Is Chemotherapy Painful? What to Know
Chemotherapy involves the use of drugs to treat cancer. The drugs target the rapidly-growing cancer cells to either slow their growth or destroy the cancer entirely.
Common side effects of chemotherapy are fatigue and lack of energy. A person is likely to experience these side effects the day of and the day after their chemotherapy appointment. The further along someone is with their treatment plan, the more severe the fatigue can be.
While pain is not a common side effect of chemotherapy, a person may experience pain during or after chemotherapy delivery.
This article will explore when pain may occur during and after chemotherapy. It will also explore what other side effects of chemotherapy may occur, how to cope and manage chemotherapy-related pain, and chemotherapy recovery.
When pain might occur during chemotherapy
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A person can receive chemotherapy in several different ways, including:
- Oral: The chemotherapy drug is in the form of pills or liquids that the person swallows.
- Intravenous (IV): A healthcare professional delivers the chemotherapy drug intravenously.
- Injection: A healthcare professional administers the drug as a shot into a muscle, under the skin, in the space between tissues that cover the brain and spinal cord (intrathecal), in an area that contains organs (for example, intraperitoneal), or directly into an artery (intra-arterial).
- Topical: A person applies the drug directly on the skin as a cream.
Routes such as topical and oral delivery tend to be painless. A person may experience pain at the injection site with IV and injection routes.
Some people may experience myalgia (muscle pain) in the injected muscle. Certain chemotherapy drugs may alsoTrusted Source cause leg cramps, which are painful contractions of the leg, foot, or ankle muscles.
RarelyTrusted Source, extravasation can occur. This is an accidental complication where the injected chemotherapy drug leaks out of a blood vessel and into the surrounding tissue.
This may happen as a result of a mistake made by the medical professional administering the drug, or because of the drug’s properties.
Chemotherapy extravasation can cause acute burning pain and swelling at the injection site.
When pain might occur after chemotherapy
Some people may experience pain after their chemotherapy appointment. Pain after receiving chemotherapy can occur in different ways.
Some chemotherapy drugs have the potential to cause a headache, such as drugs used to treat breast cancer. This can result in a throbbing, sharp, steady, or dull pain in the head.
Chemotherapy drugs target rapidly-growing cancer cells. But they also target the healthy, fast-growing cells of the body. These cells include hair follicles and cells that line the mouth and intestines.
This may resultTrusted Source in pain or swelling in the mouth, known as oral mucositis. Sores and ulcers may developTrusted Source in the mouth as well, which can be painful. A person may experience pain in their mouth when eating or drinking, as these sores may become irritated.
Because chemotherapy drugs can affect the lining of the intestines, some people may experience abdominal pain and cramps.
Another type of pain that may occurTrusted Source with chemotherapy is chemotherapy-induced peripheral neuropathy (CIPN). This is a set of symptoms that can happen because of nerve damage. The affected nerves are the peripheral nerves, which are outside the brain and spinal cord.
This is a side effect of chemotherapy drugs. Symptoms that a person with CIPN may experience in their hands or feet include:
- burning sensation
- pain or ache
- cramps in the feet
- inability to feel hot or cold sensations
These chemotherapy-related pain symptoms may resolve after chemotherapy has ended. But side effects such as CIPN may last for weeks, months, or yearsTrusted Source after a person has completed treatment.
Bone or joint pain
Some chemotherapy drugs that doctors use to treat breast cancer can lead to pain in the bones or joints. This pain can range from mild discomfort that goes away without treatment to severe pain that requires medication to relieve it.
The chemotherapy drugs that can lead to bone or joint pain include:
- albumin-bound or nab-paclitaxel
Other side effects of chemotherapy
Not every person receiving chemotherapy will experience side effects. The severity of the side effects will depend on the type of chemotherapy drug and cancer.
Some of the commonTrusted Source side effects of chemotherapy include:
- hair loss
- bruising and bleeding
- difficulty swallowing
- mood changes
- changes in sexual function and libido
- bladder and kidney changes
- fertility problems
- appetite loss
- memory problems
- problems with sleeping
Some chemotherapy drugs may causeTrusted Source long-term effects, or late effects, although many people do not have long-term problems after completing chemotherapy. These side effects can occur months or years after chemotherapy completion.
Examples of late effects include:
- memory loss
- problems concentrating
- personality changes
- problems with walking and movement
- bone loss
- changes in sexual function
- sleep disturbance
- blurred vision
- light sensitivity
- hearing loss
- heart problems
- weak joints
- shortness of breath
- dry cough
What are the side effects of chemotherapy?
Chemotherapy can prolong a person’s life and help eliminate cancer. Its side effects depend on the type of chemo drug involved, but infections, easy bruising or bleeding, and hair loss are some of the more common ones.
Other common side effects of chemotherapy include:
- nausea and vomiting
- neuropathy, or pain caused by nerve damage
Chemotherapy kills regular cells, as well as cancer cells, and this is why side effects occur. Many people experience these adverse effects, but some people have few or none.
Below, we explore 10 of the more common side effects of chemotherapy.
Medical illustration by Stephen Kelly
1. Infection and a weakened immune system
Cancer and the treatment of it can weaken the immune system.
