Pain after chemotherapy is possible, but not typical; chemotherapy is more likely to relieve the patient of pain caused by any manifestations of a malignant tumor. No painkiller can relieve metastatic bone pain as effectively as chemotherapy does.
In the terminal stage, when bone pain becomes unbearable and cannot be relieved by drugs, just one injection of a cytostatic drug can reduce the intensity of the pain, but chemotherapy in such a serious condition is impossible due to the inevitable development of fatal complications.
- Causes of pain after chemotherapy
- Features of symptoms and localization
- Diagnosis of pain after chemotherapy
- Pain therapy methods
Recovery of kidney function after chemotherapy
After chemotherapy, profuse diarrhea and uncontrollable vomiting are possible, which causes a large amount of fluid to be lost in the body. Along the way, there is a loss of sodium chloride, which is necessary to maintain the vital activity of all cells, and hydrochloric acid, which is vital for the normal functioning of the kidneys and adrenal glands.
The epithelial tissues of the renal tubules cannot reabsorb the filtered fluid into the blood, resulting in renal failure. In this case, part of the renal functions is taken over by the duodenum. Due to the loss of sodium chloride, the adrenal glands cease to fully cope with their functions. There is a disruption in the release of hormones necessary for the body, of which the main ones are norepinephrine, adrenaline, glucocorticoids, and mineralocorticoid hormones. The resulting acute liver failure due to excessive intoxication can cause failure of other organs.
Immunomodulators
The effects of chemotherapy destroy all cells that are characterized by rapid division, these can be not only cancerous formations, but also red blood cells, platelets, and leukocytes.
Such a negative effect on blood cells can cause: - decreased immunity; - anemia; - oxygen starvation of organs and tissues; - increase in coagulation time.
A lack of white blood cells can contribute to disruption of the immune system, which negatively affects the body's protective functions.
In combination with chemotherapy drugs, immunomodulators are prescribed to reduce the suppression and destruction of the immune system.
Metabolism and kidney damage
When protein breaks down, a substance called uric acid is produced. As a result of intensive tumor disintegration, which occurs under the influence of chemotherapy sessions, a large amount of uric acid is released, which leads to nephropathy - a disruption of the structure and function of kidney cells.
Uric acid nephropathy is often a predictable effect of the use of metaphase poisons - the drugs vincristine or vinblastine. These poisons are quite widely used in combination therapy of oncological diseases due to their ability to increase the sensitivity of malignant neoplasms to other drugs. But uric acid can damage the kidneys not only after the administration of metaphase poisons, but also as a result of taking other drugs.
Doses of drugs
Any effects of chemotherapy have a destructive effect on the human body, and therefore, when choosing a dosage, a specialist must calculate it so that it gives the maximum therapeutic effect, but does not kill the patient. In small doses, taking cytostatics and cytotoxics is useless, since they cannot stop the division and multiplication of cancer cells. Large dosages are dangerous; they can cause irreversible consequences and lead to death.
To avoid making mistakes in prescribing drugs, oncologists use personal experience, protocols and observations of how the disease develops. Therapy for cancer is based on stopping the growth of the tumor and stopping the movement of pathogenic cells throughout the body. Chemotherapy involves using selected medications to accomplish these two goals.
Nephropathy
Nephropathy, combined with painful or difficult urination, is usually a consequence of the use of antitumor antibiotics - epirubicin, mitomycin, doxorubicin. A large number of cases of kidney failure have been recorded after taking rituximab, a drug belonging to the group of monoclonal antibodies. This group began to be used in oncological practice not so long ago, so there is little information about side effects and safety of use.
After completion of chemotherapy, monitoring the condition of the kidneys is considered mandatory and is carried out individually for each patient. It is vitally important to restore functions such as tubular reabsorption and glomerular filtration after chemotherapy. It is also important to prevent kidney infections and the formation of urate stones, which further aggravate the condition of the kidneys.
Restoring blood
There are several main criteria by which the state of the blood is judged - a general blood test, ESR value, biochemical analysis, leukocyte formula. A frequent disorder observed after a course of such treatment is damage to hematopoietic germs, which makes itself felt only after some time.
Patients who have coped with the first stage of the chemical disease reaction will also have to cope with the second. This stage lasts from 3 to 7 days, during which all subsequent stages develop - first edema, then infiltration, then necrosis and destruction of gastrointestinal tissue, hematopoietic sprouts and other constantly dividing organs.
It is during this period that the erythrocyte sprouts of the bone marrow die under the influence of the cytotoxic effects of drugs or metabolic disorders. This causes the development of anemia, leukopenia, thrombocytopenia, the appearance of numerous bruises on the body and hemorrhages in the internal organs. The only solution may be blood transfusion, platelets and red blood cells, and sometimes a bone marrow transplant may be required.
