Overview of cancer pain syndromes
- Russell K Portenoy, MD
Russell K Portenoy, MD
- Chief Medical Officer
- MJHS Hospice and Palliative Care
- Professor of Neurology and Family and Social Medicine
- Albert Einstein College of Medicine
- Lara K Dhingra, PhD
Lara K Dhingra, PhD
- Assistant Professor of Neurology and Psychiatry and Behavioral Sciences
- Albert Einstein College of Medicine
Pain is a complex symptom that affects most aspects of life, including physical functioning, daily activity, psychological and emotional status, and social life. Among patients with cancer, there is substantial heterogeneity in how pain is experienced and in how it appears.
In many cases, the constellation of symptoms and signs can suggest a specific cancer pain syndrome . The identification of such a syndrome may help to elucidate the etiology of the pain, direct the diagnostic evaluation, clarify the prognosis for the pain or the disease itself, and guide therapeutic intervention.
Cancer pain syndromes can be broadly divided into those that are acute and those that are chronic. Acute pain syndromes usually accompany diagnostic or therapeutic interventions, whereas chronic pain syndromes usually are directly related to the neoplasm itself or to an antineoplastic therapy .
This topic review will provide an overview of acute and chronic cancer pain syndromes. Cancer pain assessment is discussed elsewhere. (See "Assessment of cancer pain".)
ACUTE PAIN SYNDROMES
Most acute cancer pain syndromes are iatrogenic, ie, related to a diagnostic test or treatment (table 1). However, some are disease-related, such as pain due to acute hemorrhage into a tumor, bone pain from a pathologic fracture, and visceral pain from acute obstruction or perforation of a hollow structure (table 2).
- Foley KM. Acute and chronic cancer pain syndromes: Oxford Textbook of Palliative Medicine, 3rd, Oxford University Press, New York 2004. p.298.
- Lalla RV, Bowen J, Barasch A, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2014; 120:1453.
- McCarthy GM, Skillings JR. Jaw and other orofacial pain in patients receiving vincristine for the treatment of cancer. Oral Surg Oral Med Oral Pathol 1992; 74:299.
- Salner AL, Botnick LE, Herzog AG, et al. Reversible brachial plexopathy following primary radiation therapy for breast cancer. Cancer Treat Rep 1981; 65:797.
- Portenoy RK. Treatment of cancer pain. Lancet 2011; 377:2236.
- Paice JA, Portenoy R, Lacchetti C, et al. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34:3325.
- Mercadante S. Malignant bone pain: pathophysiology and treatment. Pain 1997; 69:1.
- Schweizerhof M, Stösser S, Kurejova M, et al. Hematopoietic colony-stimulating factors mediate tumor-nerve interactions and bone cancer pain. Nat Med 2009; 15:802.
- Beckers R, Uyttebroeck A, Demaerel P. Acute lymphoblastic leukaemia presenting with low back pain. Eur J Paediatr Neurol 2002; 6:285.
- Jan de Beur SM. Tumor-induced osteomalacia. JAMA 2005; 294:1260.
- Feldenzer JA, McGauley JL, McGillicuddy JE. Sacral and presacral tumors: problems in diagnosis and management. Neurosurgery 1989; 25:884.
- Papagelopoulos PJ, Mavrogenis AF, Soucacos PN. Evaluation and treatment of pelvic metastases. Injury 2007; 38:509.
- Greenberg HS, Deck MD, Vikram B, et al. Metastasis to the base of the skull: clinical findings in 43 patients. Neurology 1981; 31:530.
- Da Silva AN, Schiff D. Dural and skull base metastases. Cancer Treat Res 2007; 136:117.
- Araki K, Kobayashi M, Ogata T, Takuma K. Colorectal carcinoma metastatic to skeletal muscle. Hepatogastroenterology 1994; 41:405.
- Sridhar KS, Rao RK, Kunhardt B. Skeletal muscle metastases from lung cancer. Cancer 1987; 59:1530.
- Ferrandina G, Salutari V, Testa A, et al. Recurrence in skeletal muscle from squamous cell carcinoma of the uterine cervix: a case report and review of the literature. BMC Cancer 2006; 6:169.
- Siegal T. Muscle cramps in the cancer patient: causes and treatment. J Pain Symptom Manage 1991; 6:84.
- Coombs DW. Pain due to liver capsular distention. In: Common problems in pain management. Common problems in anesthesia, Ferrer-Brechner T (Ed), Year Book Medical Publishers, Chicago 1990. p.247.
- Grahm AL, Andrén-Sandberg A. Prospective evaluation of pain in exocrine pancreatic cancer. Digestion 1997; 58:542.
- Kelsen DP, Portenoy R, Thaler H, et al. Pain as a predictor of outcome in patients with operable pancreatic carcinoma. Surgery 1997; 122:53.
- Schönenberg P, Bastid C, Guedes J, Sahel J. [Percutaneous echography-guided alcohol block of the celiac plexus as treatment of painful syndromes of the upper abdomen: study of 21 cases]. Schweiz Med Wochenschr 1991; 121:528.
- Ripamonti C. Management of bowel obstruction in advanced cancer. Curr Opin Oncol 1994; 6:351.
