When bladder cancer metastasizes, it can cause pain in the areas it spreads to — mainly the lymph nodes, pelvis, lungs, liver, and bones. The severity of the pain can vary, too, depending on how aggressive the cancer is.
For example, you may feel an ache in the hips, sharp pain in your spine, or pressure in the abdomen (which can stem from liver inflammation), says Marcin Chwistek, MD, the director of the supportive oncology and palliative care program at Fox Chase Cancer Center in Philadelphia. If tumors press on nerves, you may also have nerve pain that appears as burning, shooting, and tingling, he says.
You may also experience bladder spasms or pain and discomfort during urination, especially when the primary tumor remains in the bladder, says Stephanie Berg, DO, an oncologist in the Lank Center for Genitourinary Oncology at the Dana-Farber Cancer Institute in Boston.
While treating the cancer itself can help manage the pain, your doctor may also recommend other treatments to help you feel more comfortable.
1. Bone-Strengthening Drugs for Bone Pain
When tumor cells spread within the bone, they can cause progressive bone damage and activate the nerve fibers in the bone. This causes pain and increases the risk of fractures.
Bone-modifying medications, such as denosumab and bisphosphonates, are often recommended to help slow bone loss and reduce pain, says Dr. Chwistek. These medications “modestly reduce bone pain over time, but they are not fast-acting,” he says.
Denosumab, for instance, is a monoclonal antibody given as a monthly injection to relieve pain, reduce fractures, and improve the quality of life in people with metastatic cancer, says Chwistek. The bisphosphate medication, zoledronic acid, is delivered as an infusion every three to four weeks.
Some research shows that denosumab is more effective at relieving pain than zoledronic acid, but both medications can, rarely, cause risks such as jaw osteonecrosis (death of bone tissue).
2. Radiation Therapy for Bone Pain
Palliative radiation is also used to treat bone pain. Radiation works by shrinking tumors, which reduces pressure on bones or nerves; this can also help prevent bone loss, lowering the risk of fractures, says Chwistek.
If the bone metastases are more widespread, localized radiation may not be effective. In that case, radiation can be delivered throughout the body with oral medications containing radioisotopes, though there’s less research supporting their effectiveness in metastatic bladder cancer, says Chwistek. Close monitoring is needed because it can also affect other organs.
3. Pain Relievers for General Pain
Pain medications are the cornerstone of treating metastatic cancer pain. For mild pain, over-the-counter acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be helpful. “Acetaminophen is safe and underused,” says Chwistek.
NSAIDs can be helpful for bone pain and pain caused by inflammation, but they may increase the risk of gastrointestinal bleeding or affect kidney function, especially in people with bladder cancer, he says.
For breakthrough bone pain — severe pain that’s often triggered by movement, which occurs in about 75 percent of people with bone metastasis — fast-acting opioids are often necessary, and can also be used alongside short-acting pain medication. “Most patients with moderate to severe pain need a scheduled long-acting opioid, plus a short-acting medication for breakthrough pain,” says Chwistek.
If pain has a nerve-related component, like burning, tingling, or shooting pain, medications like gabapentin and pregabalin may help, says Chwistek.
Steroids like dexamethasone are also commonly used for cancer pain, including nerve compression pain, liver pain, and sometimes bone pain, says Chwistek. Steroids are usually only used for short periods of time, though, until you find another treatment that works, he says. (Long-term steroid use can increase the risk of infections, osteoporosis, and other complications.)
Bladder spasms can be difficult to treat, but medications that relax the bladder — such as anticholinergics or beta-3 agonists — are often recommended, says Dr. Berg.
4. Nerve Blocks and Injections for Local Pain
For more severe pain, your doctor may recommend a targeted procedure. During a nerve block, for instance, medication is injected around specific nerves to interrupt pain signals, says Chwistek. This can provide relief for weeks or even months. Pain medication pumps may also be used to deliver medication automatically, he says.
5. Heat and Ice Packs for Joint and Muscle Pain
Heat therapy, such as gel packs, electric heating pads, or hot baths, can help relax muscles and ease stiffness, especially in the lower back or pelvis.
Cold packs may help reduce inflammation and ease muscle and joint pain.
6. Exercise and Physical Therapy for General Pain
It seems counterintuitive, but staying active may help reduce pain. “There’s strong evidence that exercising improves function, reduces fatigue, and modestly improves pain,” says Chwistek.
Work with a physical therapist; they can give you a tailored, supervised program that’s safe to follow, says Chwistek. They can also help you improve your mobility and balance, which can help prevent falls, and provide you with braces and adaptive tools to make movement and daily activities easier and less painful, he says.
7. Acupuncture and Mind-Body Therapies for General Pain
Complementary therapies are commonly used for pain relief alongside traditional cancer treatments. In fact, a joint statement from the Society for Integrative Oncology and the American Society of Clinical Oncology recommends the following therapies for pain relief:
- Acupuncture can help relieve general or musculoskeletal pain and help with chemotherapy-induced peripheral neuropathy (nerve pain). It may take 6-10 weekly sessions before you see some lasting effects.
- Massage therapy can be helpful for people with advanced cancer who have moderate to severe pain. It can also provide some immediate relief.
- Mind-body therapies such as yoga, mindfulness meditation, and breathing exercises may help with pain, although are considered more effective in helping with depression and fatigue for people with cancer.
8. Therapy and Relaxation
Emotional distress can make pain worse and can lead to depression. “Pain is profoundly modulated by fear, catastrophizing, and mood,” says Chwistek. “I consider psychological support standard of care, not optional, as long as it is available to patients,” he says.
The Takeaway
- Pain from advanced bladder cancer typically appears in the areas where it metastasizes, including the bones, pelvis, lungs, and liver.
- Over-the-counter and prescription medications are frequently used for mild to moderate pain, including acetaminophen, opioids, and nerve blocks. For bone pain specifically, adiation therapy and bone-modifying drugs may be recommended.
- Complementary therapies like heat and ice, as well as acupuncture and mindfulness are commonly used alongside traditional therapies to treat metastatic bladder cancer pain.
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