When does drug resistance occur?
Cancer cells that do not respond to prescribed therapy are a big obstacle to all treatment, and therefore they are being intensively studied and methods of destruction are being sought. Tolerance to drugs develops against the backdrop of biochemical processes that can overcome the damage that medications can cause. To reduce resistance, higher doses of chemotherapy are prescribed. True, this can lead to a new problem - the destruction of healthy cells; the risk zone includes the bone marrow, which is responsible for the process of hematopoiesis. Higher dosages are recommended only in cases where bone marrow or stem cells can be transplanted. The larger the tumor, the more resistant it is to chemotherapy.
Immunity and microflora
An important step is the restoration of immunity after chemotherapy, because due to its low level, opportunistic flora becomes pathogenic and causes significant harm to the body. The transferred intoxication changes the living conditions of viruses, fungi and bacteria. After the end of drug treatment, candidiasis often appears. After treatment with antibiotics, the probability of its development is almost 100%.
Staphylococcus can appear and subsequently take root in almost any organ. After the end of the chemistry, conditions favorable for it arise in the body, as a result of which it actively multiplies and spreads through the vessels. For this reason, inflammation, foci of necrosis or perforated areas develop in them. Because of this, bleeding and sepsis occur, which are the direct cause of death in 70% of cases. Antibiotics hardly help in such cases. Symptoms of an infection include sweating and high fever. For already developed infections, antitumor antibiotics cannot be used due to the high risk of exacerbation of the disease, including sepsis.
How long do side effects last?
The duration of toxic effects depends on the rate of restoration of damaged tissue, the standard time is 21 days, during which time the intestinal mucosa and bone marrow are completely restored. A week is enough to restore leukocytes and platelets; red blood cells will require more than 4 months.
Mucositis may last for a couple of weeks, but by the end of the first week the symptoms decrease.
Restoration of the liver, kidneys, and nervous system can take up to a year without any guarantee of 100% repair.
Hair begins to grow at the beginning of the next cycle, nails are completely replaced after six months.
Liver
Metabolism in the body depends on the ability of all organs involved in it to perform their functions. Decomposition and metabolic products are excreted through the skin, kidneys, intestines, lungs and liver.
In the process of processing and removing harmful substances from the body, the main organ is the liver. In addition, it takes part in immune reactions. Therefore, the liver is sensitive to many drugs. Moreover, the drug itself has a direct effect on it, and its metabolites have an indirect effect. Massive infections, as well as changes in the blood after chemotherapy, significantly disable the cells of this organ. If a patient’s kidneys fail, then the entire intoxication function is transferred to the liver.
Pain therapy methods
Medications
In most cases, pain after chemotherapy can be reduced by taking nonsteroidal anti-inflammatory drugs (NSAIDs), especially pain in the joints and bones. Neurogenic pain in the legs is sensitive to ketoprofen from the NSAID group; they respond less well to other drugs in this group. As a rule, the need for weak narcotic drugs may arise only in case of breakthrough pain; one dose may be sufficient to relieve the syndrome. In all cases, pain treatment begins with tablets, and only if there is no effect, injections are resorted to.
Multimodal therapy
Pain after chemotherapy is most often acute and goes away within a few days, in most cases it is controlled with medications. For neurogenic pain, medications alone may not be enough. To treat polyneuropathy, several groups of drugs are used, as well as physiotherapeutic procedures and drug blockades of nerves and plexuses.
For severe chronic pain, neuromodulatory techniques are required with the introduction of narcotic analgesics into the spinal space in combination with electric current therapy of areas along the nerve endings, as well as acupuncture with acupuncture.
Relieving chronic neurogenic pain is a complex task that requires the participation of different specialists and many therapeutic techniques in the treatment process, which is called a multimodal approach.
Non-drug therapy
For severe and prolonged pain, technologies for neurodestruction have been developed—destruction of the nerve. Preference is given to non-invasive methods - without penetration into the body, but it is fundamentally possible to introduce alcohol and other chemical compounds into the nerve.
For chronic pain, radiofrequency ablation of the nerve trunk blocks the transmission of pain impulses through it without damaging motor neurons. The effect lasts for several weeks, and there is no risk of destruction of surrounding tissue due to infection.
As a rule, radiation therapy is not used for pain after chemotherapy, but for intense pain in a large joint, a single low dose of radiation can help.
Psychosocial measures
Each person feels pain in his own way, which is determined by the psychological characteristics of the individual. It's no secret that you can learn not to feel pain or at least not perceive it as a physical disaster. Psycho-emotional practices, taught to the patient by a psychologist specializing in oncological pathology, help “harden” against pain.
