Many patients report joint pain after chemotherapy. First of all, this condition is associated with the introduction into the body of complex chemical drugs that affect not only cancer cells, but also healthy ones. Passing through the bloodstream, the active components affect all organs and systems, provoking an inflammatory process.
Causes and mechanism of pain development
A course of chemotherapy involves the regular administration of a large number of chemicals, which in their composition are considered poisons. By combining with blood cells, the medicine spreads throughout the body. The autonomic nervous system, as well as parts of the brain and spinal cord, are affected. In this regard, pathological pain develops in the back, legs and arms.
Chem. the drugs negatively affect the condition of the bone marrow tissue and provoke active cell decay. In this case, inflammation develops, which leads to dysfunction of the spine and large joints of the legs, and causes periodic systemic pain.
A common cause of joint pain after chemotherapy is the development of a pathology such as polyneuropathy. It develops both as a result of an adverse reaction to drugs and during intoxication of the body after the active breakdown of cancer cells, which increases systemic inflammation. The mechanism of pain development is a negative effect on nerve fibers, which leads to their damage. Impaired functionality is either temporary or permanent and can cause disability. The main symptoms of polyneuropathy are pain in the joints of the arms and legs, body aches, muscle pain and increased sensitivity of the skin.
A side effect of chemical drugs in the joints is inflammation - arthritis.
Under the influence of chemicals, metabolic processes are disrupted, which can cause the development of diabetes. When the disease occurs, inflammatory processes occur in the joints, which provoke the formation of arthritis. If the pain becomes constant and its intensity increases, this indicates the development of serious degenerative disorders in the osteochondral tissue.
Symptoms of body intoxication during chemotherapy
Damage to the bone marrow during chemotherapy leads to disruption of the hematopoiesis process. This is manifested by a change in the blood picture, in particular, a decrease in the level of leukocytes (leukopenia), red blood cells (erythrocytes), and hemoglobin levels.
The immune system suffers from chemotherapy. This is manifested by frequent infectious diseases of the respiratory tract, the rapid development of complications of acute respiratory viral infections, acute respiratory infections (in particular, pneumonia), recurrent herpes, the manifestation of fungal infections and other signs of reduced immunity.
Intoxication of the body during chemotherapy is manifested by symptoms such as:
- nausea, vomiting,
- loss of appetite (anorexia),
- weight loss,
- weakness,
- high fatigue.
Along with these symptoms, chemotherapy may cause:
- hair loss,
- diarrhea,
- shortness of breath,
- blue skin (cyanosis),
- stomatitis (formation of ulcers in the mouth),
- development of esophagitis, gastritis, enterocolitis,
- anemia,
- frequent urination,
- menstrual irregularities and functional ovarian failure in women,
- functional testicular failure in men, impaired spermatogenesis,
- development of polyneuropathy,
- mental disorders,
- dermatitis,
- the occurrence of allergies.
Request a call back. We know how to help
Message sent!
expect a call, we will contact you shortly
Diagnosis of joint pain after chemotherapy
If pain of any nature develops, you should consult an oncologist. After collecting a complete history, the patient is sent for examination to determine the cause of the pathological condition. For joint pain, the following studies are carried out:
- Biochemical and general blood test. Determines the quantitative ratio of elements, which makes it possible to establish the presence of inflammation in the body.
- Radiography. Diagnoses structural changes in osteochondral tissue, if any.
- MRI and CT. The most informative diagnostic methods are capable of identifying even minimal disturbances in the structure of the joints.
- Study of synovial life. It is carried out after confirmation of degenerative changes in bones and cartilage.
Basic treatment
Diuretics are used to remove excess fluid from the joints.
Before starting to treat systemic pain, the doctor selects the optimal drugs that can be combined with drugs that are used for chemotherapy. Non-steroidal anti-inflammatory drugs are used. Warming gels with a local anesthetic effect are used. If there is swelling in the area of the affected joints, diuretics are used, which help accelerate the release of fluid and eliminate congestion. In the event of the development of degenerative disorders in osteochondral tissue, means are used aimed at restoring cartilage cells. Particular attention is paid to vitamin and mineral complexes. The intake of calcium, vitamin D and group B increases. To improve the body's protective functions, drugs are prescribed to increase hemoglobin levels.
Other therapeutic measures
To normalize blood circulation, improve local trophism and return normal mobility to joints, exercise therapy is used. Exercises should be done slowly with a small amplitude. To reduce swelling and pain in the joints, especially the lower extremities, traditional medicine is used. Infusions and decoctions of medicinal herbs are used.
If there is poor circulation in the joints, use chestnut tincture for rubbing. To do this, 100 g of fruit is poured into 1 liter of vodka or alcohol, and left to infuse in a cool place for one month. The product is used daily for several weeks.
Treatment of joint pain involves following the diet prescribed by the oncologist. If necessary, the doctor makes adjustments to the diet. To improve the condition of osteochondral tissue, increased amounts of vegetables, sea fish and dairy products are introduced. To reduce the load on the body and prevent the accumulation of toxins, the consumption of foods containing carcinogens and trans fats is minimized.
Oncological diseases today are very common among people of different genders and ages. Often, a method such as chemotherapy is used to treat pathology. But it affects not only pathological but also healthy cells, causing many complications. One of the negative consequences is joint pain after chemotherapy. This often indicates that the cancer has spread to the bones. Also, commonly used chemicals that are repeatedly administered in large quantities have a toxic effect on the body, causing pain in the limbs, back and head.
