Ways to Manage Pain From Advanced Lung Cancer

One in three people with non-small-cell lung cancer (NSCLC) have epidermal growth factor receptor (EGFR) mutations. If you’re one of them, you may experience pain in different parts of your body before, during, and after treatment. Metastasis, when cancer spreads to other parts of the body, can cause pain. Pain can also be a side effect of treatment. Learn about different pain management options that are available to you and why location matters when it comes to finding relief.

Chest pain is common in NSCLC. It can happen when tumors press against the lining of the lung, chest wall, ribs, or nerves. If you’ve had surgery, the nerves along the rib cage can be affected, too. Doctors may manage your pain with anti-inflammatories (NSAIDS) like acetaminophen or opioids if your pain is severe. You can also take nerve pain medicine such as anticonvulsants and antidepressants or get a nerve block injection to stop the pain messages going to your brain. Radiation can shrink the tumors, which often helps alleviate pain.

You may experience back pain with EGFR-mutated NSCLC if your cancer spreads to your spine, ribs, or adrenal glands. Pain may be muscular, especially if you’re coughing a lot. You can manage muscle pain with heating pads, light stretches, or physical therapy. For bone or nerve pain, your doctor may tell you to try NSAIDs, opioids, nerve pain medications, steroids, or bone-strengthening medicines. Vertebroplasty and kyphoplasty, where bone cement is injected into your vertebrae, may also help. 

Shoulder pain is an uncommon — but possible — symptom of lung cancer. It most often happens when the cancer grows near the top of your lungs, ribs, or spine. Pancoast tumors, a form of NSCLC located at the top of the lung, are likely to cause shoulder and arm pain. When the tumor is close to the nerves that travel to the arm and the shoulder, it can cause aches, numbness, weakness, tingling, and burning. In most cases, your doctor will prescribe steroids, opioids, and radiation to help you manage the pain. You may also receive physical therapy to keep your shoulder moving. 

Getting a headache with NSCLC could be from stress, dehydration, side effects of medication, or poor sleep. You may be able to manage these headaches with acetaminophen or NSAIDs. But a headache could mean your cancer has spread to the brain and is causing an increase in pressure. In that case, doctors can use steroids, radiation, stereotactic radiosurgery, immunotherapy, chemotherapy, targeted therapy, or surgery to treat the cancer. Always seek immediate care if you have severe pain, seizures, confusion, muscle weakness, or loss of balance, vision, memory, or speech. 

Stomach pain can be a side effect of treatment. You may have constipation, appetite loss, diarrhea, nausea, vomiting, and cramping after starting chemotherapy or immunotherapy. Immunotherapy can cause your immune system to attack your gastrointestinal tract. Sometimes, stomach pain can be caused by cancer that’s spread to your liver, bones, lymph nodes, or the lining of your abdomen. Nausea, constipation, and diarrhea treatments can help. Call your doctor if you have a hard belly, repeated vomiting, yellow skin or eyes, bloody or black stools, chest pain, or shortness of breath. 

Your skin is a common place for treatment-related side effects such as rashes, dryness, cracking, itching, and nail changes since the medications that target EGFR pathways affect not only the cancer but also the outer layer of your skin. Sometimes, NSCLC metastasizes to your skin, causing lesions. If you had chickenpox as a child, you may get shingles. Your doctor can prescribe topical steroid cream as well as an oral or topical antibiotic to help with your symptoms. Antihistamines and pain relievers can stop itching, throbbing, or sharp pains. In some cases, your treatment dose, drug, or frequency can be changed to ease side effects.

Mouth or throat pain can be symptoms of lung cancer or side effects of EGFR-positive NSCLC treatment. Cancer treatments can cause dry mouth and lips, sores, a sore throat, and infections such as thrush. Mouth rinses and topical medicine  can help relieve pain. If you’re having pain, eat softer foods, avoid spices, and drink plenty of water to keep hydrated. If you have an infection, your doctor will prescribe antifungal or antibiotic treatments or adjust your treatment dose or schedule. Let your doctor know right away if you have trouble breathing, severe chest or throat pain, or swelling in your face or neck.

Having cancer can cause muscle aches and fatigue, especially with EGFR-positive NSCLC, which causes inflammation. Many people with cancer also get muscle aches and fatigue due to anemia, weight loss, low thyroid or vitamin levels, and treatment side effects. For example, EGFR-targeted therapy such as osimertinib often causes fatigue and musculoskeletal pain. You can treat the pain with acetaminophen or NSAIDs or stronger pain medications if necessary. Yoga, stretching, meditation, physical therapy, and massage are good options, too. If aches and fatigue are making it difficult for you to do daily activities, let your doctor know right away.

Treatment for EGFR-positive NSCLC can cause joint pain. The pain can feel achy, or you may feel sharp pain in joints that gets worse when you stand or move around. Most people have joint pain in their elbows, shoulders, wrists, knees, feet, pelvis, hips, and back, since chemotherapy can cause inflammation and make these joints swell. Immunotherapy can cause your immune system to attack the body, which also causes joint pain. In some cases, joint pain may be caused by cancer that has spread into the bones. You can use heat or ice, stretches, and NSAIDs for the pain. Let your doctor know if your joints are uncomfortable.

It’s important to tell your doctor about new or worsening pain. It could mean your cancer has spread or is growing, says Kavitha Ramchandran MD, a clinical professor at the Stanford School of Medicine, who specializes in thoracic oncology and palliative medicine. “Speak with your oncologist. You’re in a partnership to try to determine what relevance the pain is in your cancer diagnosis and the best way to manage it.” Call your doctor immediately if you have weakness, severe pain, chest pressure, shortness of breath, face or arm swelling, fever, or loss of bladder or bowel control, she says.