Leukemia is a cancer that affects the blood and bone marrow. It causes symptoms like fatigue, weakness, frequent infections, and pain. But where exactly do leukemia patients feel pain? Let’s take a closer look.
Common Areas of Pain
There are several places where leukemia patients often experience pain or discomfort:
Bones and Joints
One of the most common sites of leukemia pain is in the bones and joints. This occurs because leukemia causes bone marrow to produce abnormal white blood cells, rather than normal red blood cells, platelets, and white cells. The abnormal cells crowd out the normal cells in the bone marrow, leading to anemia and low platelet counts. They also release chemicals that cause inflammation, which damages bones and joints.
Areas where bone pain is most frequently reported include:
- Lower back
- Hips
- Chest
- Skull
- Long bones like those in the arms and legs
The pain may be described as deep, throbbing, or gnawing. It can range from mild to severe. Joint pain from leukemia is often felt as aches or stiffness in areas like the knees, elbows, and ankles. This is called arthralgia.
Lymph Nodes
Swollen lymph nodes are another common site of discomfort in leukemia. Lymph nodes are small glands that filter lymph fluid and help fight infections. In leukemia, lymph nodes in the neck, underarms, abdomen or groin can become enlarged as abnormal white cells congregate there.
The swelling may be painless in some patients, while in others it causes sore and tender lymph nodes. Enlarged lymph nodes in the abdomen (the spleen and liver) can also press on nearby organs, causing pain.
Head and Neck
Patients with certain types of leukemia like acute lymphocytic leukemia may have pain in the head and neck region. Headaches, jaw pain, and sore throats are some examples.
Headaches are caused by the buildup of toxic substances released by the abnormal leukemia cells. Facial pain can happen when leukemia spreads to bones in the jaw, skull or ear canal. Sore throats and mouth pain may be caused by infections resulting from a lack of normal white cells.
Stomach and Abdomen
Some leukemia patients experience pain or discomfort in the stomach area. This can be due to swollen organs like the liver and spleen pressing on other organs. Nausea, vomiting and loss of appetite are also common symptoms.
Leukemia lowers blood cell counts, increasing vulnerability to infections. This may lead to gastrointestinal infections that cause abdominal pain, diarrhea or constipation.
Chest
Chest pain can occur if leukemia spreads to chest structures like the lymph nodes, bone, or chest wall. Breathing difficulties due to anemia or infections like pneumonia can also cause chest discomfort.
What Causes the Pain?
There are a few key factors that contribute to pain in leukemia patients:
- Bone marrow infiltration – Abnormal leukemia cells crowding out healthy marrow is a major cause of bone pain.
- Anemia – Low red blood cell count causes fatigue and shortness of breath which can be painful.
- Thrombocytopenia – Having too few platelets raises risk of bruising and bleeding which is painful.
- Infections – Due to lack of normal white blood cells, infections can develop and cause pain.
- Toxic substances – Waste products released by leukemia cells cause side effects like headaches.
- Inflammation – Chemicals released by leukemia cells trigger widespread inflammation in the body, damaging tissues.
- Enlarged organs – The spleen and liver expanding from leukemia infiltration puts pressure on other organs.
- Nerve compression – In rare cases, swollen lymph nodes may compress nerves causing pain.
Therefore, the abnormal growth and spread of leukemia calls, as well as its effects like anemia and low cell counts, all contribute to making pain a common symptom.
Types of Leukemia Pain
The main types of leukemia are acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML). The pain may present differently depending on the type.
Acute Leukemia Pain
The acute leukemias, ALL and AML, may cause the following symptoms:
- Bone pain from marrow infiltration is very common
- Joint pain and arthritis-like symptoms
- Abdominal pain from an enlarged spleen or liver
- Headaches and nerve pain
- Pain and infections in the mouth and throat area
Because acute leukemia grows rapidly, the pain tends to come on quickly and be more severe right from the onset.
