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Disease- and Treatment-Related Pain

Blood Cancer-Related Pain

Pain doesn't necessarily mean your cancer is getting worse. Blood cancer can cause pain for a number of reasons.

Leukemia or Myelodysplastic Syndromes

Leukemia or myelodysplastic syndromes (MDS) can cause bone or joint pain, usually because your bone marrow has become overcrowded with cancer cells. At times, these cells may form a mass near the spinal cord's nerves or in the joints. With acute lymphoblastic leukemia, bone pain occurs in approximately 25 percent of patients at the disease's onset. Bone pain is less common with acute myeloid leukemia or myelodysplastic syndromes. When bone pain occurs, it's most often felt in the long bones of the arms and legs and in the ribs and sternum of the rib cage. Joint pain and swelling in the large joints, such as hips and shoulders, may develop several weeks after bone pain begins.


Hodgkin lymphoma and non-Hodgkin lymphoma usually begin with painless swelling of lymph nodes — often in the neck, armpit or groin. During the disease's course, complications of the lymphoma and its treatment may cause pain — for example, chest, abdominal or bone pain.


More than two-thirds of myeloma patients have bone pain, generally in the back or chest and occasionally in the arms and legs, when they're first diagnosed. Masses of cancer cells build up, especially in the marrow, destroying normal bone tissue and making long bones and vertebrae more susceptible to fracture and collapse. Bone pain caused by myeloma may be severe, but when myeloma is successfully treated with chemotherapy, relief is usually noticeable.

Myeloproliferative Diseases

Myeloproliferative diseases can cause different types of pain, depending on the disease:

  • Primary thrombocythemia. You may have headaches or a burning or throbbing pain in your feet, sometimes made worse by heat or exercise or when your legs are hanging down for long periods. The pain is caused by reduced blood flow to the feet and toes.
  • Polycythemia vera. You may develop gout, a painful inflammation of the joints caused by increased levels of uric acid associated with the disease.
  • Idiopathic myelofibrosis. You may have severe upper-left shoulder pain caused by your spleen or impaired blood flow to part of the spleen. In rare cases, bone pain can occur, usually in the legs.


Treatment-Related Pain

Pain can also be a side effect of your cancer treatment as a result of the toxic side effects of standard drug therapies or radiation therapy used to treat blood cancers.

Radiation and Chemotherapy

Radiation and chemotherapy damage cancer cells and affect normal cells as well, causing pain and discomfort. Dry skin, difficulty swallowing and mouth sores are other common side effects of chemotherapy and radiation therapy. Some drug therapies and radiation therapy can cause damage to the peripheral nerves (peripheral neuropathy).

Bone Marrow Biopsy and Aspiration

Bone marrow testing can be painful, so your doctor may give you drugs to relieve the pain. You may have slight bone pain or discomfort where the needle was inserted for a few days after the procedure.

Stem Cell Transplantation

Painful oral ulcers, called oral mucositis, can develop as a result of harsh conditioning therapy (high-dose chemotherapy and radiation therapy) given before stem cell infusions.


Cancer therapies can also weaken the immune system, which is why shingles (a painful reemergence of the chicken pox virus, varicella zoster) is common among patients in active treatment.

Report any pain to your doctor. Most side effects from pain medicine (for example, fatigue, gastrointestinal problems) can be managed as long as you tell your physician about them.