluctant to use or try them. However, these are often excellent medications for controlling cancer pain and rarely lead to addiction when used properly.

Opioid medications block your brain’s perception of the pain. They may be mild or strong and have no upper dose limit - so there is a good deal of flexibility in terms of personalizing them to meet your needs.  Opioids are usually given by mouth, but they can also be given by injection, into your rectum in a suppository form, or through the skin in a "patch" form. Doctors will usually start at a fairly low dose and increase the dose until you either get pain relief or unpleasant side effects.

Common opioid analgesics include morphine, codeine, fentanyl, hydromorphone and oxycodone. Opioid medications can cause sleepiness, confusion and other side effects. It is important to be aware of their effects when driving or doing activities that require you to be alert.

Bone Pain Medications. Myeloma patients may have significant amounts of pain caused by bone destruction. In these cases, a special class of medications may be used. These types of drugs are called bisphosphonates and are often given by infusion. Similar medications may also be given by mouth or by nasal spray. Common bisphosphonates include Bonefos (clodronate), Aredia (pamidronate),and Zometa (zoledronate.) It may take a few weeks for the full effect of these medications to be noticed.

Steroids. Steroid medications are particularly helpful in people who have spinal cord compression pain (common in myeloma) and nerve pain. While they are not usually used by themselves, they can be very effective and often lower the need for other pain medications.

Other Medications. For people who experience nerve pain as a result of their treatment, finding relief can be very difficult. This type of pain also called neuropathic pain, is often not responsive to opioids and other traditional pain drugs. In these cases, anti-seizure medications and antidepressant medications may be helpful. Anti-seizure medications, such as carbamazepine and gabapentin, and such anti-depressants as amitriptyline, nortriptyline and imipramine work by affecting the painful signals your brain gets from damaged nerves.

Non-Medication Pain Relief

It's easy to forget that there are treatments in addition to medications that may work well to relieve pain.  Some options include:

Radiation therapy may be ordered to be palliative - that is, specifically to reduce pain and symptoms. More than half of patients will have some success with pain control using this method.

Interventional Pain Treatments such as nerve blocks and other neurological procedures may be helpful, especially with severe persistent pain.  In some of these procedures, the nerve which is transmitting the pain sensation to the brain is cut.

Non-Medication Pain Relief. There are a number of options for pain relief that do not require you to take medications, and several of these have other advantages in easing symptoms for people with cancer as well.  Some of these integrative cancer treatments (alternative treatments used along with conventional treatments) include.

The Bottom Line

Some people with blood cancers have pain, but many others do not. In most cases, pain can be controlled and managed to acceptable levels with medical and non-medical interventions. As with any kind of therapy, certain techniques will work for some but not for others.

As your own best advocate in your cancer care, it is important that you speak with your doctor about any pain you are experiencing; work together to formulate a plan to get it under control. If your health care team does not know about your pain or the impact it is having on your life, they will not be able to help you.

If you feel like your concerns are not being taken seriously enough, or if your doctor does not seem to be having any success in managing your pain, feel confident to ask for a second opinion from a pain specialist or team.

Sources

American Society of Clinical Oncology. Cancer.Net. Pain: Treating Pain with Medication. 08/2015. http://www.cancer.net/navigating-cancer-care/side-effects/pain-treating-pain-medication

Eyre, H., Lange, D., Morris, L. (2002) Informed Decisions 2nd ed. American Cancer Society. Atlanta,GA.

Kelvin, J., Tyson, L.(2005) 100 Questions and Answers About Cancer Symptoms and Cancer Treatment Side Effects. Jones and Bartlett: Sudbury, MA

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