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Chronic Pain Management in Colorectal Cancer
Chronic Pain Management in Colorectal Cancer has come a long way. The problem is educating colorectal cancer survivors as to what their options are.
This issue is important to me because I am a long-term cancer survivor myself. I live with joint, nerve, and muscle pain- all resulting from aggressive conventional therapies. Therapies that did little to manage my incurable blood cancer…
The goal of this post is to educate colorectal cancer survivors as to possible therapies that they can discuss with their oncologist. Keep in mind that there may be side effects that result from any one of these therapies.
At 36 minutes, the video below is longer than I’d like. However, the doctor speaking does a great job of explaining “pain” and then different surgical therapies to manage pain.
Neurosurgical Options for Controlling Cancer Pain
For colorectal cancer survivors living with chronic pain, especially pain related to surgery, chemotherapy (like oxaliplatin-induced neuropathy), radiation, or long-term treatment sequelae, a multimodal, individualized approach is generally recommended. This means combining medical, physical, psychological, and complementary strategies to reduce pain and improve function and quality of life. AAFP+1
🩺 Medical & Pharmacologic Options
1. Analgesic Medications
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Non-opioid analgesics: NSAIDs (e.g., ibuprofen) or acetaminophen for mild-to-moderate pain.
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Neuropathic agents:
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Duloxetine is a first-line choice for chemotherapy-induced peripheral neuropathy (CIPN).
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Gabapentinoids (gabapentin, pregabalin) and tricyclic antidepressants may be used for neuropathic pain.
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Topical agents: Creams with lidocaine or capsaicin for localized pain.
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Opioids: May be considered for severe pain but with careful monitoring for dependence and side effects. Rotation between different opioids can sometimes improve relief or reduce side effects. AAFP+1
2. Interventional Pain Procedures
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Nerve blocks, epidural injections, or regional anesthetic techniques can target focal chronic pain.
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Neuromodulation such as TENS (Transcutaneous Electrical Nerve Stimulation) or more advanced peripheral nerve stimulation may help some survivors. PMC+1
🧍♂️ Physical & Rehabilitation Therapies
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Physical therapy: Tailored programs to improve mobility, strengthen muscles, and address scar-related or post-surgical pain.
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Pelvic floor physical therapy: Particularly helpful when pelvic pain or dysfunction persists post-treatment.
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Regular exercise and movement can reduce pain intensity and improve overall wellbeing. AAFP
🧠 Psychological & Behavioral Interventions
Addressing the mind-body connection is a key component of chronic pain management:
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Cognitive-Behavioral Therapy (CBT) and Pain Coping Skills Training (PCST) can help survivors reinterpret and manage pain signals and reduce pain impact.
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Psychotherapy, education, and coping-skill programs help reduce distress and improve function.
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Mindfulness-based stress reduction (MBSR), guided imagery, relaxation, and acceptance-based approaches can improve stress, depression, and quality of life (though effects on pain intensity vary). PMC+1
🧘 Complementary & Integrative Therapies
Many survivors find adjunct therapies helpful when integrated safely with standard care:
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Acupuncture may ease neuropathic and musculoskeletal pain in some survivors.
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Massage therapy (e.g., Swedish massage) can reduce pain, stress, and muscle tension.
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Heat/cold therapy, meditation, hypnosis, and biofeedback help with symptom control.
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Some patients explore medical cannabis/cannabinoids where legal and appropriate (discuss with clinician). PMC+1
🧑⚕️ Supportive Care & Ongoing Management
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Palliative care specialists focus on comprehensive pain management—even long after curative treatment.
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Self-management programs (including internet-based pain coping skills) show promise in reducing pain severity and interference.
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Frequent reassessment is important, as pain patterns and needs can change over time. NINDS+1
🧑🤝🧑 Key Principles to Remember
✔ Chronic pain in cancer survivors is common and can have multiple sources: somatic (muscle/bone), neuropathic (nerve), visceral, or mixed.
✔ No single therapy works for everyone—combining treatments often yields the best results.
✔ Collaboration with a pain specialist, oncologist, and primary care provider ensures safe and optimal management.
Are you a colorectal cancer survivor living with chronic pain? I hope this post has given you some actionable info. Scroll down the page, post a question or comment, and I will reply to you ASAP.
Hang in there,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Management of pain in colorectal cancer patients
Highlights
- We present the pathophysiology of colorectal cancer related pain and pharmacological novelties that could improve pain alleviation methods.
- Despite the presence of guidelines and the availability of opioids, colorectal cancer pain is often inadequately managed.
- Colorectal cancer pain is prevalent in up to 70% of patients.· Pain in colorectal cancer can be receptor-mediated (nociceptive), neuropathic or psychogenic.
- Pain in colorectal cancer can be receptor-mediated (nociceptive), neuropathic or psychogenic.
- WHO guidelines for cancer pain base on the analgesic ladder: non-opioids for the 1st, weak opioids for the 2nd and strong opioids for the 3rd step.
Abstract
In this review we focus on the pathophysiology of CRC-related pain and discuss currently applied pain management. Pain is a symptom reported by over 70 % of colorectal cancer (CRC) patients.
It remains a feared and debilitating consequence of both cancer and cancer-related treatment. There are many options for pain management in CRC, consisting of intravenous, oral or topical medications.
In order to address the full spectrum of pain, proper treatment should address the nociceptive, neuropathic and/or psychogenic pain component. Currently available methods do not bring pain relief to a satisfying number of patients and, if used improperly, can cause a number of complications.
Therefore, future treatments should focus primarily on alleviating pain, but also on reducing possible side effects. In this article we cover recent and promising pharmacological and non- pharmacological developments emerging in the field of CRC treatment.
Chronic Pain Management in Colorectal Cancer Chronic Pain Management in Colorectal Cancer