31 Cancer-Related Pain
It is estimated that 40% of cancer survivors use integrative approaches to manage symptoms and improve their well-being after conventional cancer treatments, this includes: massage, acupuncture, and yoga (Sohl et al., 2015). Oncology massage is a specialty where massage techniques are modified to meet the needs of people with cancer and undergoing cancer treatments. In this field of research, there is a growing body of evidence that massage therapy can help improve their quality of life physically and emotionally for people with cancer.
Cancer-related pain is pain that is due to cancer or its treatment, such as chemotherapy.
A thorough health history intake can be done to gather information about patients’ limitations, course of pain, and prognostic factors for delayed recovery (e.g., low self-efficacy, fear of movement, ineffective coping strategies, fear-avoidance, pain catastrophizing) and answers to health-related questions. Screen patients to identify those with a higher likelihood of serious pathology/red flag conditions. Then undertake a physical examination: neurological screening test, assess mobility and/or muscle strength.
Incorporate one or more of the following chronic pain outcome measurements when assessing and monitoring patient progress:
- The Edmonton Symptom Assessment System (ESAS)
- The Fatigue Symptoms Inventory
- Brief Pain Inventory (BPI)
- Numeric Pain Rating Scale (NPRS)
- Visual Analogue Scale (VAS)
Provide reassurance and patient education on condition and management options and encourage the use of active approaches (lifestyle, physical activity) to help manage symptoms.
Massage Can be a Source of Safety, Comfort and Relief
Oncology massage is a specialty where massage techniques are changed to meet the needs of people with cancer and undergoing cancer treatments. In this field of research, there is a growing body of evidence that massage therapy helps people with cancer physically and emotionally, and it can improve their quality of life (Hilfiker et al., 2018; Kinkead et al., 2018).
Acupuncture for Symptom Management
A multi-center randomized clinical trial published in The Journal of the American Medical Association (JAMA) has demonstrated that acupuncture may reduce joint-pain from prescription aromatase inhibitors (Bao et al., 2018; Hershman et al., 2018). In addition, a recent systematic review and meta-analysis published in JAMA oncology analyzed 14 randomized trials comparing acupuncture or acupressure with control therapies (placebo, sham acupuncture, analgesics, usual care) in over 900 cancer patients. What the researchers found was that compared with sham acupuncture, real acupuncture was associated with reduced cancer pain intensity (He et al., 2020).
As for exercise and yoga practices, there is research showing being physically active during and after cancer treatment has many health benefits (Hilfiker et al., 2018; Patel et al., 2019; Schmitz et al., 2019). Exercise therapy is safe and beneficial for physical and psychosocial health in people with multiple comorbidities (Bricca et al., 2020). Regular physical activity has been shown to significantly reduce symptoms of anxiety, reduce pain, and improve function (Bull et al., 2020). The world health organization recommends adults should undertake 150-300 min of moderate-intensity, or 75-150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. These guidelines highlight the importance of regularly undertaking physical activity (both aerobic and muscle strengthening activities) emphasizing the value of any activity, of any duration, and any intensity (Bull et al., 2020).
There is a growing body of evidence that massage therapy can be a useful part of a multi-modal approach for patients with cancer-related pain (Boyd et al., 2016; Calcagni et al., 2019). It is not suggested that massage therapy alone can control symptoms but can be used to help relieve pain & reduce anxiety when integrated with standard care.
