Who wants to read about this, Joanne? Well frankly everyone. Pain is ubiquitous. While emotional and psychological pain is real and life altering, I want to address physical pain today, so lets get to it. Pain is the most common reason people present to their Docs.

Starting at the top, persistent headaches. If you have a cancer history be sure an MRI of the brain is performed to rule out brain metastasis. If its negative, migraine meds, sinus allergy drugs help. For severe I use a short course of steroids to knock down the inflammation – just about everywhere.

Head and neck pain: Patients undergoing radiation and chemo for head and neck cancers have severe mucositis which is inflammation of the throat, tongue and esophagus. They need prescription magic mouthwash and anti- fungals. For patients on chemo or antibiotics, they kill off the normal bacteria allowing our normal thrush to grow, so for every patient with complaints we check their tongue- easy for you. If it’s white, you need an antithrush medications (nystatin, clotrimazole troches or fluconizole tabs). A way to keep this from happening is 1/2 tsp coconut oil twice a day- it’s anti thrush and antibiotic properties help.

Chest: David is frightened as he describes the persistent mid chest burning. I can assure him it is not heart related. Since his treatment is esophageal, its all esophagitis and need for anti thrush meds and carafate (which acts like a sealant to the mucosa) very helpful. If his pain was on the side- then it may be rib so he needs an xray to be sure bone mets are ruled out. Ribs, thigh or arm are not joints they don’t get the overuse so “non joint pain” is bone mets til proven otherwise for a cancer patient.

Abdominal and pelvic: My rule is anything that comes and goes is ok- don’t panic but anything that grows, then keeps you up and is relentless,etc is cancer til proven otherwise. A Doc thought he had a stomach problem coming off his 25 year anniversary cruise. Thank goodness he asked for a CT- unfortunately it was pancreatic cancer, a shocker but he is now under treatment doing well.

Cancer causes a hyper coagulable state in the body with increased protein-C. Some patients’ presenting symptom is a blood clot in the leg. Pain, swelling in one leg are the symptoms. Docs check to see if there is a “positive Homan’s sign”: if there is pain in the calf when you flex your foot. This needs an ultrasound and blood thinners.

Bone lesions are common in stage 4 cancer and will show up on a bone scan, pet CT and PSMA ( for prostate) scans but also xrays. While joint pain is usually arthritis, back pain is more challenging, especially in a patient with advanced cancer so I always ask for an MRI.

Narcotics mask pain. If you have a problem, seek a work up, not a medication. We must know what is the cause because you can’t take these drugs forever- let’s fix the issue. The stronger your muscles, the less your joints and bones need to work so keep walking, exercising and strengthening.

Radiation treatments are used daily for bone metastasis and highly effective. Patients can often return to their normal activity, so don’t fear the beam. Do not let your providers “write you off”. You must be an aware patient and even demand a workup. Using words like, “Oh, I’ve always had back pain” suggests that you do not need attention. Scanning is my favorite tool. Before getting a spinal injection, get an MRI. Kyphoplasty (bone building injections) can rebuild an acutely fractured spine and really relieve pain. Several patients come in after having chiropractic services. While they can be useful and helpful, the patient must be sure someone has ruled out disease especially with a cancer history.

We will all have pain. Often it will be fleeting and we will put our big people pants on and tough it out. If you have a diagnosis of cancer and the pain remains, then it’s time to insist on a scan. You have every right to live your most comfortable life.