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Methylene blue is a salt and dye that has been used in medicine for over 100 years. It has antioxidant, anti-inflammatory, antidepressant and analgesic, or pain-relieving, properties.

Researchers and physicians, like , are exploring new ways to use this substance. Right now, I am focused on using methylene blue to help manage pain caused by some cancer treatment side effects. While I¡¯ve stained two or three of my white lab coats in the process, I¡¯m excited about methylene blue¡¯s potential to help as many people as possible.

But not all the health claims you hear about methylene blue are proven. This means it isn¡¯t always the best or safest choice for the health results you¡¯re hoping to achieve.

Here, I¡¯ll explain more about methylene blue, its uses in health care and what to know about the many health claims surrounding it.

If you¡¯ve ever had a charley horse ¡ª or a severe sudden spasm in your calf ¡ª you know that muscle cramps are no joke.??

But did you also know that muscle cramps can be a side effect of cancer treatment? Below, I¡¯ll explain why these uncomfortable spasms sometimes happen to cancer patients, how we treat them, and whether they¡¯re temporary or permanent.?

Why do muscle cramps occur in cancer patients?

There are many possible causes.?

Chemotherapy

Several classes of chemotherapy can cause muscle cramps. These include:??

• platinum-based drugs (cisplatin) ?
• vinca-alkaloid drugs (vincristine and vinblastine)??

But cramps can also be a side effect of some hormonal therapies, including the aromatase inhibitors used to treat breast cancer. All of these can damage the roots of our nerves, which may lead to muscle cramps and neuropathy.?

Electrolyte imbalances

A lot of chemotherapy drugs make patients dehydrated, which can result in electrolyte imbalances. If your potassium, magnesium or calcium levels get out of whack, that can lead to muscle cramps. Other causes of electrolyte imbalances include diuretics (fluid pills), kidney dysfunction and kidney failure.??

Anti-fungal medication

Amphotericin-B is a very potent antifungal medication used to treat opportunistic infections in neutropenic patients. It is also known to cause muscle cramps as a side effect.?

Lithium

This drug is used to treat bipolar disorders, but if you get too much or too little of it, you start seeing side effects very quickly.?

Hypothyroidism

Patients undergoing immunotherapy sometimes have this condition due to their treatment.?

Polymyositis

This is a rheumatological disorder associated with an increased risk of having cancer. Muscle cramps are an active symptom of the disease.?

Metastatic disease?

Some patients experience muscle cramps because they have metastatic cancer that has spread to the central nervous system and is now pressing on their nerves. This includes leptomeningeal disease, in which cancer spreads to the fluid surrounding the brain and spinal cord and/or the leptomeninges, the lining of the brain and spinal cord.??

Diabetes

This condition can sometimes cause muscle cramps.?

Anemia?

Red blood cells carry oxygen to the muscles. When there are not enough of them to do that job effectively, and your blood oxygen level drops, the result can be muscle cramps.?

Do muscle cramps only occur in certain locations?

No. It depends on what¡¯s causing them. People can get them in their arms, legs, abdomen or other areas.??

How are muscle cramps typically treated??

Again, it depends on the source. Here are a few things we suggest or prescribe:?

• exercise?
• oral and/or IV supplements?
• stretching?
• heating pads?
• muscle relaxers?

Are muscle cramps ever permanent??

Some cancer survivors experience side effects for years after finishing treatment. But if we can identify the underlying source of your muscle cramps ¡ª such as an electrolyte imbalance or a thyroid problem ¡ª they typically get better as soon as we fix it. The cramps might not go away completely, but they definitely improve.?

, is an internist in the?Internal Medicine Center?with a special interest in cancer-related fatigue.?

or call 1-877-632-6789.

It may seem obvious. You have a headache, you reach for acetaminophen. You start feeling menstrual cramps, you take a few ibuprofen. You wake up with stiff, arthritic fingers, you swallow some aspirin or naproxen.?

But are the rules for taking over-the-counter (OTC) pain relievers any different if you¡¯re a cancer patient on active cancer treatment? Are there any circumstances in which you should not take them??

Read on to find out.??

Over-the-counter (OTC) does not mean harmless?

The most important thing to know about OTC pain relievers is: just because you can get them without a prescription doesn¡¯t mean they¡¯re harmless. OTC medications can still pose very real risks, especially if taken inappropriately. That¡¯s why it¡¯s so important to educate yourself and ask questions if there¡¯s any confusion.

Non-steroidal anti-inflammatory drugs (NSAIDs), for instance, are a group of common OTC pain medications. Some examples of NSAIDs include:

• Aspirin?
• Ibuprofen?
• Naproxen??

While NSAIDs can be very useful, they can also be hard on the kidneys and gut. NSAIDs can be so irritating that it¡¯s possible to develop stomach ulcers after only a few doses. That¡¯s why I usually recommend taking NSAIDs with food.

Aspirin also acts as a blood thinner, which can be especially dangerous if you have low platelet counts. Platelets are the blood component that helps blood clot and prevents uncontrolled bleeding.

Many cancer patients have low platelet counts from time to time, especially if they¡¯re on active treatment with chemotherapy. But in those situations, even everyday accidents, such as cutting your finger while cooking or falling and scraping your knee, can lead to more bleeding than expected. ?

