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).
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- 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