Pain or numbness after treatment

Head and neck treatment can sometimes cause pain, numbness or other changes in sensation. If you develop any of these it is important to tell your cancer doctor. They can find the cause and give you treatments to help.

Treatments that can help relieve pain include:

  • painkillers
  • physical therapies such as massage, warmth and exercises
  • relaxation.

Surgery may affect nearby nerves and cause a change in sensation or numbness in that area.  These often improve as nerves heal. This can take up to two years. If the nerve was cut, changes in that area will be permanent.

Some chemotherapy drugs can affect nerves and cause symptoms such as pins and needles, numbness or pain to the hands and feet. This is called peripheral neuropathy. It often improves gradually after treatment ends but sometimes it is permanent.

If you have nerve pain, doctors can prescribe painkillers or drugs to relieve discomfort.

If you have numbness or altered sensation in part of your body, take extra care. Sometimes an area that is numb can be injured without you noticing.

Pain caused by treatment

If you had pain during treatment, it will usually get better as your tissues heal. Sometimes pain or discomfort lasts for several months or more.

Always tell your doctor if you have a new pain or pain that is getting worse. They can arrange tests to find out the cause. Pain can happen for different reasons. It may be caused by a late effect of treatment such as jaw stiffness (trismus), scar tightness or nerve damage. Sometimes it may be a symptom of cancer coming back.

It is natural to feel anxious if you develop pain. But it is important to get it checked as soon as possible so that you can be given treatment for it.

To help your doctor understand your pain, tell them:

  • where it is
  • how bad it is, using a scale of 0 to 10
  • whether it is constant or comes and goes
  • if anything makes it worse or better
  • how it affects you, for example when you move, eat or sleep
  • if you would describe the pain as aching, burning, dragging, intense, tender or throbbing.


Managing pain

How pain is managed depends on how severe it is and what is causing it. Painkillers are often used to manage it. Other treatments that may help include physical therapies and relaxation therapies.

Painkillers

Different painkillers are used for mild, moderate and severe pain.

Mild pain

Painkillers used for mild pain include paracetamol and anti-inflammatory drugs such as ibuprofen (Brufen®, Nurofen®).

Moderate pain

Painkillers used for moderate pain include weak opioid painkillers, for example dihydrocodeine (DF118 Forte®, DHC Continus®), codeine phosphate and tramadol.

Severe pain

This pain can be managed using strong opioid painkillers, for example morphine, oxycodone, fentanyl or diamorphine.

Some painkillers work well for muscular pain and others work better for nerve pain. Anti-inflammatory drugs help reduce inflammation and swelling. These are especially good at treating pain in the skin, muscle or bone. They can cause indigestion and may irritate the lining of the stomach, so take them after a meal or snack. If you have had stomach problems, your doctor may advise you not to take them. If muscle spasms are making your pain worse, you may be prescribed a drug to help relax the muscles, such as baclofen (Lioresal®).

Drugs that act on the nervous system, such as gabapentin and amitriptyline, are used to treat nerve pain. The dose is often increased gradually over a few days or weeks. It can take a few weeks for them to take effect.

Take your painkillers regularly, as prescribed by your doctor. They aim to make sure pain control is constant. People often think they should put off using painkillers for as long as possible. This is not a good idea as it leads to unnecessary pain. It also allows the pain to build up, which can make it harder to control.

It is important to let your doctor know if your pain is not controlled with your painkillers. Your regular dose may need to be changed or you may need a different painkiller. It sometimes takes time to get the right painkiller and dose to control your pain. You may need a combination of different types of painkiller to get the best control for your pain. Your doctor can refer you to a specialist pain team if your pain is not well-controlled.

Some painkillers can cause constipation. Constipation means that you are not able to open your bowels regularly and it can become difficult or painful for you to pass bowel motions. If the constipation is due to the painkillers that you are taking, it may be possible to adjust the dose you take. You may need to take laxatives as well. Talk to your doctor who can give you further advice.

Physical therapies

If the pain is caused by tightness from scar tissue in the jaw, neck or shoulder, taking painkillers and doing exercises to stretch the tissues may help. A physiotherapist can show you these.

Massage and warmth can also ease tightness or muscle cramps in the neck or shoulders. Check with your physiotherapist, doctor or nurse before trying these. Some people use a heat pack that can be put in the microwave to warm the area. If you want to try this, always follow the manufacturer’s safety instructions. Make sure the pack is warm and not hot, especially if there is any sensory loss in the area. If you are worried about using a heat pack, check with your therapist.

