Causes of cancer pain

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Cancer pain can be caused by pressure on, or chemical stimulation, a special nerve ending that gives a pain sign called a nociceptor (nociceptive pain), or by damage or disease affecting the nerve fibers themselves (neuropathic pain).

Video Causes of cancer pain

Infection

Tumor or surrounding tissue infections can cause increased pain quickly, but are sometimes ignored as a possible cause. One study found that infection was the cause of pain in four percent of nearly 300 cancer patients who were referred for pain relief. Another report described seven patients, whose previously well-controlled pain improved significantly for several days. Antibiotic treatment results in pain relief in all patients within three days.

Maps Causes of cancer pain

Tumor-related

Tumors can cause pain by destroying or infiltration tissue, or by releasing chemicals that make nociceptors responsive to normally painless stimuli ( cf. allodynia).

Vascular events

deep venous thrombosis

Between 15 and 25 percent of deep vein thrombosis (DVT) is caused by cancer (often by tumors that suppress blood vessels). Cancers most likely to cause DVT are pancreatic cancer, stomach cancer, brain tumors, advanced breast cancer, and advanced pelvic tumors. DVT may be the first clue that cancer is present. This causes swelling and pain (ranging from intense to vague or "severe" seizures) in the legs, especially the calves, and (rarely) in the arms.

Superior vena cava syndrome

Superior vena cava (large vein carrying circulating blood, deoxygenation to the heart) can be compacted by the tumor, most commonly small non-cell lung carcinoma (50 percent), small-cell lung carcinoma (25 percent), lymphoma, or metastasis, leading to superior vena cava syndrome. Common symptoms include shortness of breath, swelling of the face and neck, dilation of blood vessels in the neck and chest, and chest wall pain.

Nervous system

Between 40 and 80 percent of patients with cancer pain experience neuropathic pain.

Brain

The brain tissue itself does not contain nociceptors; Brain tumors cause pain by suppressing blood vessels or membranes that wrap the brain (meninges), or indirectly by causing fluid buildup (edema) that can suppress pain-sensitive tissues.

Meninges

Ten percent of patients with cancer spread to different parts of the body develop meningeal carcinomatosis, where metastatic seedlings develop in the meninges of the brain and spinal cord (with possible invasion of the brain or spinal cord). rope). Melanoma and breast and lung cancers account for 90 percent of these cases. Back pain and headaches - often severe and may be associated with nausea, vomiting, neck stiffness and pain or discomfort in the eyes due to exposure to light (photophobia) - are often the first symptoms of meningeal carcinoma. "Pin and needles" (paresthesia), bowel or bladder dysfunction and weakness of lower motor neurons are common features.

Spinal cord compression

About three percent of cancer patients have spinal cord compression, usually from vertebral or pedicle extension (fig 1) due to metastasis, sometimes involving the collapse of the vertebral body. Sometimes compression is caused by a nonvertebral metastasis adjacent to the spinal cord. The long channel compression of the umbilical cord itself produces the pain and funicular compression of the spinal cord roots (Figure 5) producing radicular pain. Seventy percent of cases involve the thoracic, 20 percent lumbar, and 10 percent of the cervical spine; and about 20 percent of cases involve many compression sites. The nature of pain depends on the location of the compression.

Infiltration or compression nerves

Infiltration or compression of nerves by primary tumors causes peripheral neuropathy in one to five percent of cancer patients.

Dorsal root ganglion inflammation Small cell lung cancer and, less commonly, breast, colon or ovarian cancers can produce inflammation of the dorsal root ganglia (Figure 5), accelerate burning, tingling in the extremities, with occasional "lightning" or sudden illness.

Brachial plexopathy

Brachial plexopathy is a common product of Pancoast tumors, lymphoma and breast cancer, and can produce painful burning disesthesia in the back of the hand, and cramps, destroying the pain of the forearm.

Bone

Bone invasion by cancer is the most common source of cancer pain. About 70 percent of breast and prostate cancer patients, and 40 percent of those with lung, kidney and thyroid cancer develop bone metastases. It is generally perceived as tenderness, with constant back pain and spontaneous or movement-related exacerbation events, and is often described as severe. Tumors in the marrow trigger a strong immune response that increases the sensitivity of pain, and they release chemicals that stimulate nociceptors. As they grow, the tumor condenses, consumes, infiltrates or cuts the blood supply to body tissues, which can cause pain.

Fracture

Rib fractures, common in the breast, prostate, and other cancers with rib metastases, can cause severe pain when twisting the torso, coughing, laughing, breathing deeply or moving between sitting and lying down. In the breast, prostate or lung cancer, multiple myeloma and some other types of cancer, sudden onset of the extremities or back pain may indicate pathologic bone fracture (most commonly in the upper femur).

