Rehab for Cancer Pain: What’s the best treatment?

Cancer treatment brings with it many layers of personal, family, social, financial, and (the obvious) health issues that the person and their loved ones are left to sift through.  The healthcare team pulls together to provide as much support to as many of these areas as possible.

As a Physical or Occupational Therapist working with someone who is undergoing cancer treatment, you want to make sure that you are also providing appropriate interventions to address some of the physical cancer symptoms that may come up either during a primary diagnosis or with metastasis.  One of these symptoms is cancer pain.  There are many different avenues a therapist can go down to treat pain, depending on what its source is – manual therapy, positional release, exercise, and modalities are among a few.  

Click here for a great guide to using modalities with cancer!

Cancer Related Pain:

Reports of pain from people with a cancer diagnosis can be quite common at every stage of the disease.  Pain is, more often than not, an indicator that something is not quite right.  It’s a way for our bodies to tell us something. 

Abstract, Background, Glitter, Pain

Among cancer symptoms, cancer pain is one that certainly cannot be ignored on a day to day basis and can become quite debilitating before, during, and after cancer treatment.  One meta-analysis in 2016 found that out of 63,533 patients, 66.4% in advanced, metastatic, or terminal stages of the disease reported pain; 55.0% reported pain during cancer treatment; and 39.3% still reported pain after undergoing curative treatment.  When looking at cancer pain severity in 32,261 patients, 38.0% reported the pain to be moderate to severe.  (Read the full article here) So, as anyone can see… this is not a small problem we are contending with!  Chronic pain, from any etiology, can have a massive impact on a person’s ability to move around, to mentally focus, and to maintain a good quality of life.  


How can we help?

There are so many ways that therapists can treat pain.  Here we highlight a few of the more practical and easier to incorporate interventions.  And as always, we would never want to put our eggs in one basket.  These interventions would be used in conjunction with others – not in isolation.

  1. Manual Therapy – The power of human touch!  Massage has shown to decrease cortisol levels and increase the amount of natural killer cells in the body.  What a great boost for the immune system, while also tackling the debilitating sensation of pain.  Now because cancer pain is something that seems to stick with the person throughout the course of cancer treatment (and even after), this may be a great opportunity to educate this person on ways to incorporate this into their life, even after therapy stops.  Showing their caregiver the techniques that seem to work the best and possibly setting them up with a local spa for a weekly or monthly appointment would be a great place to start!
  2. Exercise – Get those “feel good” juices flowing!  Therapists are going to incorporate exercise into the plan of care for obvious purposes anyway – strengthening.  But exercise also has powerful pain-relieving qualities as well!  Now, we wouldn’t expect our patient with cancer pain to experience “runner’s high”, but many forms of exercise can produce changes in the brain that can contribute to a decreased sensitivity to noxious stimuli.  Endorphins are released and our endogenous opioid system is activated which will improve the perception of pain and decrease overall stress.  
  3. Modalities – That’s right… I said it!  Despite popular belief in the clinic, many different modalities can be safely used to treat cancer pain.  Our first reaction is usually, “Well, they have cancer, so these things are contraindicated.”  And, that may be true… depending on the circumstance.  But we owe our patients the chance to benefit from this aspect of the treatment we can provide.  Electrotherapy (aka – electrical stimulation, TENS, etc.) has been shown to be effective in reducing pain that originates from many different sources.  Incorporating it into your plan of care for someone newly diagnosed, for someone already undergoing cancer treatment, for someone with metastasis, or someone who has recovered can be extremely pivotal in helping them improve function and quality of life.

Electrotherapy will cause Metastasis: Fact or Myth?

Well… it is not a simple answer unfortunately.  There is not enough research to say for certain that electrotherapy is not safe for treating cancer pain.  But there’s also not enough evidence to say that it is unequivocally safe either. 