Pain is a message: Don¡¯t ignore it?

Another important thing to remember is that pain is often a message. It¡¯s your body¡¯s way of telling you something¡¯s wrong. So, it¡¯s important to pay attention to it and let your care team know if you¡¯re experiencing any pain, especially if the pain is new or getting worse over time.

It may seem harmless to take an OTC pain reliever to help with small things like a mild headache or a stubbed toe, but many of these medications are also antipyretics, or fever reducers. That means they can temporarily mask a fever, which can be dangerous for cancer patients on active cancer treatment.

Many chemotherapies also suppress the immune system, which prevents your body from mounting the same defense against infections that it normally would. A fever is often one of the only ways your body can still respond and warn you that an infection is brewing. But if an OTC pain medication is masking that fever, you may not even know you have an infection until it has grown into something much more difficult to control.?

That¡¯s why I tell patients to always check their temperature before taking any fever reducers, just to make sure they don¡¯t have a fever already. I also recommend that they tell their care teams about any OTC medication use. There are instances in which a prescription-strength medication may be more appropriate than an OTC medication for pain management.

Joint pain can make basic, everyday activities like climbing stairs, carrying groceries or even getting up off the couch an uncomfortable experience.??

But did you know that joint pain can also be a side effect of cancer treatment???

Here, I¡¯ll explain why cancer patients experience joint pain, how we treat it, and five things you can do to relieve the discomfort.??

Why does joint pain occur in cancer patients???

Cancer and its treatment have been linked to several types of pain, including:?

• Arthralgia, or joint pain?
• Myalgia, or muscle pain?
• Ostealgia, or bone pain?

Joint pain in particular might be due to:?

Chemotherapy

Platinum-based chemotherapy drugs like cisplatin and antineoplastic agents like bleomycin can trigger inflammation. That, in turn, can cause joint pain, stiffness and swelling. Chemotherapy may also cause neuropathy, a painful tingling sensation in the fingers and toes. In some cases, this pain can extend into the joints.?

Immunotherapy

Immunotherapy activates the body¡¯s immune system to fight cancer. This can sometimes cause it to attack normal tissues, too, which may result in joint pain. Sometimes, this side effect can mimic rheumatoid arthritis.??

Targeted therapy

Targeted therapy drugs affect specific molecules or pathways that cancer cells use for growth and survival. These drugs can also sometimes affect healthy tissues. So, they can cause joint pain, too.?

Hormone therapy?

Hormone therapy works by depriving cancer of the chemical fuel it needs to grow. But in doing so, it also deprives the body of estrogen, which lubricates and protects the joints and guards against bone loss. This increases your risk of developing arthritis.??

Tumors affecting the endocrine system

Hormones control nearly every aspect of the human body, from digestion and reproduction to growth and sleep. So, cancers that affect the organs which produce them ¡ª including the thyroid gland, pituitary gland and adrenal glands ¡ª may disrupt the body¡¯s delicate balance. Joint pain can be the result.??

Are there any other possible causes of joint pain?

Yes. As with muscle cramps, quite a few other things could be going on. Many causes of joint pain are totally unrelated to cancer, particularly in older patients. These include:?

Nutritional deficiency

Not getting enough calcium, vitamin C, vitamin D or protein in your diet?

Autoimmune disorders

Chronic health conditions such as lupus, rheumatoid arthritis, and even regular osteoarthritis?

Reactive arthritis

Formerly known as Reiter¡¯s syndrome, ¡°reactive¡± arthritis sometimes occurs in response to bacterial infections. It typically involves inflammation in three locations: the joints, the eyes and the urethra.?

Sepsis

Sepsis occurs when the immune system inadvertently damages organs and tissues in an attempt to control an infection. One of its aftereffects is a condition called post-sepsis syndrome, which often comes with joint pain.?

Dairy products

Dairy products like milk, cheese, butter, yogurt and ice cream may cause an inflammatory response in some people, which can result in joint pain.?

Do certain medications or diseases tend to target particular joints??

No. Joint pain can occur anywhere in the body. But many patients report experiencing pain primarily in the larger joints, such as the hips, knees and shoulders.?

How is joint pain typically treated??

That depends on the root cause. If joint pain is caused by the pituitary gland cancer releasing too much growth hormone, then we have to treat the tumor first.??

But if it¡¯s a side effect of immunotherapy, we might use steroids, over-the-counter pain relievers or physical therapy. We tailor our response to each patient.?

Is cancer-related joint pain permanent or temporary??

I would love to say that joint pain is always temporary, but the truth is, I¡¯ve seen both outcomes. Joint pain caused by hormone therapy for breast cancer, for instance, can get a lot better once someone finishes treatment. Other kinds may last a long time.?

Is there anything you can do on your own to alleviate joint pain??

Some of the most common self-help strategies we recommend include:?

• Heating pads, when used safely and responsibly. Please note: It¡¯s important not to sleep with them on.??
• Massage therapy
• Meditation and/or mindfulness practices?
• Weight loss

But the best way to relieve joint pain is by doing gentle, low-impact exercises or a stretching routine every day. Even if you have scar tissue that makes some movements difficult, gentle exercise will gradually strengthen your joints and help you in the long run.?

, is an internist in MD Anderson¡¯s Internal Medicine Center.??

or call 1-877-632-6789.