Our Clinic uses all methods of pain relief after chemotherapy; our chemotherapists prepare each patient for special treatment according to an individual program, helping to quickly cope with adverse reactions.
Book a consultation 24 hours a day
+7+7+78
Bibliography:
- Blank M.A., Korytova L.I., Rozengauz E.V./Synchronous combination therapy in the palliative treatment of cancer patients//Palliative Medicine and Rehabilitation, 2002; No. 2-3.
- Zvatrau E.E., Medvedev I.O./Modern directions of pharmacotherapy of chronic pain syndromes//Gedeon Richter in the CIS, 2001, No. 1(5).
- Kidwell KM, Yothers G, Ganz PA, et al. /Long-term neurotoxicity effects of oxaliplatin added to fluorouracil and leucovorin as adjuvant therapy for colon cancer: Results from National Surgical Adjuvant Breast and Bowel Project trials C-07 and LTS-01// Cancer, 2012; 118.
- Mols F., Beijers T., Lemmens V., et al. /Chemotherapy-induced neuropathy and its association with quality of life among 2- to 11-year colorectal cancer survivors: Results from the population-based PROFILES registry// J Clin Oncol, 2013; 31.
- Quasthoff S., Hartung HP/ Chemotherapy-induced peripheral neuropathy// J Neurol, 2002; 249.
The cardiovascular system
Before chemotherapy courses, most patients suffer from hypertension. After its completion, a large proportion of cardiovascular diseases manifest themselves in the hypotonic type. After removal of the tumor, the pressure may stabilize.
Side effects of chemistry include cardiotoxicity, the occurrence of thrombophlebitis, and the development of heart failure. The drug doxorubicin has a strong cardiotoxic effect, which produces free radicals that are very damaging to cell membranes.
Intestines
A common cause of patient complaints is intestinal dysfunction. This kind of violation causes them a lot of inconvenience. To avoid nausea and vomiting, which are common phenomena, medications are prescribed that reduce the sensitivity of the vomiting center.
Protecting the intestinal mucosa from inflammatory phenomena is a significant problem, since there are practically no drugs that can prevent them. Therefore, painful sensations in the epigastrium, indigestion, diarrhea, lack of appetite, and dysbacteriosis are extremely common. In addition, the inflamed intestines cannot fully digest food, which further worsens the condition of patients after chemotherapy.
Nutrition
Restoring normal stomach function requires careful attention to the diet. You need to eat food fractionally - in small portions 5-7 times a day. You will have to give up fried, fatty, smoked, flour (at least partially), sweets (except fruit), and carbonated drinks. You can and should include in your diet:
- Fermented foods - yogurt, kefir, low-fat cottage cheese, if your stomach can handle such foods (consult your doctor).
- Clean water - at least a liter per day. Water helps flush out toxins and promotes proper bowel function. Remember that drinking food down is wrong. You dilute the gastric juice and risk disrupting the digestion process.
- Vegetables and fruits - they contain fiber and vitamins, as well as acids and minerals needed by the body. A mandatory item provided you are not allergic to specific fruits. If you have stomach problems, it is not always possible to eat fresh vegetables and fruits; in this case, it is best to steam them, preserving all the beneficial substances as much as possible.
- Healthy fats, for example, omega-3 - oily fish, flaxseed, walnuts, and omega-6 - soybeans, corn. It is better to choose salmon, sardines, and herring.
Avoid processed foods, including sugar and white flour. Avoid refined sugars and unhealthy fats (trans fats, partially hydrogenated or hydrogenated fats, and interesterified fats), which can harm a weakened body.
Medication-assisted recovery
To recover from chemotherapy, doctors prescribe medication. It usually includes a group of antitoxic drugs, steroidal and non-steroidal anti-inflammatory drugs, vitamins, antioxidants, and painkillers are often prescribed.
For most patients, all these medications do not bring relief. Therefore, many people prefer to restore after heavy chemotherapy using safe natural remedies. Such people are offered the use of herbal healing and a course of accompanying herbal medicine is recommended, which at the same time has a preventive effect against certain types of consequences of chemotherapy.
Treatment of complications
Traditional treatment of complications is not always possible. Vomiting is well controlled, medications cope well with leukopenia, with a high probability of 3-4 degree inhibition of the white blood sprout and before the appearance of leukopenia, the introduction of colony-stimulating factors begins in advance.
There are no specific drugs to relieve the neurotoxicity of chemotherapy, so there is an urgent need for physical therapy and various neurorehabilitation techniques.
In case of complications from the gastrointestinal tract, mainly mucous membranes and the liver, only symptomatic treatment is possible, which is why the professionalism of the medical team and the clinic’s capabilities in organizing intensive care and conducting auxiliary rehabilitation treatment, and selecting adequate nutrition are so important.