- Why leg pain is possible after chemotherapy and how to cope with it
Life after "chemo"
Chemotherapy is one of the most effective forms of cancer treatment. It helps kill a dangerous and insidious enemy, but along with cancer, “chemistry” can also affect healthy tissues and organs.
Side effects of chemotherapy drugs affect all patients without exception. How to recover from toxic treatment and return to a full life?
The reaction is immediate, unfavorable
The main difference between malignant cells is their ability to grow rapidly. Chemotherapy drugs “find” rapidly dividing cells and attack them.
At the same time, they, alas, do not take into account that some healthy cells of the body can divide quite quickly, in particular, cells of hair follicles, blood, and epithelium of the digestive tract. They are the first to be hit by chemotherapy drugs.
By affecting the bone marrow, chemotherapy leads to a decrease in the level of leukocytes, platelets, and red blood cells. Clinically, this is manifested by fatigue, malaise, a tendency to bleed, and an increased risk of contracting various infections.
By damaging the cells of the mucous membrane of the digestive tract, “chemistry” causes the development of stomatitis and ulcers. They are accompanied by nausea, changes in taste, and loss of appetite. One of the most notorious side effects of chemo is damage to the hair follicles and subsequent hair loss.
The above list is far from complete: it includes dozens of adverse reactions affecting various organs and systems. They are united by one common property - temporary, transient nature.
Of course, during chemotherapy treatment, doctors monitor indicators and, if necessary, adjust the treatment regimen, introduce new drugs that help alleviate the condition, but the body carries out the main “restorative work” itself.
New hair growth begins within a few weeks after chemotherapy. Healthy bone marrow is restored and the number of blood cells returns to normal. Ulcerative formations in the oral cavity and digestive tract heal.
And yet, a person who has undergone chemotherapy needs long-term rehabilitation. To keep your quality of life high and the likelihood of relapse low, it is important to review your lifestyle and make adjustments if necessary.
What to change?
Physical activity
Regular exercise is an effective way to improve your condition after chemotherapy.
The American Cancer Society recommends that adults undergoing cancer treatment get at least 150 minutes of exercise per week, including strength training at least two days a week.
Some early research suggests that physical activity may help reduce the risk of cancer recurrence (1).
Important: Before starting an exercise program, you should consult with your doctor and agree on the level of exercise.
Diet
The menu after cancer treatment should be reviewed. It should be dominated by fruits, vegetables and whole grains.
For those who have undergone chemotherapy, it is recommended:
- At least 2.5 cups of fruits and vegetables every day. Cup - the amount of product that fits in the palm of your hand
- Healthy unsaturated fats found in vegetable oils, as well as omega-3 fatty acids. They are rich in fish and walnuts
- Proteins low in saturated fat, found in fish, vegetable oil, eggs, nuts, seeds, legumes
- Healthy carbohydrates - whole grains, legumes, fruits, vegetables.
Important: A complete, balanced diet ensures the supply of all necessary nutrients. But many experts are skeptical about taking vitamin supplements daily. Even if vitamins seem to be what you need, you should consult your doctor before you start taking them.
Body mass
During chemotherapy, many patients lose weight, and an important goal after treatment is to normalize it. The energy value of foods should be increased, given that high-calorie foods often contain a lot of saturated, unhealthy fats.
It is fundamentally wrong to try to increase body weight by increasing the content of fatty dairy and meat products.
Important: It is better to select a diet with a balanced benefit/harm ratio together with a nutritionist.
Rest mode
Difficulty getting proper rest and sleep is a common problem among those who have undergone chemotherapy. It is necessary to overcome them: adequate sleep helps ensure optimal functioning of organs and systems, increase cognitive capabilities, normalize hormonal levels and improve overall well-being.
To restore sleep, it is recommended:
- Avoid caffeinated drinks 8 hours before bedtime
- Stick to a daily routine
- Exercise no later than 2-3 hours before bedtime
- Avoid watching TV or working on the computer 1-2 hours before bedtime
- Provide comfortable sleeping conditions (dim the lights, eliminate loud sounds, etc.).
Important: You should not take sleeping pills without consulting your oncologist.
Stress management
All patients after chemotherapy need emotional rehabilitation. Using effective stress management strategies can improve quality of life and reduce the severity of symptoms of the underlying disease.
Causes of pain
The main cause of pain in the legs after chemotherapy is the use of chemotherapy drugs, which are administered in large doses to ensure the effectiveness of the therapy. Once they are introduced into the body, their components enter the bloodstream, come into contact with proteins and are dispersed throughout the body, affecting abnormal cells and healthy tissue. All cytostatics that are used to treat cancer provoke damage to the epithelium of the gastrointestinal tract, which is why stomach pain often occurs, and also disrupts the activity of the liver, kidneys and other vital organs and systems.
The negative effects of chemical drugs also include the appearance of peripheral neuropathic severe pain, which is provoked by the neurotoxic effect of cytostatics. They damage pain neurons of the peripheral nervous system, disrupt the conduction of signals from nociceptors, which are located in the skin, fatty tissue, muscles and joints, and periosteum. Therefore, the limbs and spine often hurt, osteochondrosis and other pathologies develop.
