A Cancer Pain Tutorial

A Comprehensive Visual Short Course
on Cancer Pain Management

Post-Radical Neck Dissection Pain 
animation of neck diiection
Pain Type : Neuropathic
Cause: Surgical Injury to Cervical Nerves
Effects: Tightness Burning Sensation in are of Senory Loss

Clinical Signs:
Accessory Nerve Injury Can Cause Shoulder Drop, resulting in an aching arthritic type pain

Diagnosis : Look for Recurrence of Local Disease with Deep Throbbing Pain

This pain is caused from surgical injury to the cervical nerves.

Pain is characterized as a tightness and a burning sensation the area of the sensory loss. An accessory nerve (11th nerve) injury can cause a shoulder drop, which in turn results in an aching, arthritic type pain. In localized deep throbbing pains, one should consider recurrence of local disease.

Post-Mastectomy Pain
pciture of mastectomy
Pain Type : Neuropathic
Cause: Interruption of the Intercostalbrachail Nerve
May follow any Surgical Procedure
Effects: Tight, Constricting, Burning Pain

Clinical Signs:
Pain in Posterior Arm and Axilla Radiating across the Anterior Chest Wall, Pain exacerbation on Arm Movementin

Post-mastectomy pain occurs in the posterior arm, axilla, and anterior chest wall. It may follow any surgical procedure, even lumpectomy.

The cause of the pain is interruption of the intercostobrachial nerve, a cutaneous sensory branch of T1-T2. The pain is characterized as a tight, constricting, burning pain in the posterior arm and axilla radiating across the anterior chest wall, with pain exacerbation on movement of the arm.

Post-Thoracotomy Pain
picture of post-thoracotomy
Pain Type: Neuropathic
Cause: Postsurgical Trauma to Neurovascular Bundle or Recurrent Tumor in Distribution of the Intercostal Nerve
Effects: Constant Dull, Aching, Pressure-Like Sensation In Hip or Sacral Areas. Occasional Sensation of Burning.
Diagnosis : Traumatic Neuromas are Uncommon

Post-thoracotomy pain occurs in the distribution of an intercostal nerve. The pain is usually due to either postsurgical trauma to the neurovascular bundle or recurrent tumor in the distribution of the intercostal nerve

Traumatic neuromas are uncommon.

Post-Nephrectomy Pain
illustration of spinal cord
MRI of kidney area
Pain Type: Neuropathic
Cause: Interruption of Fibers from L1, Surgical Incisions in the Flank
Effects: Numbness, Fullness, and Heaviness in Flank, Anterior Abdomen, and Groin
Associated Cancers: Prostate, Testicle, Rectum, Bladder, Cervix
Diagnosis :CT

Post-nephrectomy pain results from surgical incisions in the flank. Pain is caused from interruption of the fibers of L1.

It is characterized by a sensation of numbness, fullness, and heaviness in the flank and anterior abdomen and occasionally the groin. CT scan to rule out recurrent disease in the retroperitoneal area around the spinal root is important.

Post-Amputation Pain
amputation animation
Pain Type: Neuropathic
Cause: Surgical Incision, Traumatic Neuroma
Effects: Burning, Dysesthetic Sensation

Clinical Signs:
Stump Pain: At Site of Surgical Incision

Phantom Sensation: After All Extermity Amputations, Same Site in Phantom Limb

Treatment :

Stump Pain: Nerve Block by Injection of Local Anesthetic
Phantom Pain: Recurrence of Pain in Phantom Limb, Recurrent Disease Proximally

Surgical amputation of an extremity can cause two distinct types of post-amputation pain. Phantom limb sensation occurs after all extremity amputations. It is not reported as pain.

Phantom limb pain continues at the same site in the "phantom limb" as prior to the amputation. It may subside with time. Stump pain occurs at the site of the surgical incision. This is usually the result of a traumatic neuroma.

Pain is characterized by a burning, dysesthetic sensation. Nerve block by injection of local anesthetic stops the pain. Recurrence of pain in a phantom limb is frequently due to recurrent disease proximally.