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  • Print publication year: 2014
  • Online publication date: October 2014

Chapter 50 - Pain management in hematological cancer: clinical case illustrations

from Section 6 - Cancer Pain


Hematologic malignancies make up about 9% of the new cancer cases in the USA in 2013. Of the new hematologic cancer cases, approximately 53% were lymphoma, 32% were leukemia, and 15% were myeloma.[1] The management of pain in hematologic cancers presents a constellation of problems that are distinctly different from those associated with solid tumors. We will review four cases of patients who presented with pain associated with hematologic cancer that illustrate the unique complexity and breadth of the problems to be addressed. We will then discuss considerations that should be taken that affect the assessment of risks and the selection of analgesic treatment, and the monitoring of clinical response.


2. Nolan CP, Abrey LE. Leptomeningeal metastases from leukemias and lymphomas. Cancer Treat Res. 2005;125:53–69. Review.
4. Lyman HG, Lyman HC, Agboola O. Risk models for predicting chemotherapy-induced neutropenia. The Oncologist. 2005;10:427–437.
5. Soares M, Feres AG, Salluh IFJ. Systemic inflammatory response syndrome and multiple organ dysfunction in patients with acute tumor lysis syndrome. Clinics. 2009;64(5):479–481.
6. Larson AR, Pui CH. Tumor lysis syndrome: definition, pathogenesis, clinical manifestations, etiology and risk factors. UpToDate 2013.
7. Chakraborty A, Wells R, Doherty M, Huynh C, Selby D. Joint pain in AML: successful pain control with radiotherapy. J Pain Symptom Manage. 2008;35(6):670–672.
8. Franchini M, Frattini F, Crestani S, Bonfanti C. Bleeding complications in patients with hematologic malignancies. Semin Thromb Hemost. 2013;39(1): 94–100.
9. McMahon B, Stein LB. Thrombotic and bleeding complications in classical myeloproliferative neoplasms. Semin Thromb Hemost. 2013;39(1):101–111.
10. Elice F, Rodeghiero F. Hematologic malignancies and thrombosis. Thromb Res. 2012;129(3):360–366.
11. Nørgaard M. Risk of infections in adult patients with haematological malignancies. The Open Infectious Diseases Journal. 2012;6:46–51.
12. Kurz K, Garimorth K, Joannidis M, et al. Altered immune responses during septicaemia in patients suffering from haematological malignancies. Int J Immunopathol Pharmacol. 2012;25(1):147–156.
13. Niscola P, Tendas A, Giovannini M, et al. Pain in blood cancers. Indian Journal of Palliative Care. 2011;17(3):175–183.
14. Levy HM, Chwistek M, Mehta SR. Management of chronic pain in cancer survivors. The Cancer Journal. 2008;14:401–409.
15. Gould HJ, III. Management of painful neuropathies. Curr Treat Options Neurol. 2007;9:75–84.
16. Rosen JC, Silbermann R, Roodman DG. Hematologic malignancies and bone. In Rosen CJ, Bouillon R, Compston JE, Rosen V, eds. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 8th ed. Wiley-Blackwell. 2013: p. 84.
17. Kariyawasan CC, Hughes DA, Jayatillake MM, Mehta AB. Multiple myeloma: causes and consequences of delay in diagnosis. Q J Med. 2007;100:635–664.
18. Oranger A, Carbone C, Izzo M, Grano M. Cellular mechanisms of multiple myeloma bone disease. Clin Develop Immunol. 2013:1–12.
19. Milligan ED, Watkins LR. Pathological and protective roles of glia in chronic pain. Nat Rev Neurosci. 2009;10(1):23–36.
20. Terman GW, Bonica JJ. Spinal mechanisms and their modulation. In Bonica J, ed. The Management of Pain, 2nd ed. Philadelphia: Lea & Febiger. 2001: pp. 73–152.
21. Ballantyne CJ, Cousins JM, Giamberardino AM. Bone cancer pain. Pain Clinical Updates by International Association for the Study of Pain. 2009;17(2):1–6.
22. Kobbe G, Bruns I, Schroeder T, et al. A 3-day short course of palifermin before HDT reduces toxicity and need for supportive care after autologous blood stem-cell transplantation in patients with multiple myeloma. Ann Oncol. 2010;21:1898–1904.
23. Hussein MA, Vrionis FD, Allison R, et al. The role of vertebral augmentation in multiple myeloma: International Myeloma Working Group Consensus Statement. Leukemia. 2008:1–6.
24. McBride A, Westervelt P. Recognizing and managing the expanded risk of tumor lysis syndrome in hematologic and solid malignancies. J Hematol Oncol. 2012;5:75–85.
25. Kelly KM, Lange B. Oncologic emergencies. Pediatr Clin North Am. 1997;44(4):809–830.
26. Hande KR, Garrow GC. Acute tumor lysis syndrome in patients with high-grade non-Hodgkin’s lymphoma. Am J Med. 1993;94(2):133–139.
27. Geeta MG, Geetha P, Ajithkumar VT, et al. Management of pain in leukemic children using the WHO analgesic ladder. Ind J Pediatr. 2010;77:665–668.
28. Niscola P, Cartoni C, Romani C, et al. Epidemiology, features and outcome of pain in patients with advanced hematological malignancies followed in a home care program: An Italian survey. Ann Hematol. 2007;86:671–676.
29. Mhaskar R, Redzepovic J, Wheatley K, et al. Bisphosphonates in multiple myeloma: a network meta-analysis (review). The Cochrane Collaboration. 2012:5.
30. Smith SH. Opioid metabolism. Mayo Clin Proc. 2009;84(7):613–624.
31. Ashton JC, Milligan ED. Cannabinoids for the treatment of neuropathic pain: clinical evidence. Curr Opin Invest Drugs. 2008;9:65–75.
32. Wang T, Collet JP, Shapiro S, Ware MA. Adverse effects of medical cannabinoids: a systematic review. Can Med Assoc J. 2008;178:1669–1678.
33. Leppert W. The role of ketamine in the management of neuropathic cancer pain: a Polish experience. In Wells CD, ed. Proceedings of the 3rd International Congress on Neuropathic Pain, May 2010. Athens, Greece: NeuPSIG. 2010: pp. 27–30.
34. Kotlin’ ska-Lemieszek A, Luczak J. Subanesthetic ketamine: an essential adjuvant for intractable cancer pain. J Pain Symptom Manage. 2004;28:100–102.
35. Hardy J, Quinn S, Fazekas B, et al. Randomized, double-blind, placebo-controlled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain. J Clin Oncol. 2012;30:3611–3617.
36. Salas S, Frasca M, Planchet-Barraud B, et al. Ketamine analgesic effect by continuous intravenous infusion in refractory cancer pain: considerations about the clinical research in palliative care. J Palliative Med. 2012;15:287–293.
37. Leppert W. Ketamine in the management of cancer pain. J Clin Oncol. 2013;31:1374.