Hematologic Cancer Pain

Abstract

Hematologic cancers represent about 10% of new cancer diagnoses annually in the United States and account for a comparable number of US cancer deaths each year. These patients experience an array of acute and chronic pain syndromes that appreciably impair their quality of life. The pathogenesis, management, and complications of multiple myeloma, lymphoma, and leukemia are reviewed to provide a better understanding of the underlying pain processes. Skeletal-related events due to bony involvement, including pain, pathologic fractures, hypercalcemia, and spinal cord compression, along with renal insufficiency, represent a significant portion of complications faced by multiple myeloma patients. Opioids continue to be the foundation of cancer analgesia in accordance with the World Health Organization three-step analgesic ladder. Many of the long-term complications in lymphoma patients are due to treatment with toxic chemotherapy regimens along with radiation. Many of the complications seen in leukemia are nonspecific and common to cancer and its treatment in general. Bone pain is common for a number of reasons in leukemia, typically manifesting as a throbbing deep and dull ache. An array of pain syndromes develop from diagnosis through cancer survival that command a multifaceted management approach. This review contains 7 tables, 3 figures and 40 references.