COMMENTARY

Cancer vs Noncancer Pain: Time to Shed the Distinction?

Charles E. Argoff, MD

Disclosures

July 23, 2013

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Cancer vs. Noncancer Pain

This is Dr. Charles Argoff, Professor of Neurology at Albany Medical College and director of the Comprehensive Pain Management Center at Albany Medical Center in Albany, New York.

What exactly is the difference between chronic cancer-related pain and chronic non-cancer-related pain? Do we have a construct that we can use that helps us to distinguish that, and are we really helping ourselves in addressing the needs of our patients, and are we helping ourselves by making a clear dichotomy when the dichotomy may not exist in a chronic setting? Let's talk about acute pain related to cancer.

If someone has a cancer-related surgery, direct tumor involvement, or a procedure related to a cancer-related matter and develops pain for several weeks, that can be attributed to various processes associated with cancer, depending upon the type of pain. Similarly, if someone sprains his or her ankle and has several weeks of acute pain not related to a cancer-related process (a sports injury, for example), that ankle sprain is clearly not cancer-related.

But let's think about the patients whom we are seeing on a regular basis in our practices and who are seeking help. Do we help those people by thinking that we can put them into neat boxes and make a dichotomy between cancer-related and non-cancer-related pain? Let's think about such a situation -- a common form of cancer in women -- and this could be extended to other situations.

Let's think about a woman with breast cancer who has persistent pain after being cured of her cancer with radiation following surgery and chemotherapy. Those therapies led to her being cured, and she has been in remission for more than 10 years. She has been told that she is cured, and she nevertheless continues to experience very severe pain, especially in her distal lower extremities, compromising her quality of life. Would this be chronic cancer-related pain?

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