The general consensus in the therapy community is that the use of electrotherapy directly over or in close proximity to a malignancy should be avoided.  The theory is that the current produced will promote the spread of cancer cells to other parts of the body.  The use of electrotherapy on a body part distant from the site of cancer would be considered a precaution, not a contraindication.  And, that sounds like good advice… in general terms.  However, our plan of care and the interventions we choose are not one-size-fits-all.  Our patients are not carbon copies of each other.  Each person’s situation is going to call for a different approach to cancer treatment and treatment of cancer pain.  If we see the person as a whole and we involve all the appropriate members of the team in this decision, there can be very useful indications for electrotherapy in this population.

Weigh the Risks and Benefits:

Firstly, as mentioned above – talk to the team, including the patient and their caregivers!  You need to have a clear understanding of “the big picture” before making any decisions.  Based on the lack of evidence neither for nor against the use of electrotherapy for cancer pain, a big deciding factor would be knowing what stage the cancer is in, if they are currently undergoing cancer treatment, and if there are already known areas of metastasis.  If they are newly diagnosed in an early stage and medical treatment aims to cure, you may choose other routes of pain management in order to avoid any chance of electrotherapy having adverse effects. 

However, if the person is in later stages and already has metastasis, electrotherapy may be something that you would want to consider, especially if the medical prognosis is poor.  Now, these statements are not meant to say that it doesn’t matter if cancer is spread in a person that already has metastasis.  All of these patient’s lives are equally valuable.  But we cannot put on blinders to the benefits it may bring them and the improvement in quality of life they may experience with the decrease in pain… simply because we are afraid of the “what if?” You want to consider how intense their cancer symptoms (especially cancer pain) are and how those symptoms are affecting their quality of life, and what the patient’s overall goals of care are. 

Ways to incorporate this treatment:

Here are some scenarios meant to provide food for thought.  There is no cookbook we can follow, unfortunately.  But if we take each patient with all the different factors in their individual situation and consider if this intervention would be useful to them, after weighing the risks and benefits and speaking to both the patient and their Oncologist… we will always come to the right conclusion!

  1. The patient with early stage cancer and good prognosis.  I mentioned above that this may be a patient you would take in a different direction with pain management.  However, like everyone, this patient’s scenario will need to be looked at on an individual basis.  They may receive curative treatment, but may have other sources of orthopedic pain that have flared up because of bouts of immobility or having to sit for hours in one position to receive chemo treatments.  This would be a great opportunity to explore the option of electrotherapy for these secondary sources of pain.  It would also be good to keep it in mind if they have lingering pain after their cancer is no longer active.
  2. The patient (at any stage) who is at the end of their rope because they have tried everything to relieve the pain they have, but nothing is effective If the severity of the pain they are feeling is at such an intensity that it is drastically affecting their quality of life, then a consideration of the use of electrotherapy is in order!  Again, this would be something you need to be in good contact with their Oncologist about in order to properly assess if the benefits outweigh the risks.  But if you can give them relief and they can start to enjoy living again, this treatment can be just as powerful as the cancer treatment itself!
  3. The patient who now has incontinence from pelvic floor dysfunction after surgery.  This affects different people in different ways.  Some will take it in stride and accommodate fairly well, and some cannot deal with this new impairment that came along with their cancer diagnosis and treatment.  A person’s outlook on incontinence may or may not have to do with the age of the person, or how active they are, or even just their own preconceived notions of the stigma they attach to it.  This may be a pain management issue or a muscle re-education issue… but either way, it would be worth evaluating if electrotherapy has a place in the plan of care.  How much is this effecting their daily life?  Where are they in their cancer treatment?  What is the prognosis?  Answering these questions will certainly help inform the next step in your decision.

It is undeniable that a cancer diagnosis and cancer treatment brings with it many obstacles people have to continuously overcome.  With all the ways that therapists can assist people in getting back to the lives they want to live after their lives have been horribly disrupted… we need to always make sure to look at the person as a whole and look at their entire situation prior to discounting any of the tools we have at our disposal.  So, should we use electrotherapy to treat cancer pain?  I would say, it depends… but hopefully now you have more confidence to consider it when it would indeed improve your patient’s overall condition.

To find out more about caring for the person with cancer, check out our jam-packed, practical, and compassionate webinar, Cancer Care: A Collaborative Approach! This short but powerful webinar is sure to give your practice the boost it needs!

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