Contemporary multimodal massage therapists are uniquely suited to incorporate a number of rehabilitation strategies for chronic pain based on patient-specific assessment findings including, but not limited to:
- Manual Therapy (soft tissue massage, neural mobilization, joint mobilization)
- Education that is Person-Centered (e.g., biopsychosocial model of health and disease, self-efficacy beliefs, active coping strategies)
- Stretching & Loading Programs (e.g., concentric, eccentric, isometric exercises)
- Hydrotherapy (hot & cold)
- Self-Management Strategies (e.g., engaging in physical activity and exercise, social activities, and healthy sleep habits)
References and Sources
Arring, N. M., Barton, D. L., Brooks, T., & Zick, S. M. (2019). Integrative Therapies for Cancer-Related Fatigue. Cancer journal (Sudbury, Mass.), 25(5), 349–356. doi:10.1097/PPO.0000000000000396
Bae, K., Yoo, H. S., Lamoury, G., Boyle, F., Rosenthal, D. S., & Oh, B. (2015). Acupuncture for Aromatase Inhibitor-Induced Arthralgia: A Systematic Review. Integrative cancer therapies, 14(6), 496–502. doi:10.1177/1534735415596573
Bao, T., Li, S. Q., Dearing, J. L., Piulson, L. A., Seluzicki, C. M., Sidlow, R., & Mao, J. J. (2018). Acupuncture versus medication for pain management: a cross-sectional study of breast cancer survivors. Acupuncture in medicine: journal of the British Medical Acupuncture Society, 36(2), 80–87. doi:10.1136/acupmed-2017-011435
Bao, T., Patil, S., Chen, C., Zhi, I. W., Li, Q. S., Piulson, L., & Mao, J. J. (2020). Effect of Acupuncture vs Sham Procedure on Chemotherapy-Induced Peripheral Neuropathy Symptoms: A Randomized Clinical Trial. JAMA network open, 3(3), e200681. https://doi.org/10.1001/jamanetworkopen.2020.0681
Bjornard, K. L., Gilchrist, L. S., Inaba, H., Diouf, B., Hockenberry, M. J., Kadan-Lottick, N. S., … Ness, K. K. (2018). Peripheral neuropathy in children and adolescents treated for cancer. The Lancet. Child & adolescent health, 2(10), 744–754. doi:10.1016/S2352-4642(18)30236-0
Bricca, A., Harris, L. K., Jäger, M., Smith, S. M., Juhl, C. B., & Skou, S. T. (2020). Benefits and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomised controlled trials. Ageing research reviews, 63, 101166. https://doi.org/10.1016/j.arr.2020.101166
Brown, T. J., Sedhom, R., & Gupta, A. (2019). Chemotherapy-Induced Peripheral Neuropathy. JAMA oncology, 5(5), 750. doi:10.1001/jamaoncol.2018.6771
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J. P., Chastin, S., Chou, R., Dempsey, P. C., DiPietro, L., Ekelund, U., Firth, J., Friedenreich, C. M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P. T., Lambert, E., … Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British journal of sports medicine, 54(24), 1451–1462. https://doi.org/10.1136/bjsports-2020-102955
Calcagni, N., Gana, K., & Quintard, B. (2019). A systematic review of complementary and alternative medicine in oncology: Psychological and physical effects of manipulative and body-based practices. PloS one, 14(10), e0223564. doi:10.1371/journal.pone.0223564
Carlson, L. E., Toivonen, K., & Subnis, U. (2019). Integrative Approaches to Stress Management. Cancer journal (Sudbury, Mass.), 25(5), 329–336. doi:10.1097/PPO.0000000000000395
Castro-Martín, E., Ortiz-Comino, L., Gallart-Aragón, T., Esteban-Moreno, B., Arroyo-Morales, M., & Galiano-Castillo, N. (2017). Myofascial Induction Effects on Neck-Shoulder Pain in Breast Cancer Survivors: Randomized, Single-Blind, Placebo-Controlled Crossover Design. Archives of physical medicine and rehabilitation, 98(5), 832–840. doi:10.1016/j.apmr.2016.11.019
De Groef, A., Van Kampen, M., Vervloesem, N., Dieltjens, E., Christiaens, M. R., Neven, P., … Devoogdt, N. (2018). Effect of myofascial techniques for treatment of persistent arm pain after breast cancer treatment: randomized controlled trial. Clinical rehabilitation, 32(4), 451–461. doi:10.1177/0269215517730863
