Pain is a distressing symptom of lung cancer that harms the quality of life. People with untreated pain might have trouble sleeping and eating and feel tired. They might also have trouble thinking clearly and doing things they enjoy. Not being able to manage pain makes it hard for people to spend time with friends and family, making them feel alone and sad. Here, we discuss the lung cancer pain that patients suffer.
Which pain do lung cancer patients experience most prominently?
Lung cancer patients predominantly experience chest pain. Almost 50% of lung cancer cases experience chest pain at the time of diagnosis. Usually, the pain develops on the side of the primary tumour. It develops as a dull, regular pain. However, the pain is severe when the primary tumour invades the lung lining or chest wall. Most non-small cell lung cancer (NSCLC) patients with chest wall migration endure chest pain.
Does lung cancer cause pain in the ribs?
In an advanced stage, cancer can spread from the lungs to bones like the ribs, spine, breastbone, shoulder blade, femur, and humerus. Either the spread occurs through the blood or lymph system. Around 20% of patients with NSCLC and 30 to 40% of patients with SCLC present bone pain due to cancer spread. Thus, lung cancer can cause pain in the ribs.
What are Pancoast tumours, and are they associated with pain?
Pancoast tumours are a type of lung cancer. Around 3-5% of lung cancers are Pancoast tumours. All of them are NSCLC type.
In Pancoast tumours, cancer is present at the top of the lungs. They also invade the apex of the chest wall. Up to 96% of patients suffer from lung cancer pain between shoulder blades. The pain is due to the spread of the cancer. It may even radiate to the head, neck, chest, and arms.
What is post-thoracotomy pain syndrome (PTPS)?
There is a possibility that lung cancer patients who undergo surgery as treatment end up developing persistent pain. Studies suggest that between 25 and 60% of patients undergoing chest surgery may develop long-lasting pain. The condition is called PTPS if the pain remains until 2 months after the surgery. Pain is moderate to severe, sometimes like numbness, tingling, burning, or itching. Lung cancer pain areas stay in one or more areas on the skin.
What are the ways to manage lung cancer pain?
WHO has created a stepwise approach for cancer pain management:
- In step 1, the advice includes use of paracetamol or a non-steroidal anti-inflammatory medicine like ibuprofen.
- In step 2, WHO recommends the use of weak opioids
- If the patient is in severe pain, then it recommends the use of strong opioids. The first line of strong opioids is morphine.
Other than medicines, doctors may perform interventional procedures for pain management. One such procedure reversibly blocks a nerve (source of pain) by injecting a drug. Such a nerve blockade provides short-term relief.
Surgeons may opt for a surgical procedure to kill nerve endings that send pain signals (rhizotomy). They choose this procedure in cases of chest wall pain due to tumour invasion.
It is best to consult a team of oncologists for a patient to choose the right course of action for lung cancer pain.
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