Skull

The base of the skull may be affected by metastases from bronchial, breast or prostate cancers, or cancer can spread directly to this area of ​​the nasopharynx (Figure 2), and this can cause headaches, paresthesia, disesthesia or pain, or cranial nerve dysfunction - the exact symptoms depend on the affected cranial nerve.

pelvis

Pain produced by cancer in the pelvis varies depending on the affected tissue, but often diffuses diffusely into the upper thigh, and may refer to the lumbar region. Lumbosacral plexopathy is often caused by cancer recurrence in the presacral space, and may refer to external genitalia or perineum. Localized cancer recurrence attached to the side of the pelvic wall can cause pain in one of the iliac fossa. Walking pain that limits the patient to bed suggests possible adherence to cancer or iliacus muscle invasion. Pain in the hypogastrium (between the navel and pubic bone) is commonly found in uterine and bladder cancers, and sometimes in colorectal cancers especially if infiltrated or attached to the uterus or bladder.

Viscera

Visera pain is diffuse and difficult to find, and is often referred to further, usually superficial.

Heart

Acute bleeding into hepatocellular carcinoma causes severe upper right quadrant pain, and may be life-threatening, requiring emergency surgery or other emergency interventions.
Tumors can enlarge the size of the liver several times and stretching the capsule may cause pain in the right hypochondrium. Another cause of pain in an enlarged liver is the attraction of the supporting ligament when standing or walking, the liver pressing the ribs or pinching the abdominal wall, and pressing the lumbar spine. In some posture the liver may pinch the parietal peritoneum against the lower rib, resulting in pain, sharp temporary, relieved by changing position. Tumors can also infiltrate the liver capsule, cause dullness, and sometimes piercing pain.

Kidney and spleen

Kidney and spleen cancers produce less pain than those caused by liver tumors - renal tumors cause pain only after the organ has been completely destroyed and the cancer has invaded surrounding tissue or adjacent pelvis. Pressure on the kidneys or ureters of tumors outside the kidneys can cause extreme waist pain. Local cancer recurrence after renal removal may cause pain in the lumbar back, or L1 or L2 spinal nerve pain in the groin or upper thigh, accompanied by weakness and numbness of the iliopsoas muscle, aggravated by activity.

Abdominal and hollow urogenital organs

Inflammation of artery walls and tissues adjacent to the common nerve occurs in tumors in abdominal and urogenital hollow organs. Infection or cancer can irritate the trigonum from the bladder, causing the detrusor muscle spasm of the urinae (muscle that squeezes urine from the bladder), resulting in deep pain over the pubic bone, possibly referring to the tip of the penis, lasting from a few minutes to half an hour.

Gastrointestinal

The pain of intestinal tumors may be due to motility, dilatation, altered blood flow, or impaired ulceration. Malignant lymphomas in the gastrointestinal tract can produce large tumors with significant ulceration and bleeding.

Respiratory system

Cancer of the bronchus tree is usually painless, but ear and facial pain on one side of the head has been reported in some patients. This pain is referred to through the auricular branch of the vagus nerve.

Pancreas

Ten percent of patients with pancreatic body cancer or experience tail pain, while 90 percent of those with pancreatic cancer head will, especially if the tumor is near ampulla hepatopancreatic. Pain appears in the upper left or right abdomen, constant, and the intensity increases over time. In some cases relieved by bending forward and compounded by lying on his stomach. Back pain can be present and, if intense, can spread to the left and right. Back pain may be referred from the pancreas, or it may indicate the cancer has penetrated the paraspinal muscle, or enter the retroperitoneum and paracharous lymph nodes

Rectum

Local tumors in the rectum or recurrences involving the presacral plexus may cause pain usually associated with an urgent need for defecation. This pain may, rarely, return as phantom pain after surgical removal of the rectum, although pain within weeks of surgical removal of the rectum is usually surgical neuropathic pain (described in one study as spontaneous, intermittent, mild to moderate photographing and exploding, or tight and pain), and pain that appears after three months (described as deep, sharp, painful, intense, and persistent, exacerbated by sitting or pressure) usually indicates a recurrence of the disease. The appearance of pain when standing or walking (described as "dragging") may indicate a deeper recurrence involving muscle or fascial attachment.

Serous Mukosa

Peritoneal carcinosis can cause pain through inflammation, irregular visceral motility, or metastatic pressure on the nerves. Once the tumor has penetrated or perforated cavities viscera, acute peritoneal inflammation appears, inducing severe abdominal pain. Pleural carcinomatosis is usually painless.

Soft-tissue

Soft tissue invasion by tumors can cause pain by inflammatory or mechanical stimulation of nociceptors, or destruction of movable structures such as ligaments, tendons and skeletal muscles.

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Diagnostic procedure

Some diagnostic procedures, such as venipuncture, paracentesis, and thoracentesis can be painful.

Lumbar Puncture

In lumbar puncture, a needle is inserted between two lumbar vertebrae, via the dura mater and arachnoid membrane surrounding the spinal cord into the fluid-splitting space between the arachnoid membrane and the spine. cables (subarachnoid cavities), and cerebrospinal fluid (CFS) are drawn for examination. In one study, 14 percent of patients felt pain in lumbar puncture. (fig 5)

Post-dural-puncture headache

In some patients, subsequent CSF leakage through puncture dura mater causes a decrease in CSF levels in the brain and spinal cord, leading to the development of post-dural puncture headache (PDPH). ) hours or days later. Onset occurred within two days in 66 percent and in three days in ninety percent of cases of PDPH. It happens very rarely as soon as a prick that other possible causes should be investigated when it happens.

