Pain in Cancer Patients Unrelated to the Cancer or Treatment

… Pain is universal and is present in practically every disease… The physician needs to know not only the various factors to which a certain pain may be due, but also the reasons why it should be produced and the different diseases giving rise to pain of similar character and location. R. J. Behan 1921.The majority of patients with cancer will experience pain in the course of their disease (Kjaer, M. The therapy of cancer pain and its integration into a comprehensive supportive care strategy. Ann. Oncol. 1997, 8 (3), 15–19; Bruera, E.; Lawlor, P. Cancer pain management. Acta Anaesthesiol. Scand. 1997, 41 (1 of 2), 146–153.). Epidemiological studies (Foley, K.M. The treatment of pain in the patient with cancer. CA, Cancer J. Clin. Walley, B.A.; Hagen, N.A. The epidemiology of cancer pain. Pain Dig. 1995, (5) 237–244; Portenoy, R.K. Cancer pain: epidemiology and syndromes. Cancer 1989, 63 (11), 2298–2307.), generally categorize the pain as 1) directly caused by the neoplastic process or related phenomena; 2) by treatment; or 3) unrelated to the neoplastic process. In approximately 10% of cancer patients who have pain, the pain is unrelated to the disease or treatment and is most often caused by muscles and connective tissue (Twycross, R. Pain Relief in Advanced Cancer; Churchill Livingstone: New York, 1994; pp. 55–61.). An overview of pathophysiological mechanisms of muscle pain is presented, followed by a structured protocol to treat frequently encountered pain of muscular origin. The purpose of this article is to provide to the practicing clinicians easy to apply approaches for the treatment of muscle-related pain.