Diagnosis of the cause of pain syndrome
If a patient’s legs hurt after chemotherapy, the attending oncologist takes into account the dosage and type of drugs included in the chemotherapy regimen and suggests the likely cause of the pain.
Table of cytostatic drugs that provoke pain in the legs:
| Drugs | Possible complications |
| Vincristine | Bone pain |
| Methotrexate, Cisplatin | Toxic to the kidneys, can cause severe swelling |
| Paclitaxel | Causes tissue damage to muscles and joints |
| Doxorubicin, Idarubicin, Floxuredin, Cytarabine, Capecitabine, 5-Florouracil | Cause hand-foot syndrome |
However, an accurate diagnosis is not established solely by the list of side effects of cytostatics. The patient must be sent for additional diagnostics, during which the degree of damage to bone and joint tissue can be determined, as well as the presence or absence of secondary foci of cancer in the bones of the legs.
To determine the exact cause of pain, studies such as:
- extended blood test (kidney tests, blood glucose level test, less often - ionized calcium test);
- computed tomography and radiography of the affected area;
- ultrasonography.
Biochemistry and an extensive blood test make it possible to determine the degree of kidney damage, blood sugar levels (and, accordingly, the presence of uncompensated diabetes), as well as the concentration of blood cells in the patient’s body.
Joint pain can be caused, among other things, by a decrease in hemoglobin due to a decrease in the number of red blood cells, so oncologists in this case pay special attention to information about the concentration of red blood cells.
Cramps in the leg muscles are most often caused by a lack of calcium, so the patient may be prescribed a blood test for an ionized microelement in order to adjust the diet and the list of medications taken in case of deficiency.
Computed tomography allows, among other things, to detect even small secondary foci of malignant tumors in the bones of the legs. The cause of pain in the legs after the end of chemotherapy may be an exacerbation of the degenerative process in the joints (arthrosis) or the appearance of bone metastases of primary neoplasia.
Ultrasound is actively used for joint pain to exclude degenerative changes in their tissues.
Degree of pain
Depending on how much healthy tissue was damaged, the degree of pain may vary in intensity. This also depends on the dosage of the drugs, the duration of treatment, as well as on the individual characteristics of the cancer patient’s body. The main cause of headache is the influence of cytostatics, regardless of the above points. This phenomenon is always observed after chemotherapy. With the development of peripheral neuropathy, numbness and tingling of the toes are observed after a course of chemotherapy, pain develops in the back and lower back, in the lower and upper extremities, bones and muscles. They usually go away within three months after completion of therapy.
Note! Chemotherapy has a huge list of side effects. The development of pain is not the most dangerous complication; its disappearance is possible after some time.
ILBI
Intravenous laser blood purification is a physiotherapeutic method of treatment after chemotherapy. Blood purification is achieved due to the absorption of laser radiation by blood cells in the vascular bed.
To do this, a thin needle is inserted into the vein, at the end of which there is a laser light emitter. When it is absorbed by blood cells, the rheological properties of the blood, oxygen supply to tissues and organs, metabolic processes are improved, and the body’s natural self-purification system is stimulated.
Head pain
Side effects after chemotherapy can manifest themselves not only in pain in the legs, muscles, intestines, but also in the head, since potent drugs affect certain areas of the brain. Most often, headaches occur periodically; only a small number of patients experience them for a long time. Due to brain damage, nerve receptors transmit impulses to the peripheral nervous system, which provokes the appearance of pain. This may also indicate the presence of an infection in the body, so it is recommended to consult a neurologist.
Plasmapheresis
The main place of accumulation of toxins is blood plasma. Plasmapheresis is the removal of contaminated, toxin-laden plasma and its replacement.
Typically, detoxification replaces up to 30% of the blood plasma.
Blood is taken from the vascular bed and enters a separator, where it is divided into two fractions - the mass of blood cells (leukocytes, erythrocytes, platelets) and plasma.
Blood plasma saturated with toxins is drained and disposed of. Its volume is replenished with pure donor plasma with a plasma-substituting solution, which may include saline solution, polyglucin, rheopolyglucin.
To relieve intoxication of the body after chemotherapy, 1 to 4 plasmapheresis procedures are usually sufficient.
Joint pain
Often, during chemotherapy, pain occurs in the knees and other joints, with frequent twisting of the legs and swelling of the limbs. This is due to intoxication after a course of treatment, which oncologists divide into several degrees: from zero to fifth. When pain occurs in the joints, they speak of the first or second degree of intoxication, in which complications manifest themselves in the form of nearby lesions. These unpleasant symptoms can be relieved with the help of painkillers, which must be taken in combination with Cerucal. In this case, it is not recommended to treat yourself; drugs should only be prescribed by a doctor. If pain occurs in people suffering from diabetes, this may be due to a complication of the pathology in the form of arthrosis. Such complications are usually classified as long-term consequences that can appear one week after the end of treatment. Therapy in this case is aimed at reducing blood sugar levels, which are elevated after chemotherapy.
If the pain does not go away within six months after treatment, this indicates the presence of degenerative pathologies in the cartilage of the joints. To confirm the diagnosis, X-rays or ultrasound are performed, only then appropriate therapy is prescribed.
Note! Often the cause of joint pain is a decrease in hemoglobin levels. Treatment should be aimed at increasing the level of red blood cells and hemoglobin.