Chronic Leukemia Pain
The chronic leukemias, CLL and CML, generally have more subtle symptoms earlier on. These include:
- Fatigue and shortness of breath from anemia
- Mild bone pain that slowly gets worse over time
- Enlarged but painless lymph nodes
- Fullness or discomfort on the left side from an enlarged spleen
- Unexplained fever and night sweats
However, as chronic leukemia advances, symptoms like bone pain, infections, and abdominal swelling tend to worsen. So in later stages chronic leukemia can cause pain very similar to the acute forms.
When Does the Pain Occur?
The timing of pain in leukemia depends on several factors:
- Initial diagnosis – Many patients have no symptoms when first diagnosed, but some do have early bone pain and fatigue.
- During treatment – Chemotherapy and other treatments can temporarily worsen pain from side effects like low cell counts and inflammation.
- After treatment – Remission brings relief, but pain may return if relapse occurs.
- Advanced disease – Uncontrolled growth in late stages causes worsening pain that is often harder to treat.
So pain may come and go. It might be absent at first then emerge over time as the disease advances. Staying on top of symptoms and promptly reporting them to your doctor is important.
How is Leukemia Pain Treated?
While treating the leukemia itself is the ultimate goal, managing pain is also key for quality of life. Options may include:
Medications
- Over-the-counter pain relievers like acetaminophen and NSAIDs help milder pain.
- Opioids like morphine offer relief for moderate to severe pain.
- Steroids help reduce inflammation contributing to pain.
- Antidepressants and anticonvulsants used for nerve pain provide general pain relief.
Therapy
- Heat/cold therapy – hot pads or cold packs applied to painful areas.
- Physical therapy – gentle exercises and stretching to improve joint mobility and reduce bone pain.
- Relaxation techniques – meditation, deep breathing, and distraction help patients cope with pain.
Other Approaches
- Integrative medicine – massage, acupuncture, hypnosis may provide additional relief.
- Radiation – precise doses of radiation shrink enlarged organs like the spleen and lymph nodes pressing on nerves.
- Supportive equipment – canes, walkers, back braces provide stability and take pressure off painful bones and joints.
Doctors tailor the pain management plan to each patient’s specific symptoms and needs. The goal is to improve quality of life while keeping side effects of treatment to a minimum.
When to See a Doctor
It’s important to report any new, worsening or persistent pain to your doctor right away. This includes:
- Bone pain that disrupts sleep or worsens at night
- Unexplained headaches, especially with dizziness or vision changes
- Abdominal swelling or pain with vomiting
- Shortness of breath or chest pain
- Severe nerve pain, numbness or weakness
Prompt evaluation and treatment of pain helps identify complications and prevent suffering. Don’t try to tough it out. Your oncology team needs to know what you are experiencing so they can help you feel better.
When is Pain an Emergency?
Seek emergency care if you have:
- Sudden, severe bone pain, especially in the back or hips which may indicate a spinal compression fracture
- New, severe headache with confusion or passing out which could signal bleeding in the brain
- Difficulty breathing or chest pain that could mean a blood clot in the lungs
- Severe stomach pain with vomiting and diarrhea that may be a gastrointestinal bleed or infection
Rapid treatment is vital for these critical issues. Call 911 or go to the ER right away if you have any of these worrisome symptoms.
Coping with Leukemia Pain
Living with leukemia pain can take an emotional toll. Some tips to help you cope:
- Communicate openly with your medical team about your pain.
- Take medications as prescribed and report any side effects.
- Explore integrative therapies like massage, acupuncture, and meditation.
- Join a support group to connect with others facing the same challenges.
- Enlist help from family and friends when the pain limits your mobility.
- Set small daily goals you can achieve despite the pain.
- Stay hydrated, eat nutrient-rich foods, and get enough rest.
While leukemia pain can’t always be eliminated, keeping your doctor informed and taking good care of your body and mind will help you manage it better.
Conclusion
Leukemia often causes pain due to infiltration in bones, joints and organs, along with low blood counts and inflammation. The intensity ranges from mild to severe. Acute leukemia tends to cause sudden pain, while chronic leukemia pain often slowly worsens over time. Treatment focuses on controlling the cancer, relieving pain through medication and therapy, and improving quality of life. Promptly reporting symptoms and staying attuned to your body will allow your medical team to keep the pain in check.