Cancer patients undergoing treatments like surgery, radiation, and chemotherapy frequently develop chronic pain syndrome. Chemotherapy causes burning sensations in the hands and feet, osteoporosis, osteonecrosis, arthralgias, and myalgia. Radiotherapy contributes to pain through mechanisms like apoptosis and inflammation. This type of pain, affecting around 40% of survivors, typically persists beyond three months.1 Along with medical approaches to help patients manage cancer-related pain, lifestyle changes can also decrease discomfort and improve quality of life.
Cancer patients often experience major disruptions to their lives once treatment begins that can exacerbate their discomfort. For example, early onset acute pain is linked to the stress of adapting to a new chemotherapy routine. It was shown that being able to adjust to the new routine reduced the experience of pain. In addition, frequent and prolonged hospital stays can turn the hospital into a cancer patient’s second home. Suddenly, cancer patients live within an unfamiliar institutional setting, which impacts their pain experience negatively.
Sun et al. discuss three barriers to successful pain management in the hospital-home: patient, professional and systematic. First, cancer patients under-report pain to their providers.3 Lahousse et al. describe this phenomenon and cite that most patients believe their pain cannot be controlled and thus under-report.1 Second, healthcare professionals fail to recognize key indicators of pain and are poorly educated about pain relief, addiction, and tolerance as well as dosing.3 Improving education about pain assessment is paramount to reducing cancer pain. Over the past decade, the approach to pain management has evolved from a biomedical to a biopsychosocial model, acknowledging the complex interplay between psychological states and pain since their neural signals emerge from the same brain regions. Cognitive psychological states, for example, a feeling of “injustice” in a patient who was diagnosed with lung cancer but never smoked, intensify pain. A patient who develops feelings of anxiety and depression due to a new chemotherapy routine will experience more severe pain too. 1
Education is pivotal in managing chronic pain and is a critical lifestyle change as part of reducing cancer pain.1 Education decreases a patient’s sensation of being threatened by the pain and decreases catastrophic thinking, for example, the thoughts of injustice. Finally, legal, and regulatory limitations systematically lead to suboptimal care in the clinical setting. 1,3
Many lifestyle changes are under the patient’s control and can reduce cancer-related pain. These changes improve stress, insomnia, diet, obesity, smoking, alcohol consumption, and physical activity, which have all been linked to chronic pain syndrome. Stress dysregulates the feedback cycle among the autonomic, endocrine, and immune responses leading to pain. Pain disrupts the circadian rhythm of patients and creates an insomnia cycle. In breast cancer patients, physical activity was shown to reduce musculoskeletal pain and stiffness caused by using aromatase inhibitors. Alcohol withdrawal has been linked to alcoholic neuropathy and musculoskeletal disorders. Nicotine acts as an acute analgesic which makes it attractive to chronic pain sufferers, but in the long-term, nicotine tolerance makes pain management harder to maintain.1 In the disease cycle of cancer, cancer survivors can conquer chronic pain by making beneficial lifestyle changes with the support of their informed health professionals and the hospital institution.
References
- Lahousse, Astrid et al. “Lifestyle and Pain following Cancer: State-of-the-Art and Future Directions.” Journal of clinical medicine vol. 11,1 195. 30 Dec. 2021, doi:10.3390/jcm11010195
- Zhao, Jian et al. “Dynamic Associations Between Daily Pain and Mood during Chemotherapy for Gynecologic Cancers.” Pain management nursing : official journal of the American Society of Pain Management Nurses, S1524-9042(23)00143-1. 8 Aug. 2023, doi:10.1016/j.pmn.2023.07.002
- Sun, Virginia Chih-Yi et al. “Overcoming barriers to cancer pain management: an institutional change model.” Journal of pain and symptom management vol. 34,4 (2007): 359-69. doi:10.1016/j.jpainsymman.2006.12.011