Chemotherapy is a scary and challenging phase in the treatment of cancer and related ailments. There are plenty of myths and misconceptions regarding chemotherapy, but one thing we cannot deny is that chemotherapy has various side effects that will depend on each patient. The list is very long, and even though you will not experience them all, every one of them is bothersome and sometimes very difficult to deal with.
People often talk about nausea and vomiting, losing your hair and feeling exhausted, but if you’re reading these lines, it is likely you have also felt joint or muscle pain. They are not the most common side effect of chemotherapy, but there is also an explanation to it and something you can do to reduce your symptoms.
Is it common to experience joint and muscle pain after chemotherapy?
Joint and muscle pain are not the most common side effect of chemotherapy in general because it often appears in patients receiving a specific type or subtype of chemotherapy agent. The most prevalent chemotherapy agent known to cause joint pain and muscle pain is paclitaxel. It is commonly used in breast, ovarian, lung, bladder, and prostate cancer, and results in a pain syndrome that is addressed as “unique” by some authors.
This type of joint and muscle pain lasts up to 7 days after chemotherapy, and it is often crippling and disabling, often forcing doctors to use opioid therapy to improve the symptoms. Paclitaxel-induced arthralgia/myalgia syndrome is often located on the shoulders, pelvis, thighs, or paraspinal region of the body (on both sides of the spinal column).
Paclitaxel is the most common, but not the only one cancer therapy associated with joint and muscle pain. Aromatase inhibitors are important drugs used along with chemotherapy agents. They fight off cancer cells by preventing the aromatase enzyme from converting testosterone into estrogen. They prevent an excess formation of estrogen, and they are likely to be used in patients receiving chemotherapy for breast cancer, ovarian cancer, and any other type of cancer that responds to an excess hormone concentration in the bloodstream.
According to a study performed in patients with early-stage breast cancer, patients receiving this type of treatment had two different types of joint problems: joint pain and joint stiffness, and only a few of them did not complain of joint symptoms at all.
Why does that happen?
Paclitaxel-induced arthralgia/myalgia syndrome has been studied over many years, and we don’t yet have a definite answer as to the reason why it happens. There is convincing evidence that it is not due to an injury to the articulation or muscle itself, and that is why a study published in The Cancer Journal investigated the possible reasons of joint and muscle pain after chemotherapy by studying the symptoms carefully and providing a reasonable explanation.
In this research, the investigators found that pain often involves various regions of the body, so it is likely not related to an injury to a single tissue. It is transitory and associated with muscle weakness and other motor problems, which is why they argue that paclitaxel-induced arthralgia/myalgia syndrome is caused by an increase in sensitivity of the nerve terminals for pain perception. They are called nociceptors, and they are found throughout the body, and not only in the skin. When they become too sensitive, nociceptors start sending pain signals to the brain, even though there is no injury or structural problem in the muscles or articulations.
Other studies have also found there is a sudden increase in inflammatory markers after using paclitaxel as a chemotherapy agent. Since inflammatory cytokines stimulate nerve terminals and trigger pain, it is possible this might be a clear explanation to why joint and muscle pain appears after this type of chemotherapy.
Relieving joint and muscle pain after chemotherapy
Similar to other side effects associated with cancer therapy, chemotherapy-induced joint pain is often difficult to treat. Doctors often need to start opioid treatment, which is the very last stage of painkillers, to manage this type of pain. However, there are certain non-medical treatments you can also try to improve your pain.
One of the most widely accepted non-medical practices to reduce joint pain after chemotherapy is acupuncture, but it is essential to ask your doctor before initiating this type of procedure on your own. Another interesting technique is called biofeedback, in which patients use especial gadgets to be aware of their own body and learn to deal with pain and their health condition. Relaxation techniques are useful as well, but it might be difficult when pain symptoms are very intense
In these patients, it is imperative to look for emotional assistance, and doing so would even improve their pain symptoms in most cases. Patients feeling depressed or angry are typically more susceptible to feeling pain. It is quite common to feel this way when you’re undergoing a severe health problem such as cancer, and that’s why it is crucial not to underestimate the importance of psychotherapy.
Massage, pressure, vibration, and temperature changes may also improve your symptoms. However, this is something each patient needs to try in their own account. Remember that one of the possible explanations for these symptoms is that nerve terminals become over-reactive to stimuli. Therefore, in some patients stimulating the skin would increase the perception of pain instead of improving the symptoms.
In this table, we have summarised the most common non-medical treatments for joint and muscle pain after chemotherapy, and what you need to be aware when you’re trying each one of them:
| Treatment | What is it | Caution |
| Acupuncture | An ancient technique with needles that would be placed throughout the body and left for 15 to 20 minutes | It should be performed by a certified professional and only after approval by your doctor |
| Biofeedback | A modern technique to increase awareness and self-control by placing electronic gadgets in the body and keeping track of one’s vital signs. | Like many other digital tools, these gadgets should be calibrated and would be ideally placed under the guidance and instruction of a professional. |
| Relaxation techniques | There are breathing techniques, aromatherapy, and many other ways to relax and feel better. | It is not easy to relax when the pain becomes severe. |
| Psychotherapy | A type of therapy that addresses your emotions and the inner thoughts and motivations of the subconscious mind | By addressing your emotional causes of pain, you should first understand that your goal is not controlling pain but learning to deal and manage the symptom. |
| Mechanical stimulation | Massages, vibration, alternating hot and cold. All of them create a mechanical stimulus to the skin that often results in improving the pain symptoms. | In some cases touching the skin is not a good idea and might increase pain instead of improving your symptoms |
References:
Crew, K. D., Greenlee, H., Capodice, J., Raptis, G., Brafman, L., Fuentes, D., … & Hershman, D. L. (2007). Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer. Journal of Clinical Oncology, 25(25), 3877-3883.
Pusztai, L., Mendoza, T. R., Reuben, J. M., Martinez, M. M., Willey, J. S., Lara, J., … & Valero, V. (2004). Changes in plasma levels of inflammatory cytokines in response to paclitaxel chemotherapy. Cytokine, 25(3), 94-102.
Loprinzi, C. L., Maddocks-Christianson, K., Wolf, S. L., Rao, R. D., Dyck, P. J. B., Mantyh, P., & Dyck, P. J. (2007). The paclitaxel acute pain syndrome: sensitization of nociceptors as the putative mechanism. The Cancer Journal, 13(6), 399-403.
Cancer.gov (2019). Cancer Pain. Retrieved from https://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-hp-pdq
Cancer.org (2019). Non-medical Treatments for Cancer Pain. Retrieved from https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/pain/non-medical-treatments-for-cancer-pain.html