Pain in the bones
After treatment with cytostatics, bone pain is of moderate or severe intensity. This is observed due to damage to bone marrow preparations, which is involved in hematopoiesis. Bone marrow cells multiply and grow quite quickly, and the action of chemicals is aimed precisely at such cells, which include cancer cells.
Bone marrow is located in the cavities of the bones; when it is exposed to harmful substances, it accumulates toxins, which provokes the development of pain. To relieve moderate pain, doctors recommend following a diet that is aimed at restoring bone marrow.
How Chemotherapy Works
One of the main differences between cancer cells and normal cells is rapid division. The rate at which cancer cells divide depends on their degree of malignancy, or differentiation.
Highly differentiated cells differ little from normal ones. The rate of their division is slightly higher than normal. Such tumors grow slowly and rarely recur after removal. The prognosis for treatment is usually favorable.
Moderately differentiated cells are already significantly different from normal ones, but they can still be classified as one or another type of tissue.
Poorly differentiated cancer cells no longer have anything in common with normal ones. They lose their functions and the only thing they do is rapidly divide. Such malignant tumors are the most dangerous. They grow quickly, actively metastasize, are difficult to treat and often recur after removal.
Chemotherapy drugs affect rapidly dividing cells.
The problem is that not only cancer cells undergo rapid division, but also some normal cells of the body, in particular, the mucous surfaces of the gastrointestinal tract, bone marrow, and hair follicles.
Chemotherapy drugs act indiscriminately on all rapidly dividing cells. Therefore, along with cancer cells, they also destroy normal ones.
This causes inevitable side effects that require correction of the condition, including detoxification of the body.
Leg pain: what to do after chemotherapy
Pain syndrome can have varying degrees of intensity. This is due to tissue damage to the peripheral nervous system, bone marrow destruction, and vascular dysfunction. In this case, the doctor prescribes painkillers and antiepileptic drugs. Ketolorac has proven itself well; it is prescribed for short-term treatment of pain. For severe pain, Diclofenac is prescribed.
- What to do if your finger joints hurt? How to treat hands
After undergoing chemical treatment for cancer, hand-foot syndrome often occurs, which manifests itself in redness, swelling, burning and pain on the soles of the feet or palms of the hands. This is due to the fact that a small percentage of drugs seeps through the capillaries on the skin of the extremities. Toxic substances damage tissue in the area of leakage. This pathology can provoke the development of ulcers, cracks or blisters on the skin, fever, and rash.
Diagnosis of pain syndrome is aimed at identifying its cause. For this purpose, various methods are used in oncology and surgery: Blood and urine tests, ultrasound, radiography, MRI and CT. Consultation with other specialists is almost always required to determine the exact cause of complications after chemotherapy. Diagnostic measures are carried out with the involvement of a urologist, proctologist, neurologist, gastroenterologist and others.
Drug treatment of pain in the lower extremities after chemotherapy
Treatment of pain syndrome is symptomatic in most cases. After chemotherapy is completed, the problem resolves on its own.
For hand-foot syndrome, anti-inflammatory drugs (Indomethacin, Diclofenac) or over-the-counter analgesics (acetaminophen) are prescribed. If the period of admission is short, then Ketorolac can be used. To locally relieve inflammation, it is recommended to apply ointments containing corticosteroids to the affected area.
Dimethyl sulfoxide, also used topically, reduces the leakage of chemotherapy drugs into soft tissues and inhibits further damage.
The optimal dosage of analgesics is:
- Diclofenac: up to 150 mg per day for short-term therapy, 75-100 mg for long-term treatment;
- Ketorolac: up to 40 mg per day (4 tablets), course no more than 5 days.
It must be taken into account that painkillers and anti-inflammatory drugs inhibit hematopoiesis, which can increase thrombocytopenia, anemia and leukopenia resulting from a chemotherapy course. Exceeding the dose and long-term use of Diclofenac provokes loss of bone tissue strength.
Therapy for peripheral neuropathy includes, in addition to analgesics, antiepileptic drugs (gabapentin), and less commonly, antidepressants (Cymbalta, duloxetine, etc.).
Swelling and pain associated with the deterioration of the condition of blood vessels and kidneys due to the cancer process and intensive treatment are eliminated with the help of diuretics, adsorbents and a list of other drugs that are used for varicose veins of the legs (venotonics, anticoagulants, etc.). Following a special diet and exercise can make life easier for the patient during chemotherapy.
If it is determined that the pain is of a hematopoietic nature, then the oncologist may prescribe a course of erythropoiesis stimulants (the formation of red blood cells). The use of erythropoietin is mandatory when undergoing chemotherapy with drugs containing platinum compounds.
Sometimes bones, joints or muscles continue to hurt more than several months after completing the course: in this case, re-diagnosis of the cause and treatment of arthrosis, osteoporosis and other diseases are required.
Treatment of secondary symptoms
Elimination of pain after treatment of cancerous tumors is symptomatic. The patient is prescribed painkillers, the dosage of which is selected by the doctor after the patient has passed all the tests. These can be non-steroidal drugs, antiepileptic drugs, antidepressants, vitamins.
Note! The doctor cannot select a drug for the treatment of cancer that will not cause any side effects. Therefore, the manifestation of pain after therapy is most often observed. After taking chemical drugs, it is recommended to carry out symptomatic treatment of complications.
