Dominic Stone
Cancer and its treatment can cause muscle pain and weakness. Muscle pain, called myalgia by doctors, can range from a deep, steady ache to a sharp jab and can be felt in one specific area or all over the body. Cancer treatments such as chemotherapy, radiation therapy, and hormonal therapies can cause muscle pain due to nerve damage or as a side effect of certain medications. Cancer itself can also lead to muscle pain by causing muscle inflammation (myositis) or by interrupting the brain's ability to communicate signals to certain muscles, resulting in a chemical imbalance. Additionally, cancer-induced bone pain (CIBP) can also contribute to muscle pain and dysfunction. Understanding and managing cancer-related muscle pain involve considering various factors, including the type of cancer, treatment methods, and individual patient experiences.
| Characteristics | Values |
|---|---|
| Cancer-induced muscle pain | Myalgia |
| Cancer-induced muscle wasting | CIMW |
| Tumor-induced activation of the host immune system | Cachexia |
| Chemotherapy causing muscle pain | Doxorubicin |
| Radiation therapy causing muscle pain | Radiation-induced fibrosis |
| Hormonal therapies causing muscle pain | Tamoxifen |
| Cancer treatment causing nerve pain | Radiotherapy, chemotherapy |
| Cancer-induced bone pain | CIBP |
| Cancer spread into the bone | Somatic pain |
| Cancer spread into soft tissue | Visceral pain |
| Cancer treatment causing skin irritation | Radiotherapy |
| Cancer treatment causing leg cramps | Chemotherapy |
| Cancer treatment causing muscle weakness | Chemotherapy |
| Cancer treatment causing muscle spasms | Chemotherapy |
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What You'll Learn
Tumours pressing on nerves, bones or organs
Tumours pressing on nerves, bones, or organs can cause muscle aches. This is one of the major causes of cancer pain. The pain can be acute or chronic. Acute pain is due to damage caused by an injury and tends to only last a short time. For instance, having an operation can cause acute pain, which can be controlled by painkillers until the wound heals. On the other hand, chronic pain can be due to changes to the nerves caused by cancer pressing on them or by chemicals produced by a tumour. Chronic pain can also be caused by nerve changes due to cancer treatment and may continue long after the injury or treatment is over, ranging from mild to severe.
Cancer can spread into the bone and cause pain by damaging the bone tissue. The cancer can affect a specific area of bone or several areas. Bone pain is called somatic pain and is often described as aching, dull, or throbbing. Soft tissue pain, also called visceral pain, refers to pain from a body organ or muscle. For example, tissue damage to the kidney can cause pain in the back. This type of pain is usually sharp, cramping, aching, or throbbing, and it can be challenging to pinpoint its exact location.
Nerve sheath tumours, which occur in Schwann cells, can cause muscle weakness and aching, burning, or sharp pain. They usually appear as nodules or masses under the skin but can also affect deeper nerves. About 60% of Schwannomas affect the vestibular nerve in the inner ear, while others form under the skin or deeper in the tissues and organs. In rare cases, long-lasting tumours can become cancerous and involve several types of tissue in the nerve sheath.
Tumours pressing on nerves can also cause long-term nerve pain after surgery, as it takes a long time for cut nerves to heal due to their slow growth. This type of nerve pain can also occur after cancer treatments such as chemotherapy and radiotherapy. Chemotherapy drugs can cause numbness and tingling in the hands and feet or a burning sensation at the injection spot. Similarly, radiotherapy can cause skin redness and irritation, and if administered near the bladder, it can cause inflammation, a condition called radiation cystitis.
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Cancer treatments like chemotherapy, radiation therapy, and hormonal therapies
Muscle pain, or myalgia, can be caused by cancer treatments such as chemotherapy, radiation therapy, and hormonal therapies. Chemotherapy-induced peripheral neuropathy (CIPN) occurs when chemotherapy damages nerves, causing tingling, numbness, or pain in the hands and feet, and muscle weakness in the legs. This nerve damage can also happen due to radiation therapy or targeted therapies like Tamoxifen. In the case of breast cancer, radiation-induced fibrosis can cause muscles to feel stiff and tight, leading to pain and weakness. Certain chemotherapy drugs can also cause dehydration, resulting in electrolyte imbalances that lead to muscle cramps.
Cancer treatments can cause acute or chronic pain. Acute pain is typically due to damage caused by an injury, such as post-operative pain, and can usually be managed with painkillers until the wound heals. Chronic pain, on the other hand, can persist long after the injury or treatment and is often associated with nerve changes caused by cancer treatments.
Chemotherapy drugs like doxorubicin can contribute to muscle wasting and atrophy via increased oxidative stress and the formation of reactive oxygen species. This results in a loss of muscle mass and atrophy. Additionally, cancer treatments can lead to metastatic cancer spreading to the central nervous system and pressing on nerves, causing muscle cramps.
While muscle pain and cramps can be a side effect of cancer treatments, it is important to note that not all pain is related to cancer. Some pain may be due to other factors, such as infection, disease, or general aches and pains that can affect anyone from time to time.
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Cancer-induced muscle wasting (CIMW)
Muscle pain, or myalgia, can be a symptom of cancer and its treatment. Cancer-induced muscle wasting (CIMW) is a major clinical problem in advanced-stage cancer and is usually associated with bone pain, fractures, hypercalcemia, and nerve compression. It is one of the major symptoms of cancer cachexia, a severe and disabling clinical condition that frequently accompanies many types of cancer. Cachexia results in muscle wasting due to decreased protein anabolism, increased proteolysis, or a combination of both. The prevalence of muscle loss depends on the type and stage of cancer and the assessment tool used, ranging from 16% in early-stage breast cancer to 40.3% in hepatocellular carcinoma.
