Disease- and Treatment-Related Pain

People with cancer can have pain caused by the cancer itself, its treatment, or both. They may also have pain caused by other health problems that are unrelated to cancer (like arthritis or diabetes).

Increased pain does not mean that the cancer is getting worse, but you should always tell your healthcare team if you have increased pain.

It’s important to remember that no matter what the cause, pain can be treated.

Blood Cancer-Related Pain

Many people with blood cancers have pain caused by the cancer itself. For instance, cancer cells can build up in the bone marrow (the spongy tissue inside bones where blood cells are made) and form a mass. That mass may then press on nerves or joints and cause pain. Some of the ways in which specific blood cancers can cause pain are listed below.

Leukemia or Myelodysplastic Syndromes (MDS)

Some people with leukemia or myelodysplastic syndromes have bone or joint pain. This bone pain is most often felt in the long bones of the arms and legs, in the ribs and in the breastbone. Joint pain and swelling of the large joints, like the hips and shoulders, sometimes starts several weeks after bone pain begins.

People with chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML) and hairy cell leukemia (HCL) sometimes have pain or feel full below the ribs on their left side. This happens when cancer cells build up in the spleen and cause it to swell (enlarge). The spleen is a small organ in the upper left part of the body under the ribcage. It acts primarily as a filter for your blood.

Lymphoma

People with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) often have swollen lymph nodes. This rarely causes pain at the time of diagnosis. Sometimes, depending on where a mass of abnormal cells forms, a person can have pain in one or more places in the body where the mass is—most commonly in the chest, abdomen (belly) or bones. For instance, a mass in the abdomen can cause back or belly pain. Over time, some people with lymphoma also develop bone pain.

Myeloma

Many people with multiple myeloma have pain. Back pain is often the first symptom, but because back pain is so common in our society, it might not be initially linked to myeloma.

When myeloma cells build up in the bone marrow, they release chemicals that cause an imbalance in the process called “bone remodeling” (reabsorption of old bone and formation of new bone). This imbalance causes greater bone destruction and less new bone formation, leading to bone thinning (osteoporosis) or holes in the bones (lytic lesions). Bones can fracture easily, or vertebrae (the small bones making up the spinal column) may collapse. This causes severe pain and could be an emergency. Common areas of pain in people with myeloma are the back, ribs, arms, legs, hips and shoulders.

Myeloproliferative Neoplasms (MPNs)

Some people with myeloproliferative neoplasms have pain. Each MPN disease is different, so people with different types of myeloproliferative neoplasms can have different kinds of pain.

  • Essential Thrombocythemia (ET) is a type of blood cancer in which the bone marrow produces too many platelets, making it difficult for the blood to flow. Some people with ET have pain in their hands and feet caused by reduced blood flow. This pain is often described as “numbness,” “tingling,” “throbbing” or “burning.” Some people get headaches or chest pain.
  • Polycythemia Vera (PV) is a type of blood cancer in which the bone marrow produces too many red blood cells, increasing the chance of bleeding, bruising and blood clotting. Some people with PV develop gout, a kind of arthritis that causes painful joint swelling. PV is also linked to painful ulcers in the stomach, small intestine and esophagus. PV might cause burning or tingling pain of the skin, most often on the arms, legs, hands or feet.
  • Myelofibrosis (MF) is a type of blood cancer in which abnormal blood cells and fibers build up in the bone marrow, making it difficult for the body to produce healthy blood cells. Some people with MF feel pain or have a sensation of fullness below the ribs on their left side, where the cancer causes the spleen to swell. MF may also cause bone or joint pain.

Treatment-Related Pain

Pain can also be a side effect of your cancer treatment as a result of the side effects of drug therapies or radiation therapy used to treat blood cancers.

Radiation and Chemotherapy

Chemotherapy can cause painful mouth sores, headaches, muscle aches and stomach pains. There are treatments that help control these side effects.

Radiation therapy is linked to skin dryness and sunburn-like irritation in the parts of the body exposed to radiation. There are many ways that the side effects of radiation can be managed. 

Chemotherapy and, less commonly, radiation therapy can also cause nerve damage. This can lead to pain that tends to start in the hands or the feet and is often 4 Pain Management described as “burning” or “tingling.” This condition is called “peripheral neuropathy” (PN).

Both chemotherapy and radiation therapy weaken the immune system. This puts the body more at risk for viral infections and diseases. For instance, shingles, the painful blisters on the skin caused by a reactivation of the chickenpox virus, can develop. Shingles can also lead to post-herpetic neuralgia. This is nerve pain that lasts long after the rash and blisters from shingles have gone away. Talk to your doctor about the shingles vaccine.

Bone Marrow Biopsy and Aspiration

Bone marrow biopsy and bone marrow aspiration can be uncomfortable and sometimes painful procedures. Talk to your healthcare team about getting medicine to help reduce any pain or discomfort during or following the procedure. Some people have mild pain for a few days at the place where the needle was inserted.

Stem Cell Transplantation

Most of the side effects of stem cell transplantation, including pain, are a result of the high-dose chemotherapy used. Common painful side effects include mouth and throat sores, stomach cramping, vomiting and diarrhea. There are ways to manage and even help prevent these effects.

Patients will have weakened immune systems for many months after a stem cell transplant. This puts the body at higher risk for viral infections like shingles, which causes painful rashes and nerve pain.

Stem cells for transplantation may be taken from the patient (autologous transplant) or a donor’s bone marrow or blood (allogeneic transplant). People who donate stem cells from bone marrow may experience temporary soreness, bruising and aching in the hip and lower back following the procedure. People who donate stem cells from the blood receive an injection of growth factor to stimulate the movement of stem cells into the blood. For the donor, the growth factor injection may cause mild, flu-like symptoms, temporary joint pain, bone pain or headaches.

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