Usually, after three months, side effects after cancer treatment in the form of pain in the legs disappear, as the tissues of the peripheral nervous system, as well as blood vessels and capillaries, are restored. Fatigue, heaviness and swelling in the legs also disappear.
Polyneuropathy in oncology
Polyneuropathy in malignant neoplasms is a consequence not only of a side effect of chemotherapy with vincristine, cisplatin, procarbazine, misonidazole, but also of tumor infiltration of the spinal and cranial nerves or metastases in the meninges, paraneoplastic syndromes. The most common is subacute sensory polyneuropathy, caused by symmetrical damage to the spinal ganglia. It develops against the background of lung cancer, which can be asymptomatic for a long time.
Damage to peripheral nerves is manifested by the following symptoms:
- subacute pain;
- paresthesia and dysesthesia in the arms, legs and face;
- ataxia (disorder of movement coordination);
- abasia (staggering when walking and in the Romberg position).
Patients lose all sensation in the upper and lower extremities, sometimes in the face and oral mucosa. With complete areflexia, muscle strength is almost not reduced.
Taking vitamins and microelements
Pain in the legs may appear due to a lack of microelements and vitamins in the body of a sick person. Oncologists often prescribe B vitamins and folic acid, this promotes the absorption of iron, which is involved in the formation of hemoglobin. If anemia develops as a result of bone marrow destruction and iron deficiency, the oncologist may prescribe drugs such as Actiferrin, Maltofer or Sorbifer. When using these medications, weakness and fatigue, dizziness and tachycardia gradually go away.
Doctors often attribute magnesium to relieve intense pain in the limbs and joint sensitivity to changes in weather conditions. Magnesium helps reduce symptoms.
Note! Magnesium preparations should be prescribed in combination with vitamin B6.
Often, oncologists prescribe calcium, and before taking it, they prescribe a blood test for an ionized microelement to select the dosage of the drugs. Additionally, antidepressants may be prescribed to relieve stress.
ethnoscience
Traditional medicine also helps eliminate unpleasant symptoms after cancer treatment. To eliminate pain in the arms and legs, use essential oils of lavender, tea tree, lemon, and so on. They are rubbed into problem areas for several weeks at intervals of seven days. It is recommended to avoid contact with cosmetics, detergents, and chemicals. It is necessary to rest often, follow a diet and wear comfortable shoes.
- Why joints hurt: what to do and how to treat
Pain after chemotherapy is possible, but not typical; chemotherapy is more likely to relieve the patient of pain caused by any manifestations of a malignant tumor. No painkiller can relieve metastatic bone pain as effectively as chemotherapy does.
In the terminal stage, when bone pain becomes unbearable and cannot be relieved by drugs, just one injection of a cytostatic drug can reduce the intensity of the pain, but chemotherapy in such a serious condition is impossible due to the inevitable development of fatal complications.
Preparing veins for chemotherapy and preventing side effects
- For the manifestation of veins with their low accessibility - a serious obstacle to therapy.
Patients are advised to drink more water and keep their hands warm. Immediately before the chemotherapy procedure, an expander and warm wraps will help. The doctor may use a pressure gauge to create compression.
- To reduce the toxic effects of drugs on veins.
In this case, injections of a solution of cytostatics are made in the minimum permissible concentrations. The most gentle method of administration is drip infusion with a large amount of liquid. When administered by the jet method, after the injection, rinsing the vein with an isotonic solution is required.
But it is not always possible to choose - each drug has its own recommended concentration, rate of administration and method.
Injections of chemotherapy drugs should be carried out alternately into the veins of different limbs, if, again, such a possibility exists.
- To reduce the risk of inflammation or swelling.
For the next 48 hours after chemotherapy, it is recommended to keep the “suffering” limb in an elevated position as often as possible.
Causes of pain after chemotherapy
Chemotherapy cannot always reduce the tumor conglomerate, but even with the progression of the process against the background of active antitumor treatment, the administration of chemotherapy has a positive analgesic effect. Indications for chemotherapy include a recommendation for the use of cytostatics during further progression of cancer exclusively for symptomatic purposes, when it is necessary to relieve the painful manifestations of the disease, including pain, without hope of stopping cancer growth and prolonging life.
Another thing is that chemotherapy can also induce pain, however, they rarely become chronic - that is, they persist for more than 3 months; as a rule, after chemotherapy the pain, although acute, is mostly short-lived.
Pain after chemotherapy occurs due to the development of adverse reactions in the form of damage to cytostatic-sensitive cells of the mucous membranes and nervous system. Pain during stomatitis is especially excruciating, when areas appear on the inflamed oral mucosa that are almost completely devoid of cells, which prevents the patient from eating or drinking without severe pain. Suffering is caused by damage to the intestinal and genitourinary mucosa, which lines the joints of the synovial membrane.
Chemotherapy can be complicated by breakthrough pain, which is very severe pain that suddenly arises, when every part of the body hurts. Severe pain is caused by the release into the bloodstream of biologically active substances - cytokines, which aggressively affect the nociceptors of the peripheral nerves. Scientists have explained the mechanism of breakthrough pain, but it is not possible to predict its occurrence and it is impossible to determine which drug and in what case is capable of inducing this terrible pain.