Sometimes pain is caused by lymphoedema. Your doctor can refer you for treatment for this.

Relaxation

Feelings like fear, anxiety, depression and tiredness can make pain worse. Learning to relax and let go of your worries, even if only for a short time each day, can help you manage and control pain.


Sore mouth

After radiotherapy or chemoradiation, mouth soreness usually gets better within a few weeks. But you may be more likely to get infections or ulcers in your mouth. Your mouth may be more sensitive to spicy, salty, hard or crunchy foods. Alcohol, especially spirits and wine, may also irritate your mouth and make it sore.

If you have a sore mouth, it is still important to continue with regular mouth care. Change to a small, soft-bristled toothbrush until your mouth recovers. If toothpaste irritates your mouth, try a flavourless toothpaste or a brand that does not contain sodium lauryl sulphate (check the ingredients label). You can read more information about toothpaste in our section on dry mouth and changes in saliva after treatment.

Always ask your doctor or nurse for advice. They can check for signs of infection and prescribe treatment for you.

Your doctor or dentist may prescribe a mouthwash called Caphosol®. This can be helpful in preventing sore mouth or dryness and treating oral mucositis.

There are also treatments that you can apply directly, such as Gelclair® and Episil®. They work by coating the inside of the mouth and protecting sore areas. Your doctor may advise you to use them about an hour before eating.

Your doctor or specialist nurse can advise you on the best painkillers for your situation. Soluble aspirin is often used to help relieve mouth pain. Dissolve one 300mg aspirin tablet in 100ml of water and swish the solution around your mouth before swallowing it. Diluted Difflam® mouthwash can help with pain and inflammation in the mouth and pharynx.

Warm salt water rinses can help. Take 250ml of boiled water that has cooled to a warm temperature, and mix in one teaspoon of table salt. Rinse the salt water gently around the mouth then spit it out. Repeat as often as you like.


Numbness

If a nerve was damaged during surgery, you may have a change in sensation or numbness in that area. It can take up to two years for nerves to heal and normal feeling to return.

For a few people, the only way to remove all the cancer is by cutting the nerve. If this happens, sensation changes to that area will be permanent.

Pain can be a useful warning to protect us against injury. If you have numbness or a change in sensation in a part of your head or neck, take extra care to protect it. Sometimes an area that is numb can be injured without you noticing.

If you shave, be careful around skin that is numb. It is safer to use an electric razor. You will also need to be careful not to expose the numb area to very hot or very cold temperatures.


Peripheral neuropathy

Some chemotherapy drugs can cause changes in sensation to the hands, feet and legs. This is called peripheral neuropathy. This is when there is damage to the nerves that carry messages between the brain, the spinal cord and the rest of the body. Nerve damage causes symptoms such as pins and needles, numbness or pain to the hands and feet.

These symptoms usually begin to improve gradually, a few months after chemotherapy treatment ends. Sometimes damaged nerves do not completely recover and some people have long-term changes. But symptoms may become less troublesome over time if you find ways of coping with them.

Managing peripheral neuropathy

There isn’t a drug or treatment that can repair damaged nerves. But nerve pain, sometimes called neuropathic pain, can be treated. Your doctor can prescribe drugs that change nerve impulses and so help to relieve the pain. These include some anti-depressants, anti-convulsants (used to treat epilepsy) and some heart drugs. If your pain is difficult to treat, you can ask your doctor to refer you to a pain clinic for expert help from specialist doctors and nurses.

If nerve damage is affecting your balance or walking, a physiotherapist can give you treatment and advice. If daily tasks are difficult, ask to be referred to an occupational therapist. They can suggest aids and equipment to help.

If your symptoms continue for more than six months and you find walking or daily activities difficult, you may be able to get financial help. Call our cancer support specialists on 0808 808 00 00 for more information.

There are also things you can do to help yourself:

  • Keep your hands and feet warm. Wear gloves and warm socks in cold weather.
  • Avoid walking around barefoot, and check your feet regularly for any problems.
  • Wear well-fitting shoes or boots.
  • Wear gloves when working with your hands, for example doing household chores, gardening or DIY.
  • Before baths or showers, test the temperature of water with your elbow to make sure it is not too hot.
  • Turn the temperature control to a lower setting for hot water or have a temperature control (thermostat) fitted.
  • Keep areas that you walk through free of clutter and well lit.

For more information you can read our sections on controlling cancer pain and peripheral neuropathy.