Severe headache and is described as "burn and spread like hot metal," which involves the back and front of the head, and spreads to the neck and shoulders, occasionally involving neck stiffness. This is exacerbated by movement, and sitting or standing, and relieving to some degree by lying down. Nausea, vomiting, pain in the arms and legs, hearing loss, tinnitus, vertigo, dizziness and paresthesia of the scalp are common.

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Related to care

Potentially painful cancer treatments include immunotherapy that can produce joint or muscle pain; radiotherapy, which can cause skin reactions, enteritis, fibrosis, myelopathy, bone necrosis, neuropathy or plexopathy; chemotherapy, often associated with mucositis, joint pain, muscle pain, peripheral neuropathy and abdominal pain due to diarrhea or constipation; hormone therapy, which sometimes causes painful flares; targeted therapies, such as trastuzumab and rituximab, which can cause muscle, joint or chest pain; An angiogenesis inhibitor such as bevacizumab, known to occasionally cause bone pain; and surgery, which can produce post-operative pain, post-amputation pain or myalgia on the pelvic floor.

Chemotherapy

Chemotherapy can cause mucositis, muscle pain, joint pain, abdominal pain caused by diarrhea or constipation, and peripheral neuropathy

Peripheral neuropathy induced by chemotherapy Between 30 and 40 percent of patients undergoing chemotherapy have chemotherapy-induced peripheral neuropathy (CIPN): stinging tingling, severe pain, and cold hypersensitivity, starting in the hands and feet and sometimes continuing to the arms and legs. Chemotherapy drugs associated with CIPN include thalidomide, epothilone such as ixabepilone, vinca alkaloids vincristine and vinblastine, paclitaxel taxanes and docetaxel, proteasome inhibitors such as bortezomib, and platinum-based cisplatin, oxaliplatin and carboplatin drugs. Whether CIPN appears, and to what extent, is determined by the choice of drug, duration of use, total amount consumed and whether the patient already has peripheral neuropathy. Although the symptoms are mainly sensory - pain, tingling, numbness and temperature sensitivity - in some cases affected motor nerves, and sometimes, too, the autonomic nervous system.

CIPN often follows the first dose of chemotherapy and increased severity with ongoing care, but this development usually decreases after treatment is completed. Platinum-based drugs are the exception; with these drugs, the sensation may continue to worsen for several months after the end of treatment. Some CIPNs seem to be irreversible. Pain can often be helped with medication or other treatments but numbness is usually resistant to treatment. A 2007 American study found that most patients do not remember being told to expect CIPN, and doctors who monitor the condition rarely ask how it affects daily life but focuses on practical effects such as dexterity and gait.

Mucositis

Cancer drugs can cause biochemical changes in the mucous membrane resulting in severe pain in the mouth, throat, nasal passages, and gastrointestinal tract. This pain can make talking, drinking, or eating difficult or impossible.

Muscle and joint pain

Withdrawal of steroid drugs may cause joint pain and spreading muscle pain accompanied by fatigue; these symptoms disappear by restarting steroid therapy. Chronic steroid therapy may cause aseptic necrosis of the humoral or femoral head, resulting in shoulder or knee pain that is described as blunt and painful, and reduce the movement or inability to use the arm or hip. Aromatase inhibitors can cause diffuse and painful muscles and joint stiffness, and may increase the likelihood of osteoporosis and consequent fractures.

Radiotherapy

Radiotherapy can affect the connective tissue that surrounds the nerves, and can damage or kill white matter or gray matter in the brain or spinal cord.

Fibrosis around the brachial or lumbosacral plexus

Radiotherapy can produce excessive fibrous tissue growth (fibrosis) around the brachial or lumbosacral plexui (nerve group), which can cause damage to the nerves over time (6 months to 20 years). This nerve damage can cause numbness, "pins and needles" (dysesthesia) and weakness of affected limbs. If the pain develops, it is described as pain spread, severe, burning, increasing over time, part or all of the affected limb.

Spinal cord damage

If radiotherapy includes the spinal cord, changes may occur that may not become apparent until some time after treatment. "Delayed early induced delayed ureopathy" may manifest from six weeks to six months after treatment; the usual symptoms are the sign of Lhermitte ("numbness, tingling, and often electrical dissatisfaction, such as coming from the neck to the spine and extremities, triggered by neck flexion"), usually followed by improvements two to nine months later. onset, although in some cases the symptoms persist for a long time. "Slow-induced slow-induced myelopathy" may occur six months to ten years after treatment. The typical presentation is Brown-SÃÆ' Â © quard syndrome (motion and numbness problems to touch and vibration on one side of the body and loss of pain and temperature sensation on the other). Onset may be abrupt but usually progressive. Some patients improved and others worsened.

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The work cited

• Fitzgibbon, DR; Loeser, JD (2010). Cancer Pain: Assessment, diagnosis and management . Philadelphia. ISBNÃ, 1-60831-089-2.

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References

Source of the article : Wikipedia