Care During Chemotherapy and Beyond
Common Forms Of Pain:
Joint Pain (Arthralgias)
| Bone Pain | Muscle Pain (Myalgias)
What Is Muscle Pain (Myalgias)?
Myalgias can be defined as muscle aches. Myalgias can be a deep, constant, dull
ache, or a sharp, sporadic ache. Myalgias are often a result of:
- Medications - certain chemotherapy medications
can cause myalgias and joint pain (arthralgias), which usually resolve when the
medication is removed. These may include biologic therapies (such as interferon
or aldesleukin), or growth factors (such as filgrastim). Certain types of
chemotherapy, such as paclitaxel, may also cause myalgias.
Other possible causes of myalgias are:
- Infections - Infection in the blood, which produces a fever, may
cause muscle aches. You may also have an infection or inflammation in one of your
muscle groups, that may have caused pain.
- Prolonged muscle use - usually with exercise or movements that
your body is not used to.
- Other inflammatory conditions - such as fibromyalgia (a syndrome
characterized by widespread muscle pain, lack of sleep, headaches, and depression),
or polymyalgia rheumatica (PMR).
Symptoms of Myalgias:
- You may have muscle pain in a local area, or the pain may be more widespread. The
pain may be a dull ache, or sharp.
- This pain may be mild, or severe. The pain may last a few minutes, or it may be
- You may have fever, chills, if you have an infection.
- You may have pain in your joints, as well as your muscles.
- 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 your pain is constant.
Things You Can Do To Minimize Myalgias:
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
Location - Where is the pain? Can I point to it with my finger, or is it spread
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
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?
Your mood - Are you depressed or anxious? Does this make the pain worse?
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.
If you already have a source or cause for your pain, whether chemotherapy
or some other cause, it is important to follow your healthcare
provider's recommendations. Also, continue to keep a pain diary, and chart your
Keep your bowels moving. People in pain tend to move around less,
drink less fluid, and become constipated from pain medications that slow down the
movement of food through your stomach. This is easily treated by:
- Increasing your daily intake of fresh fruit and fiber. Prunes, and prune juice may
work for some individuals. It is important to move your bowels daily.
- If you do not move your bowels every day, your health care provider may prescribe
stool softeners and laxatives to help prevent constipation. Work with your healthcare
provider to develop a regimen that will work for you.
- Drink 2 to 3 quarts of fluid every 24 hours, unless you were told to restrict your
fluid intake. This will decrease your chances of being dehydrated, which can lead
- Increase your activity, if tolerated.
- People with pain, who may not be taking deep breaths, need to circulate air from
the bottom of their lungs and out of your 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 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. Warm baths may help as well, to relieve muscle aches.
- 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 are often 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 That May Be Prescribed by Your Doctor:
If your muscle pain was a result of a medication or treatment, removing that medication
may relieve your discomfort. If you still are experiencing myalgias, depending
on your overall health status, your doctor may recommend that certain drugs be used
to help decrease your muscle 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 muscle 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.
- Antidepressants - are used to treat depression and pain in adults.
People who have pain for a long period of time (chronic), may 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®) works
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 your myalgias are a result of inflammation.
- 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
- 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
- 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 your symptoms worsen or do not improve in 2 days of therapy.
- If you suspect:
- 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
- Hypercalcemia - is known as an elevated blood calcium level. When
the level of calcium in the blood is too high, certain problems may occur. Symptoms
of hypercalcemia may include:
- Frequent urination.
- Poor appetite.
- Nausea and vomiting.
- Excessive weakness and fatigue.
- Muscle twitching.
- Confusion, or behavior changes.
- If you notice these symptoms, notify your healthcare provider immediately.
Note: We strongly encourage you to talk with your health care professional
about any pain you are experiencing, whether or not you believe chemotherapy to
be the cause. We also encourage discussion 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.
Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org