Surgery is often a critical part of cancer treatment, but it can bring significant pain along with the healing. While removing tumors or affected areas is crucial, it often leaves patients with pain as a common side effect.
As part of Red Butte Pain Solutions‘ ongoing series on managing pain from cancer treatments, today we will focus on the types of pain that can follow cancer surgery. We’ll discuss effective ways to manage it, reduce its impact, and improve your quality of life.
Let’s dive into what causes post-surgical pain and how you can find relief.
Why Cancer Treatment Pain Follows Surgery
For many cancer patients, surgery is one of the primary ways to eliminate or reduce cancer cells. However, surgery impacts the body in several ways. Surgeons often remove large amounts of tissue, sometimes including muscle, nerves, and even bone, depending on the location and extent of the tumor. This can leave patients with discomfort and soreness as the body begins to heal.
Moreover, every surgical incision causes tissue damage, which naturally leads to pain. Post-surgical pain, therefore, is not only common but expected in most cases. However, knowing what type of pain to expect and how to handle it can make the healing process easier.
Types of Pain After Surgery for Cancer Treatment
Post-surgical pain is not the same for every patient. It can vary widely depending on the type of surgery, location, and individual pain tolerance. Below are some of the most common types of pain experienced after cancer surgery.
Acute Pain
Acute pain is often the most immediate type of pain after surgery. It typically begins right after the procedure and can be sharp, intense, or throbbing. While acute pain usually starts to improve within days to weeks, it can be uncomfortable. For many patients, this pain is most intense around the incision site or near the area where tissue was removed.
Chronic Pain
For some cancer patients, post-surgical pain may turn chronic, lasting months or even years after the procedure. Chronic pain from surgery may result from nerve damage or scar tissue. For instance, after breast cancer surgery, some patients report ongoing pain in the chest wall or underarm due to nerve sensitivity or scar tissue formation. Managing chronic pain usually requires a longer-term approach, combining medications, therapy, and possibly additional procedures.
Neuropathic Pain
Neuropathic pain occurs when surgery impacts the nerves. This type of pain feels different from others; many patients describe it as burning, tingling, or “electric shock” sensations. Because neuropathic pain can be particularly challenging to manage, specialized treatments like nerve blocks, specific medications, or even spinal cord stimulation may be required for relief.
Phantom Pain
Phantom pain is a unique type of pain that can occur after an amputation, whether it involves a limb or part of the body. This condition causes patients to feel pain in a body part that no longer exists. Although the pain isn’t coming from an actual injury, it feels very real and can be severe. Phantom pain is still not entirely understood, but treatment options are available to help patients cope with it.
Factors That Affect Pain After Cancer Surgery
The level and type of post-surgical pain vary due to several factors. Here are some that play a major role:
- Type of Surgery Performed: Different procedures have different impacts. A minor biopsy may cause little pain, while a major abdominal surgery may be much more intense.
- Location of the Surgery: Areas with many nerves, like the head, chest, or abdomen, are more prone to post-surgical pain.
- Extent of Tissue Removal: The more tissue removed, the greater the potential for pain. Removing large tumors often requires larger incisions and more extensive tissue removal.
- Nerve Involvement: When surgery involves cutting through or near nerves, the risk of neuropathic pain increases.
- Pre-existing Health Conditions: Patients with conditions like arthritis or diabetes may experience more intense or long-lasting pain.
Understanding these factors can help patients and their care teams prepare for potential post-surgical pain and plan appropriate pain management strategies.
How Cancer Treatment Pain Impacts Recovery
Pain following surgery doesn’t just affect the surgical site; it can impact a patient’s whole recovery experience. Let’s take a look at some of the ways pain affects healing and quality of life:
- Limited Mobility: Pain often limits physical movement, making it harder to stay active during recovery. Reduced mobility can slow healing and increase the risk of complications like blood clots.
- Poor Sleep Quality: Many patients report difficulty sleeping due to pain, which can delay the healing process. Lack of sleep often leads to fatigue and emotional challenges.
- Emotional Impact: Persistent pain can take a toll on mental health, leading to stress, anxiety, or even depression. Staying positive during recovery can be tough when pain is a constant presence.
- Reduced Appetite: Pain may reduce appetite, leading to poor nutrition and slower healing. When patients aren’t getting the nutrients they need, their bodies can’t recover as quickly.
Each of these effects underscores the importance of effective pain management. By keeping pain under control, patients are better equipped to recover fully and maintain a positive outlook.