A similar mechanism for the development of pain after chemotherapy is characteristic of influenza-like syndrome, but the intensity of the pain is significantly inferior to breakthrough pain, although the whole body also hurts, but the pain itself is more like an ache.
Pain after chemotherapy can be a manifestation of neurotoxicity - damage to both the peripheral nerves themselves and disruption of nerve conduction with the initiation of muscle cramping pain due to the destruction of the nerve sheaths.
Neurological pain after chemotherapy is caused by activation of the herpes virus. Due to the natural decrease in local immunity for cytostatics, the herpetic virus that constantly lives in nerve cells passes from a dormant state to reproduction, which is manifested by severe pain along the nerve root with subsequent skin damage. Herpetic pain often lasts up to a year, but its intensity is incomparable with the heyday of herpes zoster.
The nature of the pain syndrome and its intensity are very individual, dependent not only on the degree of tissue damage, but also on the patient’s personality characteristics, and are to some extent determined by the cancer chemotherapy regimen, but often after chemotherapy it is impossible to determine which drug from the combination caused the pain.
Features of symptoms and localization
Different patients with the same type of antitumor treatment may develop the same complications, but the nature of pain after chemotherapy and the severity of other symptoms are different and very individual. It has been noted that women tolerate pain better, but nausea and vomiting during chemotherapy are much less common and do not bother men as intensely. No gender preferences have been found regarding damage to mucous membranes by cytostatics, but it is known exactly which chemotherapy drugs can damage which normal cells.
Joint pain after chemotherapy
Joint pain - arthralgia is often part of a flu-like syndrome with fever, weakness and muscle aches. The intensity of pain in the acute period can reach 2 points, that is, it will put you to bed for half a day, but the pain syndrome itself rarely lasts more than one or two days and disappears without a trace. The peculiarity of arthralgia is that the pain is completely independent of movements in the joint - the joint hurts constantly, but the pain does not increase with movement and does not decrease at rest.
It is assumed that chemotherapy, as well as corticosteroid hormones as part of a taxane or irinotec premedication regimen, temporarily unblocks the enzyme that promotes the synthesis of prostaglandins and leukotrienes. High concentrations of cytokines affect sensory receptors in the nervous system, resulting in pain in many joints.
The mechanism of local pain in one or two joints is different - it is an increase in intra-articular pressure due to damage to the mucous lining inside the joint and increased secretion production.
Arthralgia can be a complication of many cytostatics, but the selective effect of any specific drug has not been found, that is, joint pain is possible with any chemotherapy. The main feature is short duration and low intensity.
Stomach hurts after chemotherapy
Abdominal pain is a common manifestation of damage to the mucous membranes as a result of side effects of chemotherapy. As a rule, the pain is spastic and is often accompanied by a violation of the stool - diarrhea or simply increased frequency without changing the consistency of stool.
Colitis and enterocolitis are characteristic of the antimetabolites - methotrexate and fluorouracil. High doses of methotrexate used for malignant blood diseases can be complicated by necrotizing enterocolitis with severe spastic, to the point of loss of consciousness, abdominal pain, accompanied by high fever and significant deterioration of the condition.
In most cases, toxic damage to the mucous membranes as a result of chemotherapy is limited to dyspeptic syndrome: varying degrees of stomatitis, esophagitis, gastritis and colitis with nausea and even episodes of vomiting, heartburn and diarrhea. Mucositis with dyspepsia develops by the end of the first week after administration of fluorouracil or methotrexate and disappears completely within two weeks. By the way, the standard 3-week interval between administrations of chemotherapy drugs is due to the time required for complete restoration of the intestinal mucosa.
During the administration of irinotecan, specific neurogenic manifestations occur - cholinergic syndrome with acute cramping abdominal pain, profuse salivation and tears, short-term diarrhea and nausea. The intensity of symptoms, including pain, is reduced by administering certain medications before chemotherapy.
During chemotherapy for malignant diseases of the blood and lymphoid tissue, when the massive death of tumor cells sharply increases the level of uric acid in the blood and tissues, pain occurs that is very similar to renal colic, with diffuse pain in the groin area and a local focus in the lower back. This pain is expected and drug prevention of life-threatening hyperuricemia is started ahead of time.
Leg pain after chemotherapy
As a rule, pain in the legs or one leg after chemotherapy is neuropathy and manifestations of neurotoxicity. Neurogenic pain can be burning or boring, breakthrough or pulling - any, its peculiarity is that it increases from course to course and has a significant duration.
Pain due to nerve damage always coexists with sensory disturbances in the form of crawling goosebumps or hyperesthesia, when touching the skin gives off pain, as well as perversions of sensations. The pain may be accompanied by gait disturbances and muscle cramps. All chemotherapy drugs that cause neurogenic pain are known, but prevention has not been developed. Another problem is long-term pain that is not relieved by stopping chemotherapy and can persist for more than a year.
Bone pain after chemotherapy is also possible, but rarely; as a rule, these are manifestations of an increase in the concentration of inflammatory mediators, similar to the mechanism of development of influenza-like syndrome. The pain is short-lived and quickly relieved with non-steroidal anti-inflammatory drugs.
Muscle pain, most often the calf, may be a manifestation of generalized myalgia or neurotoxicity. Myalgia is possible in principle with any chemotherapy, is quickly relieved by medications and may not occur again.
