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When Pain Persists

Posted 9/9/2016

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  First, an apology for somewhat abbreviated entries this week. As some of you know, we have been at our cottage in Maine which is perfect in every way except for the internet connection. A satellite connection is the best available option, and it is not so good. Some days are better than others, and I used to think it was weather related: if there were clouds, it was worse. Today the sun is shining, and it is gorgeous, but the connection has been making me nuts. It fades in; it fades out. Everything is slow...

  And this is an important topic. The best estimate is that up to 40% of cancer survivors live with chronic pain.

  In my practice, this usually means surgical pain that never disappears or peripheral neuropathy from chemotherapy The surgical pain is often related to breast reconstruction post mastectomy, but I have heard lots of stories from women who had other kinds of surgery and have persistent pain for months and years. The neuropathy, usually from one of the Taxanes, is highly variable, but some people are really uncomfortable and eve limited in activities

  Given my ongoing fight with the internet, I am going to stop here and give you the beginning and the link to an excellent article from Cancer Net. There sadly are not a lot of solutions, but there is increasing attention being paid to the problem, so we can hope that that help will come.

When Pain Persists During or After Cancer Treatment

  · Lidia Schapira, MD, FASCO
It is difficult to talk about pain. It can be impossible to find words to describe unpleasant or unbearable feelings and sensations. Pain is subjective and fluid. It may be incapacitating one moment and gone the next, or it can be a constant and unwelcome companion. Researchers who study pain understand this very well and consider pain when they design clinical trials. Some people believe that pain is a natural aspect of being human and are prepared to accept some pain for some time. For others, pain is frightening and devastating and something that must be extinguished using whatever means available.

For those who have lived with cancer, it is no surprise that cancer-related pain often continues for months or years after treatment has ended. A panel of experts convened by the American Society of Clinical Oncology (ASCO) recently published an important guideline on chronic pain in survivors of adult cancers. These experts performed an exhaustive review of the scientific literature and provided recommendations for management of chronic pain. I was surprised to read that as many as 40% of cancer survivors in the United States report living with chronic pain. This fact serves as an important reminder to all of us that being cured of cancer carries a high price. Similarly, the shadow of pain follows those living with cancer as a chronic illness, who have an uncertain future or face relapses and periods of remission.


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