It is difficult to say whether your pain is related to your history of lymphoma. Patients with lymphoma can develop deep vein thrombosis and are particularly at risk when enlarged lymph nodes in the abdomen or pelvis compress the veins draining the legs. However, your symptoms are not typical of either lymphoma or complications of prior lymphoma treatment. The symptoms of deep vein thrombosis typically also include swelling, not just pain. If you are in remission, it would be unlikely for you to develop a blood clot at this time related to lymphoma. However, it does sound like you need a thorough, in-person evaluation by your physician. Q2. I had non-Hodgkin’s lymphoma more than four years ago. I had the CHOP and radiation and feel fine. I do have numbness in my left foot and had deep vein thrombosis in that leg. A shunt was put in and I am off all meds but prostate (for benign prostate enlargement). Is the leg thing normal? Patients with large lymph nodes in the pelvis or groin may develop deep vein thrombosis (DVT), which is treated with blood thinners. I’m not sure what you mean by a “shunt,” but if a patient cannot take blood thinners, sometimes a filter is placed in the large vein in the abdomen (called the inferior vena cava) to prevent a blood clot from traveling from the leg to the lung. The vincristine (Oncovin) drug in CHOP can also cause numbness and tingling in the fingers and toes which can rarely persist for a year or more. Sometimes bypass grafts are placed if the arterial blood supply to the leg is poor, but this is typically not related to the lymphoma or DVT. [Medical editor’s note: CHOP stands for cyclophosphamide, doxorubicin/hydroxydoxorubicin, vincristine/Oncovin and prednisone. Read more about this treatment in our Life with Lymphoma blog. Q3. My husband had non-Hodgkin’s lymphoma four years ago. He now has Morton’s neuroma in his foot, diagnosed by a podiatrist who assured him it is not lymphoma based on a CT scan. How is that distinguished from a lymphoma tumor? He had one wrapped through a muscle in his butt, but did not have pain. He does have pain with the foot mass. It would be very unusual for lymphoma to show up in the foot, where Morton’s neuroma is common. Morton’s neuroma involves painful inflammation of the nerve usually between the third and fourth toes and bottom of foot near these toes. There are also certain defining characteristics that appear on CT scan that are helpful in evaluating the nature of the lesion. Q4. Does joint pain or hip pain signify a reoccurrence of non-Hodgkin’s lymphoma? It is certainly possible, though there are many other causes of joint and hip pain, the most common being osteoarthritis. Non-Hodgkin’s lymphoma can occur anywhere, though when it involves bone it may or may not cause pain. You should be evaluated by your oncologist to identify the cause of the pain. Q5. I was diagnosed with stage IV follicular lymphoma in August 2007, including involvement in the bones. I received treatments of Cytoxan (cyclophosphamide), Fludara (fludarabine), Rituxan (rituximab) and Neulasta (pegfilgrastim) for six months in 28-day cycles. Before treatment I had some bone pain that was relieved with over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs). During treatment, the bone pain increased to a level that required Duragesic (fentanyl) 50 mg patch to control it. My PET scan indicates possible remission, waiting on bone marrow results. It has been two months since my last chemo and Neulasta, and I am still having severe bone pain. Is this severe pain caused by the chemotherapy or Neulasta? I know that Neulasta causes increased bone pain, but I haven’t had an injection in two months. Is this something that may improve with time, or could it last a while? I am really tired of taking pain medication. Severe bone pain is not a typical symptom experienced by patients receiving the chemotherapy regimen you describe. You’re correct that Neulasta can cause severe bone pain, but it typically lasts only several days. It is difficult to say why you have such significant discomfort with a negative PET scan, and it is very uncommon for patients who have bone marrow involvement with the indolent (slow-growing) lymphomas to have significant bone pain as one of their symptoms. It may be worthwhile for you and your doctor to investigate other causes of bony pain, including arthritis. Q6. I have nodal marginal zone lymphoma stage IIIB+. Lately, I am having pain in my left leg that has localized to the large bone in my lower leg. There is an area of thickening over the painful area. Is it possible for lymphoma to metastasize to bone? I took Rituxan with horrible side effects in June and have refused further chemo at this time. I am 55 years old and also have stage III heart failure. Lymphoma — both the slow-growing types (like marginal zone lymphoma) and the more aggressive types — can affect bone. I would suggest that you be fully evaluated