Pain therapy methods
Medications
In most cases, pain after chemotherapy can be reduced by taking nonsteroidal anti-inflammatory drugs (NSAIDs), especially pain in the joints and bones. Neurogenic pain in the legs is sensitive to ketoprofen from the NSAID group; they respond less well to other drugs in this group. As a rule, the need for weak narcotic drugs may arise only in case of breakthrough pain; one dose may be sufficient to relieve the syndrome. In all cases, pain treatment begins with tablets, and only if there is no effect, injections are resorted to.
Multimodal therapy
Pain after chemotherapy is most often acute and goes away within a few days, in most cases it is controlled with medications. For neurogenic pain, medications alone may not be enough. To treat polyneuropathy, several groups of drugs are used, as well as physiotherapeutic procedures and drug blockades of nerves and plexuses.
For severe chronic pain, neuromodulatory techniques are required with the introduction of narcotic analgesics into the spinal space in combination with electric current therapy of areas along the nerve endings, as well as acupuncture with acupuncture.
Relieving chronic neurogenic pain is a complex task that requires the participation of different specialists and many therapeutic techniques in the treatment process, which is called a multimodal approach.
Non-drug therapy
For severe and prolonged pain, technologies for neurodestruction have been developed—destruction of the nerve. Preference is given to non-invasive methods - without penetration into the body, but it is fundamentally possible to introduce alcohol and other chemical compounds into the nerve.
For chronic pain, radiofrequency ablation of the nerve trunk blocks the transmission of pain impulses through it without damaging motor neurons. The effect lasts for several weeks, and there is no risk of destruction of surrounding tissue due to infection.
As a rule, radiation therapy is not used for pain after chemotherapy, but for intense pain in a large joint, a single low dose of radiation can help.
Psychosocial measures
Each person feels pain in his own way, which is determined by the psychological characteristics of the individual. It's no secret that you can learn not to feel pain or at least not perceive it as a physical disaster. Psycho-emotional practices, taught to the patient by a psychologist specializing in oncological pathology, help “harden” against pain.
Our Clinic uses all methods of pain relief after chemotherapy; our chemotherapists prepare each patient for special treatment according to an individual program, helping to quickly cope with adverse reactions.
Bibliography:
- https://osteokeen.ru/zabolevania/bolyat-sustavy-posle-himioterapii.html
- https://oncoved.ru/vosstanovlenie/posle-himioterapii-bolyat-nogi-i-sustavy-chto-delat
- https://sprosivracha.com/questions/251192-perifericheskaya-neyropatiya-posle-himioterapii
- https://health.mail.ru/consultation/1617262/
- https://www.euroonco.ru/departments/himioterapiya/bol-posle-himioterapii
The present time is characterized by the active development of scientific oncology, in particular in the direction of drug treatment of tumors with cytostatics, which often gives positive results. At the same time, complications arising from their use can significantly worsen the quality of life of patients, imposing strict conditions when choosing doses of drugs and the mode of their administration. Early prevention and correction of chemotherapy complications is a prerequisite for adequate treatment of cancer patients.
Many modern cytostatics cause neurotoxicity, requiring dose modification, delay of subsequent cycles of therapy, and even complete cessation of treatment. One of these complications is polyneuropathy (CRF) that occurs after chemotherapy. Unlike other types of polyneuropathy, it manifests itself with the predominant involvement of sensory and autonomic nerve fibers, and there is a dependence on the dose and type of chemotherapy with a weakening of symptoms after discontinuation of the agent that caused it.
CRF is the result of damage to peripheral motor, sensory and autonomic neurons by neurotoxic cytostatics [8, 14]. The degree of its severity is directly dependent on the cumulative dose of chemotherapy and usually occurs several weeks or months after the start of treatment. Chemotherapy, including the use of neurotoxic cytostatics, increases the risk of developing chronic renal failure. The main drugs with neurotoxic effects are presented in Table. 1
(according to D. Michael et al. [13]).
The exact mechanism of chronic renal failure has not been established. The most reasonable assumption is that most manifestations of polyneuropathy are the result of a violation of the microtubular architecture of axons (axonopathy). Less common are diffuse or segmental demyelination of neurons (myelinopathy) or degeneration of their bodies (neuronopathy) [5, 15]. The main link in the pathogenesis of peripheral axonopathy is damage to tubulin, an intracellular protein that plays a leading role in ensuring the normal physiology of the nervous system. Cytostatics have the greatest damaging effect, the target of which is tubulin in the microtubules of tumor cells. This group includes vinca alkaloids, which induce the depolymerization of tubulin, taxanes and epothilones, which stimulate its pathological polymerization, as well as platinum derivatives, which cause denaturation of tubulin, thus disrupting the structure and function of intracellular microtubules. Unlike the central nervous system, peripheral axons do not have a blood-brain barrier. This allows metabolites of cytostatics to penetrate through direct diffusion into nerve fibers from the surrounding interstitial fluid and accumulate in them, causing damage to tubulin and a number of other proteins (kinesin, actin). The clinical manifestation of axonopathy develops several weeks after the start of antitumor treatment. Unlike axonopathy, the symptoms of neuronopathy are early, as they arise from direct damage to the dorsal ganglia [1, 21]. Early neurotoxicity after oxaliplatin administration is associated with damage to sodium channels in the membranes of neurons and synapses [4]. Additional risk factors for the development of chronic renal failure are: diabetes mellitus, HIV infection, alcoholism and deficiency of B vitamins [20].