Role of the Anesthesiologist in Managing Cancer Treatment Pain
Anesthesiologists play a vital role in pain management during and after cancer surgery. Their expertise goes beyond simply ensuring patients remain comfortable during surgery; they also employ specialized techniques to reduce pain after surgery and even minimize the risk of developing chronic pain. Here are several strategies that anesthesiologists use to enhance pain control:
Regional Anesthesia Techniques
For certain surgeries, anesthesiologists may use regional anesthesia, which involves numbing a specific area of the body. This technique, such as a nerve block or epidural, can effectively reduce pain immediately after surgery and may even provide pain relief for hours or days afterward.
- Nerve Blocks: Nerve blocks involve injecting anesthetic directly around the nerves responsible for sensation in the surgical area. By blocking these pain signals before they reach the brain, nerve blocks offer significant relief both during and after surgery. Patients undergoing surgeries on the arms, legs, chest, or abdomen often benefit from nerve blocks.
- Epidural Anesthesia: Often used for abdominal or pelvic surgeries, epidurals deliver continuous anesthesia near the spinal cord. The anesthetic is delivered through a small catheter, allowing it to provide ongoing pain relief. Epidural anesthesia not only keeps patients comfortable post-surgery but may also reduce opioid requirements, minimizing their side effects.
By reducing the immediate intensity of pain following surgery, regional anesthesia techniques can help lower the risk of chronic pain developing. Research suggests that well-managed acute pain is less likely to become chronic, as lower initial pain levels reduce sensitization in the nervous system.
Multimodal Pain Management
Multimodal pain management is an approach that combines multiple pain relief methods to improve overall control. Anesthesiologists often use a combination of medications to target pain from different angles, reducing reliance on any single drug. This strategy allows for effective pain relief with lower doses, thus reducing potential side effects.
- Combination of Medications: For instance, an anesthesiologist might use a mix of NSAIDs, acetaminophen, local anesthetics, opioids, and, if necessary, low doses of ketamine. Each medication targets a different aspect of pain, working together to provide better relief.
- Preventive Analgesia: Anesthesiologists sometimes administer pain-relieving medications before surgery begins. This approach, known as preventive analgesia, can “pre-empt” the pain response, effectively lowering post-surgical pain levels.
Because multimodal pain management reduces the need for high doses of opioids, it also lessens the risk of opioid-related side effects, such as nausea, constipation, and sedation. Additionally, patients may experience a smoother recovery with fewer complications.
Patient-Controlled Analgesia (PCA)
Patient-controlled analgesia (PCA) is a method that allows patients to manage their own pain relief after surgery. A PCA device delivers a controlled dose of pain medication (often an opioid) when the patient presses a button. Limits are set to prevent overdose, and patients feel empowered to control their pain.
The benefit of PCA is that patients don’t have to wait for a nurse or doctor to administer pain medication. Instead, they can manage their own discomfort, leading to better pain control and potentially faster recovery. Studies suggest that PCA may reduce anxiety about pain and improve overall satisfaction with pain management, as patients can take charge of their comfort levels.
Continuous Infusion Techniques
In addition to nerve blocks or epidurals, anesthesiologists may use continuous infusion techniques to provide ongoing pain relief. For example, continuous nerve blocks can be administered through a catheter, delivering a steady dose of anesthetic to the area.
- Benefits of Continuous Infusion: By maintaining a consistent level of pain control, continuous infusion prevents pain from spiking and can reduce the need for additional pain medications. This technique is particularly helpful for patients who may need prolonged pain relief after surgery, as it maintains stable comfort levels without frequent dosing.
Continuous infusion techniques help to stabilize post-operative pain, reducing the “pain memory” that sometimes contributes to chronic pain. By keeping pain levels low, these techniques may help reduce the risk of developing long-term pain after surgery.
Non-Pharmacological Interventions
Your team may also recommend non-pharmacological techniques to support pain relief, in combination with medication. These methods provide complementary support for pain management and can enhance the effectiveness of other treatments.
- Cold and Heat Therapy: Applying cold packs to the surgical site can reduce inflammation and numb pain, while heat can ease muscle stiffness.
- Relaxation Techniques: Breathing exercises, guided visualization, and relaxation techniques can be beneficial for managing pain perception. These practices help reduce stress and anxiety, which can otherwise heighten pain levels.
- Physical Therapy Involvement: Early engagement with physical therapy can also aid in recovery and reduce pain levels. Working closely with a physical therapist can prevent muscle stiffness, improve flexibility, and support faster healing.
Using non-pharmacological methods alongside other pain management strategies offers patients a well-rounded approach to pain control. By incorporating these practices, patients often feel more comfortable and experience a sense of control over their recovery process.