by your oncologist who may even suggest taking a biopsy of the area to make sure it looks similar to your other areas of involvement. The likelihood of reacting to Ritxuan (rituximab) is highest on the first infusion and as the disease shrinks, it is better tolerated. You may want to consider chemotherapy first, with or without Rituxan added later. Q7. I have non-Hodgkin’s lymphoma, and every day is a different story. Some days I feel relatively good, and other days I have aches and pains in all different areas. Could this be related to the lymphoma? As of my last CAT scan, I have some new areas showing up with tiny tumors, but my doctor didn’t take any action and told me to come back in six months for another CAT scan to see what is going on. Next month I go for that CAT scan and will know more, but I’m wondering if any of my arthritic-type aches and pains can be related to the lymphoma? Do you hear of other people with these complaints? Intermittent aches and pains are not typical symptoms of lymphoma, particularly if the pain comes and goes and CT scans show minimal disease. It is not impossible that lymphoma could be the reason for your discomfort, but I would think it is much more likely to be related to arthritis. Q8. I had a stem cell transplant for mantle B-cell lymphoma in August 2007. I am doing very well and all my tests show no evidence of disease (bone marrow biopsy and PET scan). My blood tests are good, and my platelet counts are around 90 for now. My problem is that I am having pain in my spine and arms and legs. My wrists and hands hurt and become numb at times. My neck is stiff, it is painful and I have headaches. Is this related to the stem cell transplant? I did have Rituxan (rituximab) in 2005, and I had very bad reactions to it. The specialist that did my transplant said that I would be considered allergic to it, and it would not be given again. I don’t expect the disease to reoccur, but I sure am having trouble with the pain in my bones or around my bones. It is difficult to know what is causing your symptoms. It would be very unusual for symptoms like these to be directly caused by the transplant, especially if they are developing for the first time a number of months after the procedure. Many patients have a reaction to Rituxan on the first infusion, and rarely the reaction is so severe that doctors would not give the medication a second try. I don’t think the two are related (your reaction to rituximab and your current problems with pain). In terms of your pain and numbness, I think you need to have a full neurological evaluation to sort out if this could possibly be related to your disease or some other condition. Q9. My mom had lymphoma, and she had a large knot removed in her armpit and a breast biopsy. She had “shocking” pain in her lower back that shot to the breast they did the biopsy on. She was on Neurontin [gabapentin] while she was having chemo and radiation and had it under control. It was gone for six months and is now back. The Neurontin does not seem to be working. Her doctors are at a loss and have never seen this before. Neurontin is a medication that works for some pain caused by nerve damage, also called neuropathic pain. While it is sometimes effective alone or at low doses, at times additional pain medications may be needed, or the dose of Neurontin may need to be increased. It is difficult to predict if these solutions would help your mother. If the pain is the same as before and caused by the same nerve damage, it may be reasonable to increase her dose of Neurontin or add on a new pain medication. In terms of non-drug therapy, there are studies indicating that acupuncture may effectively treat pain of neuropathic origin. I think acupuncture would be a very reasonable approach for your mom to try in hopes of avoiding the need for more medications. Finally, on the off chance that she may have developed an entirely new source of pain, she should be fully evaluated by her physician. Q10. Since having CVP (cyclophosphamide, vincristine and prednisone) treatment for lymphoma, I have developed joint pain, especially in my shoulders. What, if anything, can be done to alleviate this pain? Doctors continually tell me that it is not documented that this is a side effect, but I can guarantee that it is. Although joint pain is not a typical symptom associated with CVP chemotherapy, it is certainly possible that your pain is related. Patients sometimes feel achy when coming off the prednisone. You may want to try simple things first, such as Tylenol (acetaminophen) or possibly exercises suggested by a physical therapist to maintain range of motion. If these don’t help, you should speak with your doctor and ask if he/she recommends cautious use of non-steroidal anti-inflammatory agents (which can aggravate the stomach) or something stronger, such as a low dose narcotic to keep you comfortable. Learn more in the Everyday Health Lymphoma Center.
