Chemo Care

What Is Joint Pain (Arthralgias)?

What are arthralgias? Arthralgias are defined as any discomfort or pain in the joints (joint pain).

What Causes Arthralgias?

Arthralgias may be due to side effects of certain cancer chemo treatments and medications such as paclitaxel, bleomycin, cladribine, L-asparaginase as well as biologic response modifiers (e.g. filgrastim, pegfilgrastim, sargramostim). Other causes of joint pain include:

• Rheumatoid Arthritis (RA) - an inflammatory disease involving many joints in the body. This is known as an autoimmune disease, which means, your immune system is contributing to your pain. 
• Osteoarthritis (OA) - an inflammatory disease with pain and stiffness in many joints in the body. This is fairly common, lasting less than 30 minutes in the day after awaking from sleep. Many people with OA complain of morning stiffness. 
• Medications - certain medications, as a side effect, can cause joint pain. The joint pain is usually relieved when the medications are stopped. 
• Infections in the joint 
• Other inflammatory conditions, such as gout (a collection of uric acid crystal deposits in the joint), or lupus

Symptoms of Arthralgias:

• You may have swelling and redness of the painful joints or experience pain in one specific region, such as back pain. This pain may be mild, or severe. The pain may last a few minutes, or it may be constant. 
• You may have fever, chills, if you have an infection.
• You may have pain in your muscles, as well as your joints.
• You may be overly tired, or very weak (fatigued). It may be hard for you to do any kind of your normal activities.
• You may feel depressed if you have constant pain.

Things You Can Do To Minimize Arthralgias:

Keep a diary of your pain. If you are having pain for any reason, your healthcare provider will ask certain questions to determine the cause of your pain. Things to include are:

• Onset - when did the pain start? What was I doing when I had pain? 
• Quality - what does the pain feel like? Is it knifelike and stabbing, or dull and constant? 
• Location - Where is the pain? Can I point to it with my finger, or is it spread all over? 
• Intensity - How bad is your pain all the time? How bad is it with certain activities that cause you to feel pain, on a 1-10 scale, with the number "10" being the worst pain imaginable? 
• Duration - How long did the pain last for? Is it while I was walking to the door, or did it continue for a while?
• Character - Does the pain come and go whenever I perform a certain activity, or is it unpredictable? 
• Relieving factors - What can I do to make the pain go away? Does anything help? What have I used in the past that have worked, and does this work now? 
• How is your mood? Are you depressed or anxious? Does this make the pain worse? 
• If you already have a source or cause for your pain, it is important to follow your healthcare provider's recommendations. Also, continue to keep a pain diary, and chart your progress.
• People with pain, who may not be taking deep breaths, need to circulate air from the bottom of their lungs and out of their lungs (oxygenation), to prevent infection and pneumonia. Using an incentive spirometer for 15 minutes a day, twice a day, can help promote oxygenation.
• Physical therapy is important. Try to exercise, as tolerated, to maintain your optimal level of functioning.. Exercise, in persons with bone problems, will help promote strengthening and bone remodeling (repair). Discuss with your healthcare provider how you can create a specific exercise program to suit your needs. Make sure to exercise, under the supervision of your healthcare provider. Walking, swimming, or light aerobic activity may help you to lose weight, and promote the flow of oxygen in your lungs and blood (oxygenation).
• If you have symptoms of back pain, or pain due to bone problems, braces or assistive devices (such as walkers or canes), may help.
• If you can locate your pain, especially if it is muscle related, warm compresses may help. 
• Occupational therapy (OT): you may be taught in OT how to do many tasks that you normally do, in a more effective manner. 
• People who are in constant pain often feel overly tired. To minimize excessive tiredness (fatigue) due to pain or cancer chemotherapy: 
• You should ask yourself: Am I experiencing fatigue? If so, how severe is it on a 1-10 scale? Is it interfering with my ability to function?
• It is important to weigh the value of certain activities. 
• If you feel anxious, use relaxation techniques to decrease the amount of anxiety you have. Place yourself in a quiet environment, and close your eyes. Take slow, steady, deep breaths, and try to concentrate on things that have relaxed you in the past. This is called behavioral therapy.
• Participating in support groups may be helpful to discuss with others what you are going through. Ask your healthcare provider if he or she is aware of any support groups that would benefit you.

If You Are Ordered A Medication To Treat This Disorder:

• Do not stop taking any medication unless your healthcare provider tells you to. 
• Take the medication exactly as directed. 
• Do not share your pills with anyone.
• Many medications to treat pain may cause you to feel dizzy or drowsy. Do not operate any heavy machinery unless you know how the medication will affect you. 
• Antacids, such as Mylanta®, Pepcid®, NexiumTM and others, may change the way many medications are absorbed. If you have any questions specific to medications that may have been ordered for you, ask your healthcare provider.  
• If you miss a dose of your medication, discuss with your healthcare provider what you should do. 
• If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
• Keep all your appointments for your treatments.