CIMW is caused by a combination of host and tumor factors, including decreased levels of testosterone and IGF-1, decreased food intake, and increased muscle protein degradation. Chemotherapy can also induce muscle wasting and fatigue, especially in striated muscles. In addition, alterations in energy metabolism involving mitochondrial dysfunction have been implicated in the wasting process. Treatments such as resiniferitoxin and selective androgen receptor modulators are currently being tested and show promise in increasing lean mass.
Exercise has been proposed as a crucial component of the multimodal approach to cancer cachexia and CIMW. Endurance training can stimulate oxidative metabolic adaptations, while resistance training can lead to muscle hypertrophy and improve insulin sensitivity. However, implementing exercise programs for cancer patients can be challenging due to factors such as chronic fatigue, anemia, cardiac dysfunction, and other comorbidities. The complexity of exercise interventions in clinical settings, along with the simultaneous delivery of multimodal cancer treatments, presents logistical difficulties.
While some studies have shown that exercise can help prevent and treat CIMW, the literature yields mixed results. The divergent reports are due to factors such as evolving definitions and diagnostic criteria of muscle loss, differences in tumour type and treatment, and variations in the type, timing, and quality of exercise interventions. Further research is needed to fully understand the role of exercise in preventing and treating CIMW, especially in individuals with advanced cancer or aggressive muscle wasting.
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Cancer-induced bone pain (CIBP)
The skeletal system is the third most common site for cancer metastases, with tumours from the breast, prostate, lungs, and kidneys having a strong tendency to metastasize to bone. This cancer spread to the bone causes pain by damaging bone tissue, which can affect a specific area or multiple areas. Local acidosis, triggered mainly by osteoclasts and tumour cells, plays a crucial role in tumour-induced bone destruction and CIBP. Additionally, alterations in sphingolipid metabolism in the spinal cord, specifically changes in ceramide, sphingosine, and sphingosine 1-phosphate (S1P) levels, may also contribute to CIBP.
The neuropathic mechanisms involved in CIBP include cancer-induced damage to sensory fibres, pathological remodelling of the peripheral nervous system, and the consequences of cancer treatments such as chemotherapy, radiotherapy, and surgery. Central sensitization, neuroinflammation, glial cell activation, and an acidic environment are also considered factors in neuropathic pain associated with CIBP.
The treatment of CIBP should be multimodal, including both pharmacological and non-pharmacological approaches. Causal anticancer treatments, such as local surgery, radiotherapy, chemotherapy, and systemic therapies, help reduce tumour mass and infiltration, thereby decreasing pain intensity. Symptomatic analgesic treatments are also used to manage pain and improve quality of life.
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Cancer-induced nerve damage
Cancer treatments can cause nerve damage, which in turn leads to muscle aches. Peripheral neuropathy is damage to the nerves that carry messages between the brain, spinal cord, and the rest of the body. It can be caused by cancer or its treatment. Chemotherapy drugs can damage the central nervous system and the peripheral nervous system. The nervous system is made up of the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS comprises the brain and spinal cord and controls thoughts, emotions, coordination, and actions of the body. The PNS, on the other hand, includes cranial nerves, spinal nerves, and peripheral nerves.
Some anti-cancer drugs can damage the nerves, and this is the most common cause of peripheral neuropathy in cancer patients. If a tumour is growing close to a nerve, it can press on it and cause peripheral neuropathy in one area of the body. Surgery may also damage nerves and cause symptoms in the affected area. For example, breast cancer surgery may result in numbness, tingling, and pain in the arm. Radiation therapy to the brain or spinal cord can damage the CNS, while radiation to the head, neck, or the whole body can cause peripheral nerve damage.
Nerve damage can cause muscle aches. Damage to motor nerves, which help muscles move, can result in weak or achy muscles. This can lead to a loss of balance, tripping, and difficulty with tasks such as buttoning shirts or opening jars. Chemotherapy can also cause muscle pain and weakness due to nerve damage, which is a side effect of some chemotherapy medications. This can lead to muscle stiffness and tightness, further contributing to muscle pain and weakness.
Cancer-induced muscle wasting (CIMW) is a significant problem in advanced-stage cancer and is often associated with bone pain, fractures, and nerve compression. It is one of the major symptoms of cancer cachexia, which involves skeletal muscle loss due to decreased protein anabolism and increased proteolysis. CIMW is caused by multiple factors, including decreased testosterone levels, increased oxidative stress, and decreased food intake.
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Frequently asked questions
Yes, cancer can cause muscle aches. Tumors can grow and push on normal parts of the body, including muscles, causing pain. This pain can be acute or chronic.
Muscle pain can range from a deep, steady ache to a random sharp jab. It can be felt in one specific area or all over the body.
Muscle pain in cancer patients can be caused by the cancer itself or by cancer treatments. Cancer treatments that can cause muscle pain include chemotherapy, radiation therapy, and hormonal therapies.
Muscle pain in cancer patients can be treated through various methods, including medication, physical therapy, and gentle stretching exercises.
Yes, cancer can cause muscle weakness, especially in lung cancer patients. This can be due to a variety of factors, including the location of the tumor, breathing difficulties, stress, and inactivity.
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