How To Avoid Worrying About Pain

One day a breast cancer survivor came to my office with a bump on the back of her heel. She told me that it was painful and she was worried her cancer had returned. This woman, an executive and a runner, had a smooth, soft and tender mass about the size of a walnut. Immediately I knew the diagnosis was bursitis—in this region commonly called a “pump bump” because high heeled shoes (or “pumps”) aggravate it.

Is it possible that I knew the right diagnosis within less than a minute, and that she didn’t need an x-ray, bone scan or MRI to rule out cancer recurrence? Absolutely. This definitely wasn’t cancer. But, the thing is…it hurt. This woman had pain. And when cancer survivors have pain (even if there isn’t a visible bump or lump), they worry.

Being a cancer survivor myself, I know the worry associated with physical pain and the emotional pain associated with the worrying. Any pain anywhere might be a cause for concern. Who knows? After all, we’ve had bad news before…

In my book,  ” After Cancer Treatment: Heal Faster, Better, Stronger,” I wrote about how survivors have an instantaneous pain filter. We experience pain and instantly analyze whether that pain is something to worry about. Not because we aren’t tough or can’t “handle” the pain (some pain is intolerable and may be undertreated, of course—however sometimes the pain isn’t as much of a problem as the concern about what is causing it), but rather because it might signal recurrence or spread of our original cancer or even a new cancer diagnosis.

One of my friends and colleagues is writer Katherine Russell Rich who shared her story of being a Stage IV breast cancer survivor — for more than 17 years (!) — in the New York Times. Kathy has written about how fearful and worried one can become living with cancer and once described “fingernail cancer”— an imaginary disease created by the worry associated with analyzing every new pain.

A study that was just released in the “Clinical Journal of Pain” found that the fear of pain caused survivors with advanced disease to experience significant limitations and disability. Think about that. Fear causes limitations and disability. Not the pain itself. The fear of it.

This means when you are a cancer survivor who is experiencing pain you may have two problems:

The pain itself
The worry or fear associated with the pain

Unlike the patient with the pump bump who came to my office, I certainly can’t diagnose anyone’s pain symptoms over the Internet. But, but what I can do is to share with survivors who come to CancerForward seeking information when to worry about pain (and when not to). The first thing to keep in mind is that pain from cancer is unrelenting. In medicine we often say “it declares itself”, because it is so persistent — even waking people up at night or not allowing them to fall asleep. Cancer pain is sort of like having a loud, overbearing person in the room — you can’t ignore it. Another type of pain, musculoskeletal for example, is generally more intermittent and waxes and wanes in intensity. A good example is the pump bump — it only hurts when there is pressure on it from a shoe or someone pushing on it. With shoulder tendonitis, you may only experience it when you lift your arm overhead or at night when you roll onto the affected side. It’s intermittently painful.

There are far too many types of pain and causes for pain to explain them in an article, but there are “rules” that work pretty well to guide you about when to be concerned. So, here are my four rules for when to worry about pain:

Your doctor should check any pain that lasts for more than two weeks, though often pain that lasts for two weeks is musculoskeletal and not a serious threat to your health. Many doctors use the “two-week rule”, because a lot of musculoskeletal pain will resolve within a two-week period. Also, a two-week delay in diagnosis is very unlikely to change someone’s prognosis if the pain is due to cancer. Though the two-week rule applies to most pain, sometimes you should ignore this rule and seek treatment sooner (see Rules 2, 3 and 4).

A doctor should immediately check all pain associated with acute trauma, such as a car accident or fall off a ladder. Usually people aren’t overly worried about cancer if they have trauma that results in immediate or even slightly delayed pain. However, all pain associated with trauma necessitates examination by a doctor.

Any severe pain that doesn’t allow you to move about normally needs to get checked out sooner rather than later. Often this kind of pain is not cancer but may be the result of something serious such as a heart attack, appendicitis or ruptured blood vessel (aneurysm).

Talk to your doctor about any pain that keeps you awake at night. Sometimes night pain is more serious than pain that occurs during the day with normal activities. However, keep in mind that a lot of musculoskeletal pain bothers people at night. Hip bursitis or shoulder tendinitis often keeps people awake if they lie on the affected side. But if you’ve had cancer, don’t take any chances—report your symptoms to your doctor.

It’s normal to be worried about pain if you are a cancer survivor. However, undiagnosed and untreated pain may cause you far more concern than is truly warranted. If you aren’t sure what is going on, it’s a good idea to check in with your doctor. A little reassurance goes a long way.

The information found here is not intended to provide nor should it be interpreted to provide professional medical, legal or financial advice. You should consult a trained professional for more information.

Category: Experts Speak

Tags: Breast Cancer, cancer pain, cancer survivor, emotional pain, fingernail cancer, Harvard Medical School, JulieSilverMD, Pain, physical pain