Deng, G., & Cassileth, B. (2013). Complementary or alternative medicine in cancer care-myths and realities. Nature reviews. Clinical oncology, 10(11), 656–664. doi:10.1038/nrclinonc.2013.125
Deng, G. (2019). Integrative Medicine Therapies for Pain Management in Cancer Patients. Cancer journal (Sudbury, Mass.), 25(5), 343–348. doi:10.1097/PPO.0000000000000399
Dilaveri, C. A., Croghan, I. T., Mallory, M. J., Dion, L. J., Fischer, K. M., Schroeder, D. R., Martinez-Jorge, J., Nguyen, M. T., Fokken, S. C., Bauer, B. A., & Wahner-Roedler, D. L. (2020). Massage Compared with Massage Plus Acupuncture for Breast Cancer Patients Undergoing Reconstructive Surgery. Journal of alternative and complementary medicine (New York, N.Y.), 26(7), 602–609. https://doi.org/10.1089/acm.2019.0479
Garland, S. N., Xie, S. X., DuHamel, K., Bao, T., Li, Q., Barg, F. K., Song, S., Kantoff, P., Gehrman, P., & Mao, J. J. (2019). Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial. Journal of the National Cancer Institute, 111(12), 1323–1331. https://doi.org/10.1093/jnci/djz050
Garland, S. N., Mahon, K., & Irwin, M. R. (2019). Integrative Approaches for Sleep Health in Cancer Survivors. Cancer journal (Sudbury, Mass.), 25(5), 337–342. doi:10.1097/PPO.0000000000000398
Ghesquiere, A., Wyka, K., Smith, M., & Kutner, J. S. (2019). Associations between psychological symptoms and treatment outcomes of a massage therapy intervention: Secondary analyses of a randomized controlled trial. Complementary therapies in medicine, 46, 116–122. doi:10.1016/j.ctim.2019.07.014
Genik, L. M., McMurtry, C. M., Marshall, S., Rapoport, A., & Stinson, J. (2020). Massage therapy for symptom reduction and improved quality of life in children with cancer in palliative care: A pilot study. Complementary therapies in medicine, 48, 102263. doi:10.1016/j.ctim.2019.102263
Gentile, D., Boselli, D., O’Neill, G., Yaguda, S., Bailey-Dorton, C., & Eaton, T. A. (2018). Cancer Pain Relief After Healing Touch and Massage. Journal of alternative and complementary medicine (New York, N.Y.), 24(9-10), 968–973. doi:10.1089/acm.2018.0192
Godette, K., Mondry, T. E., & Johnstone, P. A. (2006). Can manual treatment of lymphedema promote metastasis?. Journal of the Society for Integrative Oncology, 4(1), 8–12.
Greenlee, H., DuPont-Reyes, M. J., Balneaves, L. G., Carlson, L. E., Cohen, M. R., Deng, G., … Tripathy, D. (2017). Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: a cancer journal for clinicians, 67(3), 194–232. doi:10.3322/caac.21397
Gress, K. L., Charipova, K., Kaye, A. D., Viswanath, O., & Urits, I. (2020). An Overview of Current Recommendations and Options for the Management of Cancer Pain: A Comprehensive Review. Oncology and therapy, 8(2), 251–259. https://doi.org/10.1007/s40487-020-00128-y
He, Y., Guo, X., May, B. H., Zhang, A. L., Liu, Y., Lu, C., Mao, J. J., Xue, C. C., & Zhang, H. (2020). Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain: A Systematic Review and Meta-Analysis. JAMA oncology, 6(2), 271–278. https://doi.org/10.1001/jamaoncol.2019.5233
Hershman, D. L., Unger, J. M., Greenlee, H., Capodice, J. L., Lew, D. L., Darke, A. K., … Crew, K. D. (2018). Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to Aromatase Inhibitors Among Women With Early-Stage Breast Cancer: A Randomized Clinical Trial. JAMA, 320(2), 167–176. doi:10.1001/jama.2018.8907
Hilfiker, R., Meichtry, A., Eicher, M., Nilsson Balfe, L., Knols, R. H., Verra, M. L., & Taeymans, J. (2018). Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. British journal of sports medicine, 52(10), 651–658. doi:10.1136/bjsports-2016-096422
Ibrahim, E. Y., & Ehrlich, B. E. (2020). Prevention of chemotherapy-induced peripheral neuropathy: A review of recent findings. Critical reviews in oncology/hematology, 145, 102831. https://doi.org/10.1016/j.critrevonc.2019.102831
