Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer

Chronic Pain after Cancer Treatment
Pain is a common experience during cancer treatment, either from the cancer itself or from the treatment. Usually,
after the treatment is finished, there is no more pain. For some people, however, pain continues to be a side effect ofeither the cancer or its treatment, even when the cancer is in remission and treatment has been completed. For cancer
survivors, long-term pain may occur for a variety of reasons, such as damage to bones, joints, or nerves resulting fromtreatment with radiation, surgery, certain chemotherapy medications, or corticosteroids.
What is the difference between acute and chronic pain?
Acute pain is generally the result of illness (such as cancer), injury and/or surgery and is usually confined to a limited
period of time. Acute pain has a biologic purpose, that is, it tells us that we are hurt or ill, so that we can protect
ourselves.
Chronic pain lasts after the underlying illness or injury has resolved. Chronic pain is a problem because the longer thepain lasts, the more complicated it might become, particularly in the way it could affect a survivor’s quality of life.
Pain is very complex
Healthcare providers used to think that the amount of pain a person had was directly related to the extent of physicaldamage to body tissue. Healthcare providers now know that the pain people feel is affected by many physical,emotional, and cognitive factors that are unique to everyone.
Recent studies involving new technology to study the brain are confirming that many processes are involved in chronic
pain. The experience of pain is the result of a complex interchange of information from many different areas of thebrain. These studies have also helped us to understand that pain can sometimes persist (even when the original injury
has healed) due to changes in the way the body sends and receives pain signals.
Healthcare providers have learned that different people perceive pain in different ways. These differences can be seenin brain imaging studies as individuals rate their pain to the same source of pain, or “stimulus.” That is, some people
seem to be very sensitive, whereas others may report little pain even with the same stimulus. While you might be bornwith some of these differences, environmental factors tend to play an important role too. Factors such as age, sex,
developmental level, family and cultural traditions, prior pain experience, and circumstances surrounding the injury allcontribute toward how a cancer survivor might interpret, experience, and cope with pain.
Pain and Psychological Health
Psychological factors play a role in the amount of distress that is experienced, or how upsetting the pain might be toeach individual. Furthermore, other factors, such as family or work environment, can also affect the ability to cope withpain.
In the case of chronic pain that lasts for months and years, it is possible for cancer survivors to become increasingly
depressed if they don’t have ways to cope with the pain in a healthy way. Survivors with pain may sometimes become
frustrated and angry, especially if pain is preventing them from doing activities that they used to enjoy. If a survivor
believes that pain controls his or her life, then they may begin to feel powerless, develop low self-esteem, and avoid
taking on challenges and opportunities for growth. Pain can develop into a troublesome cycle. For example, a survivor
might stop moving around and doing physical activities because they are afraid of triggering or worsening their pain.
However, the less active they are, the weaker their muscles become, which can then worsen the pain.

Copyright 2023 © Children’s Oncology Group. All rights reserved worldwide.

Chronic Pain | Version 6.0 | October 2023 | Page 1 of 2

Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer

Sometimes, people begin to anticipate the physical sensations of pain in a fearful way. They may withdraw from social orcommunity activities to avoid having to deal with pain in public situations, and they may increasingly isolate themselves.
Depression, anxiety, and chronic stress may follow, which can make the pain worse. This may also lead to physicalchanges in the body associated with stress, depression, and anxiety, which can lower the pain thresholds.
How is Pain Treated?
Fortunately, there are ways to manage and cope with chronic pain. Chronic pain can be treated with medicine, without
medicine using behavioral treatments (such as relaxation or meditation), or by a combination of the two. Non-medicine
treatments can be used along with medications to manage pain during and after cancer treatment. Studies of patients
suffering from chronic pain show that training in pain-coping skills can help increase self-confidence and reduce distressfrom pain. Changes in how a person copes with pain and what they believe about their pain may also produce positivechanges in behavior, such as increased exercise, improved pacing of activities, better results with medication, andincreased participation in social activities.
Behavioral skills can be helpful in treating and coping with pain. Specific techniques include relaxation, meditation,
guided imagery, distraction, and redirected thinking, as well as changing thoughts and beliefs about pain and what
it means. Other effective approaches include support groups, massage, music, and counseling focused on pain
management and behavioral modification.
Written by Sunita K. Patel, PhD, City of Hope Comprehensive Cancer Center, Duarte, CA.
Reviewed by Kayla L. Foster, MD, MPH; Beth Fisher, DNP, APRN, CPNP; and Melissa Acquazzino, MD, MS.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or youngadulthood.
Disclaimer and Notice of Proprietary Rights
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health Links
were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’s Oncology
Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding a medicalcondition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.
To physicians and other healthcare providers: The Informational Content is not intended to replace your independent clinical judgment, medical advice, or to exclude other legitimate criteria
for screening, health counseling, or intervention for specific complications of childhood cancer treatment. Neither is the Informational Content intended to exclude other reasonable alternative
follow-up procedures. The Informational Content is provided as a courtesy, but not intended as a sole source of guidance in the evaluation of childhood cancer survivors. The Children’s Oncology
Group recognizes that specific patient care decisions are the prerogative of the patient, family, and healthcare provider.
No endorsement of any specific tests, products, or procedures is made by Informational Content, the Children’s Oncology Group, or affiliated party or member of the Children’s Oncology Group.
No Claim to Accuracy or Completeness: While the Children’s Oncology Group has made every attempt to assure that the Informational Content is accurate and complete as of the date of publication, nowarranty or representation, express or implied, is made as to the accuracy, reliability, completeness, relevance, or timeliness of such Informational Content.
No Liability on Part of Children’s Oncology Group and Related Parties/Agreement to Indemnify and Hold Harmless the Children’s Oncology Group and Related Parties: No liability is assumed by theChildren’s Oncology Group or any affiliated party or member thereof for damage resulting from the use, review, or access of the Informational Content. You agree to the following terms of indemnification: (i)“Indemnified Parties” include authors and contributors to the Informational Content, all officers, directors, representatives, employees, agents, and members of the Children’s Oncology Group and affiliatedorganizations; (ii) by using, reviewing, or accessing the Informational Content, you agree, at your own expense, to indemnify, defend and hold harmless Indemnified Parties from any and all losses, liabilities, ordamages (including attorneys’ fees and costs) resulting from any and all claims, causes of action, suits, proceedings, or demands related to or arising out of use, review or access of the Informational Content.
Proprietary Rights: The Informational Content is subject to protection under the copyright law and other intellectual property law in the United States and worldwide. The Children’s Oncology Group retains
excursive copyright and other right, title, and interest to the Informational Content and claims all intellectual property rights available under law. You hereby agree to help the Children’s Oncology Group secure
all copyright and intellectual property rights for the benefit of the Children’s Oncology Group by taking additional action at a later time, action which could include signing consents and legal documents andlimiting dissemination or reproduction of Informational Content.

Copyright 2023 © Children’s Oncology Group. All rights reserved worldwide.

Chronic Pain | Version 6.0 | October 2023 | Page 2 of 2