Because chemotherapy kills healthy immune cells, it can make a person more vulnerable to infection. And because the immune system is weakened, any infections may last longer than usual.
Eating plenty of fresh fruits and vegetables, frequently washing the hands, avoiding anyone with an infectious illness, and seeking prompt medical care for signs of an infection can reduce the risk of a serious illness.
2. Bruising and bleeding more easily
Chemotherapy can cause a person to bruise or bleed more easily. Many people having chemotherapy experience this side effect.
Bleeding more heavily than usual can be dangerous. It is a good idea to take precautions, such as wearing gloves when gardening or cutting food. Also, take extra steps to prevent injuries such as falls.
Contact a doctor about any serious wounds or any injuries or bruises that seem to be healing slowly. The American Cancer Society (ACS) recommends contacting the cancer team right away about any bleeding or unexplained bruising during cancer treatment or any blood in stool or urine.
3. Hair loss
Chemotherapy can damage hair follicles, causing the hair to weaken, become brittle, and fall out. Any hair that regrows may be of a different texture or color. This usually continues until the treatment ends, after which hair almost always regrows.
The authors of one study estimate that 65% of people receiving chemotherapy experience hair loss. There is no guaranteed way to prevent it, but good hair care may slow the loss and promote regrowth.
4. Nausea and vomiting
Nausea and vomiting can start suddenly. These issues may occur right after each chemotherapy session or days later.
Dietary changes, such as eating smaller meals or avoiding certain foods, can help. Antinausea medications can also help, especially if a person experiences the side effects at predictable intervals, such as immediately after chemotherapy.
Neuropathy is nerve pain caused by damaged nerves. It often affects the hands and feet, causing tingling, numbness, and unusual burning sensations. Some people also experience weakness and pain.
Neuropathy is often worse in people who take certain chemotherapy drugs, according to a 2014 review.
Lotions containing lidocaine or capsaicin may help, but more research is necessary, the ACS note.
6. Constipation and diarrhea
Chemotherapy may trigger digestion problems because it can damage cells that help digestion.
Other side effects of chemotherapy, such as nausea, can force people to change their diets, but these changes may also cause or worsen constipation or diarrhea if they are sudden.
Avoiding foods that irritate the stomach may help. And over-the-counter remedies for constipation, such as a stool softener or fiber supplement, can make bowel movements less painful.
In addition, being well-hydrated can reduce the severity of constipation and also prevent dehydration caused by diarrhea.
Chemotherapy can alter the immune system in ways that cause rashes and other skin changes. The drugs can also trigger skin changes directly.
Severe rashes can cause painful, intense itching. If a person scratches until their skin bleeds, there is a risk of infection. Moisturizing lotions and over-the-counter anti-itch creams may help.
8. Mouth sores
Some people develop painful oral sores 1–2 weeks after having some forms of chemotherapy. The soreness can vary in severity, and the sores may bleed or become infected.
A person can try using a nonabrasive toothpaste or a numbing gel. Some people also find relief from rinsing their mouths with warm saltwater. See a doctor for treatment if any sores are very painful or weeping.
9. Breathing problems
Sometimes, chemotherapy can damage the lungs and make it harder to take in enough oxygen. Breathing issues can also result from some types of cancer.
Staying calm, sitting and propping up the upper body with pillows, and practicing pursed lip breathing may help. A doctor may prescribe medication if breathing problems continue.
Call 911, or otherwise contact local emergency services, if anyone has:
- breathing problems that start suddenly and do not improve
- a bluish tint to their mouth, nail beds, or skin
- chest pain
- weakness or dizziness
- difficulty speaking
Some side effects of chemotherapy can cause pain. For example, there may be:
- pain in the mouth and throat, possibly due to oral sores
- nerve pain
- pain at the injection site
Pain can also occur as cancer progresses. The ACS encourages people to contact their cancer care team if they experience headaches or pain at an injection or catheter site.
If pain occurs, do not stop having the treatment before discussing this with a doctor. They may be able to help.
Rare side effects
Some people experience rare side effects of chemotherapy. Some examples that may signal an emergency include:
- Hypersensitivity: This involves the immune system reacting to the chemotherapy drug.
- Extravasation: This is when fluid leaks from a blood vessel into surrounding tissues.
- Neutropenic typhlitis: This is inflammation of the gut that can affect people with a weakened immune system.
- Pancreatitis: This is inflammation of the pancreas.
- Acute hemolysis: This involves the destruction of red blood cells.
The ACS recommend seeking immediate medical care if any of the following occur after chemotherapy:
- a high fever, usually over 101°F
- intense chills
- unusual bleeding or bruising
- an allergic reaction, which may cause swelling, a rash, or severe itching
- pain at the injection or catheter site
- intense headaches or other unusual pain
- persistent diarrhea, vomiting, or both
- blood in the stool or urine
- difficulty breathing, in which case, someone should call 911
Chemotherapy can be an effective treatment for cancer, but it can also have adverse effects.
Before starting the treatment, speak with the doctor about which side effects are most likely, how long they might last, and how severe they might be.
If side effects occur, the cancer care team may be able to help manage them. Treatments and coping techniques can ease and relieve many chemotherapy side effects.
Last medically reviewed on April 20, 2021
Posted in: In Treatment, Risks, Side Effects, Treatment