Drugs or Recommendations That May Be Prescribed by Your Doctor:

• If the cause of your pain has been undiagnosed, your healthcare provider may order certain tests or examinations based on your pain. This may include x-rays, CAT Scans, bone survey or scan, or an MRI. Your healthcare provider will order the exams that are right for you.
• Depending on your overall health status, your doctor may recommend that certain drugs be used to help decrease your pain. Some of the common drugs that are used to treat your pain may include:
• Antibiotics - If your doctor or healthcare provider suspects that you have an infection that has caused your joint pain, he or she may order antibiotics, either in a pill form or intravenous (IV). If you are prescribed antibiotics, take the full prescription. Do not stop taking pills once you feel better.
• Anticonvulsants - these medications are used in the treatment of chronic (long-term), nerve related pain in adults.
• When there is nerve injury present anywhere in the body, certain pain receptors may create new nerve endings. The threshold for pain (the point at which you experience pain) related to the nerves, may be decreased. Therefore, pain may be noticed while you are at rest, or while you are moving, when these nerve endings are irritated. 
• The exact way that the anticonvulsants, such as gabapentin (Neurontin®) works to prevent nerve related pain is unknown, but it is thought to decrease nerve pain at certain cell receptor sites, by decreasing your response to nerve pain.
• Anticonvulsants can be referred to as an "adjunct" medicine, meaning, it is used with another medication to make it work better. Many patients, in addition to gabapentin, will be on a narcotic pain reliever, such as oxycodone, or morphine sulfate. These medications will work together to better control your pain, each working in a different way.
• Antidepressants - are used to treat depression and pain in adults. People who have pain for a long period of time (chronic) become tired and depressed.
• Certain nerve signals, when activated, make pain worse, and cause more depression. Serotonin and norepinephrine are important conductors of nerve signals (neurotransmitters), which are found in the central nervous system (CNS). The places that these neurotransmitters work are highly important. These neurotransmitters contribute to depression. 
• Medications, such as venlafaxine (Effexor® ) work by blocking the "reuptake" of the neurotransmitters serotonin and norepinephrine, thus decreasing your depressive symptoms. 
• Corticosteroids - Corticosteroids work by decreasing inflammation (swelling) in many areas of the body. The corticosteroids prevent infection-fighting white blood cells (polymorphonuclear leukocytes) from traveling to the area of swelling in your body. This means you are more prone to infection while on steroids. 
• You may be taking steroids if you have a cancer that has spread (metastasized) to your spine, brain, or bone.
• Steroids will decrease the swelling in areas where tumors are located, which may decrease the pressure of the tumor on your nerve endings, and decrease your pain.
• Narcotics -The central nervous system (CNS) is a way for our brain to send messages to our body in a timely manner. It is highly alert, especially when we are experiencing pain. Many narcotic analgesic (pain medicines) work by blocking these messages, such as morphine sulfate and oxycodone.
• Make sure you discuss with your healthcare provider common side effects, such as constipation, drowsiness, nausea and vomiting, and how to control these side effects. 
• Non-steroidal anti-inflammatory (NSAID) agents and Tylenol®  such as naproxen sodium and ibuprofen may provide relief of musculoskeletal pain.
• If you are to avoid NSAID drugs, because of your type of cancer or chemotherapy you are receiving, acetaminophen (Tylenol®) up to 4000 mg per day (two extra-strength tablets every 6 hours) may help. 
• It is important not to exceed the recommended daily dose of Tylenol®, as it may cause liver damage. Discuss this with your healthcare provider.
• Your healthcare provider will discuss with you which treatments are helpful to you.
• Do not stop any medications abruptly, as serious side effects may occur.

When to Contact Your Doctor or Health Care Provider:

The following guidelines suggest when to call your doctor or health care provider if you have signs of:

• Spinal cord compression - the spinal cord controls movement, sensation, and other important functions. When the spinal cord and/or its nerves become squeezed, additional swelling (edema) may develop, and serious complications may occur, which may be permanent. If you notice:
• A band-like pain around your waist or chest (radicular)
• New and increasingly severe back pain 
• Numbness and tingling down your legs
• Weakness and decreased sensation of the lower extremities 
• Loss of bowel and bladder control. 
• Notify your doctor immediately! If your symptoms worsen or do not improve after 2 days of therapy

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.