Currently, there are no standards for the treatment of chronic renal failure and there is no drug that is approved specifically for the treatment of chronic renal failure. Commonly used drugs are used to treat diabetic and other types of neuropathies, which help relieve symptoms such as pain, paresthesia, dysesthesia, allodynia (Table 2)
.
They do not affect weakness or sensory loss.
Gabapentin and pregabalin, often used in the treatment of neuropathic pain of various origins, have not shown any advantages over placebo in chronic renal failure [10, 17]. The advantages of the 5% lidocaine patch are ease of use and minimal side effects, but the main area of its application remains postherpetic neuralgia [12]. Duloxetine is quite effective for the treatment of neuropathic pain, but cannot be used in patients taking tamoxifen and drugs that alter serotonin reuptake (tricyclic antidepressants, tramadol). Currently, a study is being conducted on the effectiveness of therapy for chronic renal failure with duloxetine [16, 18, 22].
It was not possible to obtain evidence of the effectiveness of tricyclic antidepressants in chronic renal failure. Therefore, at present they are not the drugs of choice for this pathology [7, 9].
Opioids provide a rapid analgesic effect, but have many side effects that limit their use, especially in the long-term. There are also data from two small studies showing the effectiveness of acetyl-L-carnitine in the treatment of paclitaxel- and cisplatin-induced chronic renal failure [11].
Currently, the concept of choosing a drug for the treatment of chronic renal failure is as follows: one drug is used, the dose of which, if necessary, is gradually increased to the maximum tolerated. If one drug is insufficiently effective, the possibility of adding a second drug, which differs from the first in its mechanism of action (for example, gabapentin in combination with an opioid drug), or complete withdrawal of the first drug and replacing it with a drug of another group, may be considered.
There are also non-pharmacological methods for treating neuropathies: electrical stimulation (all studies in the literature concern diabetic neuropathy, there are no data on the treatment of chronic renal failure) [6]; acupuncture [23]; physical exercise [3, 10, 19]; therapy with a pulsating source of infrared light (there are no data on the treatment of chronic renal failure) [2].
All of the listed treatment methods have been studied in small groups of patients suffering mainly from diabetic polyneuropathy; therefore, it is not possible to reliably judge their effectiveness in chronic renal failure. Therefore, the problem of developing specialized regimens for the treatment of chronic renal failure seems so urgent.
The purpose of this study is to identify the characteristics of the manifestation and select treatment regimens for polyneuropathy that occurs as a complication of chemotherapy for various oncological diseases.
Material and methods
Examination and treatment were carried out in 44 cases of CNP development. The distribution of patients by disease for which patients received chemotherapy is presented in Table. 3
.
All patients complained of pain, numbness, tingling, cramping and swelling of the hands and feet, 3 (6.8%) of them also complained of difficulty walking due to weakness in the legs; 4 (9.1%) patients were forced to interrupt treatment with cytostatics until the symptoms of polyneuropathy resolved. An objective examination revealed cyanosis, swelling of the hands and feet in 35 (79.5%) patients, hypoesthesia of pain sensitivity like “gloves” and “socks”, of which in 14 (31.8%) cases the swelling and cyanosis extended to the forearms and shins, and hypoesthesia was defined as “high gloves” and “high golf”.
According to the severity of manifestations, patients were divided into 3 groups, which are presented in Table. 4
.
Before the start of therapy, 34 patients underwent an electroneuromyographic (ENMG) study: in 5 (14.7%) cases no abnormalities were found, in 19 (55.9%) a decrease in the speed of impulse conduction along sensory fibers was detected, in 6 (17. 6%) - decrease in impulse conduction in both sensory and motor fibers. In 4 (11.8%) cases, peripheral autonomic failure involving the parasympathetic and sympathetic departments was detected.
Complex treatment of chronic renal failure consisted of a combination of allo-, homeopathic treatment and hydrotherapy. As for the first, various chemotherapy regimens were used to treat the underlying disease, including drugs with neurotoxic effects - procarbazine, vinblastine, carboplatin, oxaliplatin, docetaxel, capecitabine.
Patients received two courses of therapy, during each of which all of the following drugs were taken simultaneously:
Results and discussion
After treatment, clinical improvement was observed in all patients. In 23 (52.3%) patients, complete regression of pathological symptoms was noted (observation period from 4 to 9 months), in 16 (47.7%) there was a marked improvement in subjective and objective indicators (decreased numbness and weakness in the limbs , severity of other symptoms). 4 patients were forced to interrupt chemotherapy due to complications, but were then able to return to the interrupted treatment. The condition of patients after treatment of chronic renal failure is shown in Table. 5
.
Thus, in the present study it was confirmed that chronic renal failure has a number of clinical features, the main of which is the predominance of the sensory-vegetative component of disorders over the motor one. The treatment regimen for chronic renal failure developed by the authors and presented in the article is safe and quite effective. Considering the characteristics of this group of patients (contraindications to physiotherapy and mud therapy, the use of biostimulants, the ineffectiveness of drugs used for other types of polyneuropathy), the described complex treatment seems to be an adequate alternative and can be recommended for the treatment of chronic renal failure.