- Ripamonti C, Mercadante S. Pathophysiology and management of malignant bowel obstruction. In: Oxford textbook of palliative medicine, 3rd, Doyle D, Hanks GW, McDonald N, Cherny N (Eds), Oxford University Press, New York 2005. p.496.
- Archer AG, Sugarbaker PH, Jelinek JS. Radiology of peritoneal carcinomatosis. Cancer Treat Res 1996; 82:263.
- Stillman M. Perineal pain: diagnosis and management, with particular attention to perineal pain of cancer. In: Second International Congress on Cancer Pain - Advances in pain research and therapy, Foley KM, Bonica JJ, Ventafrida V (Eds), Raven Press, New York 1990. Vol 16, p.359.
- Berger MS, Cooley ME, Abrahm JL. A pain syndrome associated with large adrenal metastases in patients with lung cancer. J Pain Symptom Manage 1995; 10:161.
- Karanikiotis C, Tentes AA, Markakidis S, Vafiadis K. Large bilateral adrenal metastases in non-small cell lung cancer. World J Surg Oncol 2004; 2:37.
- Russo P. Urologic emergencies in the cancer patient. Semin Oncol 2000; 27:284.
- Taillibert S, Laigle-Donadey F, Chodkiewicz C, et al. Leptomeningeal metastases from solid malignancy: a review. J Neurooncol 2005; 75:85.
- Nolan CP, Abrey LE. Leptomeningeal metastases from leukemias and lymphomas. Cancer Treat Res 2005; 125:53.
- Gupta SR, Zdonczyk DE, Rubino FA. Cranial neuropathy in systemic malignancy in a VA population. Neurology 1990; 40:997.
- Cheng TM, Cascino TL, Onofrio BM. Comprehensive study of diagnosis and treatment of trigeminal neuralgia secondary to tumors. Neurology 1993; 43:2298.
- Kori SH. Diagnosis and management of brachial plexus lesions in cancer patients. Oncology (Williston Park) 1995; 9:756.
- Weinstein SM. Phantom pain. Oncology (Williston Park) 1994; 8:65.
- van der Schans CP, Geertzen JH, Schoppen T, Dijkstra PU. Phantom pain and health-related quality of life in lower limb amputees. J Pain Symptom Manage 2002; 24:429.
- Flor H, Elbert T, Knecht S, et al. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 1995; 375:482.
- Halbert J, Crotty M, Cameron ID. Evidence for the optimal management of acute and chronic phantom pain: a systematic review. Clin J Pain 2002; 18:84.
- Bone M, Critchley P, Buggy DJ. Gabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study. Reg Anesth Pain Med 2002; 27:481.
- Jaeger H, Maier C. Calcitonin in phantom limb pain: a double-blind study. Pain 1992; 48:21.
- Huse E, Larbig W, Flor H, Birbaumer N. The effect of opioids on phantom limb pain and cortical reorganization. Pain 2001; 90:47.
- Kern U, Altkemper B, Kohl M. Management of phantom pain with a textile, electromagnetically-acting stump liner: a randomized, double-blind, crossover study. J Pain Symptom Manage 2006; 32:352.
- Belleggia G, Birbaumer N. Treatment of phantom limb pain with combined EMG and thermal biofeedback: a case report. Appl Psychophysiol Biofeedback 2001; 26:141.
- Weiss T, Miltner WH, Adler T, et al. Decrease in phantom limb pain associated with prosthesis-induced increased use of an amputation stump in humans. Neurosci Lett 1999; 272:131.
- Johansson S, Svensson H, Denekamp J. Dose response and latency for radiation-induced fibrosis, edema, and neuropathy in breast cancer patients. Int J Radiat Oncol Biol Phys 2002; 52:1207.
- Minsky BD, Cohen AM. Minimizing the toxicity of pelvic radiation therapy in rectal cancer. Oncology (Williston Park) 1988; 2:21.
- Newman ML, Brennan M, Passik S. Lymphedema complicated by pain and psychological distress: a case with complex treatment needs. J Pain Symptom Manage 1996; 12:376.
- Ganel A, Engel J, Sela M, Brooks M. Nerve entrapments associated with postmastectomy lymphedema. Cancer 1979; 44:2254.
- ACUTE PAIN SYNDROMES
- Directly related to cancer
- Associated with antineoplastic treatments
- - Oral mucositis
- - Chemotherapy-induced neuropathy
- - Other chemotherapy-related acute pain syndromes
- - Radiation plexopathy
- - Radiation enteritis and proctitis
- CHRONIC PAIN SYNDROMES
- Tumor-related somatic pain syndromes
- - Multifocal bone pain
- - Soft tissue pain
- Tumor-related visceral pain syndromes
- Tumor-related neuropathic pain
- - Leptomeningeal metastases
- - Cranial neuralgias
- - Radiculopathies
- - Plexopathies
- - Peripheral mononeuropathies
- - Paraneoplastic syndromes
- Pain related to antineoplastic treatments
- - Chemotherapy-related neuropathy
- - Bone complications and glucocorticoids
- - Antiandrogens and gynecomastia
- Postsurgical pain syndromes
- - Pain and phantom sensation after limb amputation
- Postradiation pain syndromes
- - Plexopathies
- - Myelopathy
- - GI tract
- - Lymphedema
- - Osteonecrosis
- INFORMATION FOR PATIENTS