When evaluating pain in patients with a history of cancer, the differential diagnosis includes:
Pain resulting from damage caused by the original tumor, often nerve damage.
Pain from treatment-related toxicity (e.g., surgery, radiation, chemotherapy).
Especially in the case of radiation therapy, pain as a manifestation of delayed toxicity may present years to decades later.
Pain from malignancy—a new malignancy or relapse of primary cancer.
Pain from new non-malignant disease.
The first step in management is to be aware of the problem and take it seriously. One common complaint of cancer survivors is that their pain complaints are not heeded. Acknowledgment and explanation by themselves can be very reassuring. Much of this chapter is devoted to descriptions of pain syndromes reported in survivors of different cancers to assist the reader in recognizing the various pain syndromes among cancer survivors. The second step is to acknowledge that at this point very little good evidence is available for treatment of the types of cancer-related pain syndromes. This is not surprising when one considers that the evidence base for treatment of pain in cancer patients is also weak.22 Finally, it is essential that we recognize that as treatments for cancer change and progress, and the natural history of disease is altered, new types of pain syndromes may emerge in cancer survivors.
Many of the pain syndromes described to date in cancer survivors share in common iatrogenic nerve injury with a resulting neuropathic pain syndrome.23,24 The following paragraphs will therefore concentrate on current recommendations for neuropathic pain. It should be noted that survivors may experience other kinds of pain as well, and readers are referred to current texts for further discussion.25-27
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