Izgu, N., Metin, Z. G., Karadas, C., Ozdemir, L., Çetin, N., & Demirci, U. (2019). Prevention of chemotherapy-induced peripheral neuropathy with classical massage in breast cancer patients receiving paclitaxel: An assessor-blinded randomized controlled trial. European journal of oncology nursing: the official journal of European Oncology Nursing Society, 40, 36–43. doi:10.1016/j.ejon.2019.03.002
Jacobs, S., & Mowbray, C. (2019). The Power of Massage in Children with Cancer-How Can We Do Effective Research?. Children (Basel, Switzerland), 6(1), 13. doi:10.3390/children6010013
Kinkead, B., Schettler, P. J., Larson, E. R., Carroll, D., Sharenko, M., Nettles, J., … Rapaport, M. H. (2018). Massage therapy decreases cancer-related fatigue: Results from a randomized early phase trial. Cancer, 124(3), 546–554. doi:10.1002/cncr.31064
Listing, M., Krohn, M., Liezmann, C., Kim, I., Reisshauer, A., Peters, E., … Rauchfuss, M. (2010). The efficacy of classical massage on stress perception and cortisol following primary treatment of breast cancer. Archives of women’s mental health, 13(2), 165–173. doi:10.1007/s00737-009-0143-9
Liou, K. T., Root, J. C., Garland, S. N., Green, J., Li, Y., Li, Q. S., Kantoff, P. W., Ahles, T. A., & Mao, J. J. (2020). Effects of acupuncture versus cognitive behavioral therapy on cognitive function in cancer survivors with insomnia: A secondary analysis of a randomized clinical trial. Cancer, 126(13), 3042–3052. https://doi.org/10.1002/cncr.32847
Lopez, G., Liu, W., Milbury, K., Spelman, A., Wei, Q., Bruera, E., & Cohen, L. (2017). The effects of oncology massage on symptom self-report for cancer patients and their caregivers. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 25(12), 3645–3650. https://doi.org/10.1007/s00520-017-3784-7
Lyman, G. H., Greenlee, H., Bohlke, K., Bao, T., DeMichele, A. M., Deng, G. E., … Cohen, L. (2018). Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 36(25), 2647–2655. doi:10.1200/JCO.2018.79.2721
Mao, J. J., Wagner, K. E., Seluzicki, C. M., Hugo, A., Galindez, L. K., Sheaffer, H., & Fox, K. R. (2017). Integrating Oncology Massage Into Chemoinfusion Suites: A Program Evaluation. Journal of oncology practice, 13(3), e207–e216. doi:10.1200/JOP.2016.015081
Massingill, J., Jorgensen, C., Dolata, J., & Sehgal, A. R. (2018). Myofascial Massage for Chronic Pain and Decreased Upper Extremity Mobility After Breast Cancer Surgery. International journal of therapeutic massage & bodywork, 11(3), 4–9.
Montagnini, M., Javier, N., Mitchinson, A. (2020). The Role of Rehabilitation in Patients Receiving Hospice and Palliative Care. Rehabilitation Oncology. 38(1):9–2.
Mustian, K. M., Alfano, C. M., Heckler, C., Kleckner, A. S., Kleckner, I. R., Leach, C. R., … Miller, S. M. (2017). Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. JAMA oncology, 3(7), 961–968. doi:10.1001/jamaoncol.2016.6914
Nijs, J., Wijma, A. J., Leysen, L., Pas, R., Willaert, W., Hoelen, W., … Wilgen, C. (2019). Explaining pain following cancer: a practical guide for clinicians. Brazilian journal of physical therapy, 23(5), 367–377. doi:10.1016/j.bjpt.2018.12.003
Patel, A. V., Friedenreich, C. M., Moore, S. C., Hayes, S. C., Silver, J. K., Campbell, K. L., … Matthews, C. E. (2019). American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Medicine and science in sports and exercise, 51(11), 2391–2402. doi:10.1249/MSS.0000000000002117
Radossi, A. L., Taromina, K., Marjerrison, S., Diorio, C. J., Similio, R., Njuguna, F., … Ladas, E. J. (2018). A systematic review of integrative clinical trials for supportive care in pediatric oncology: a report from the International Society of Pediatric Oncology, T&CM collaborative. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 26(2), 375–391. doi:10.1007/s00520-017-3908-0
Samuels, N., & Ben-Arye, E. (2020). Integrative Approaches to Chemotherapy-Induced Peripheral Neuropathy. Current oncology reports, 22(3), 23. https://doi.org/10.1007/s11912-020-0891-2
Schmitz, K. H., Campbell, A. M., Stuiver, M. M., Pinto, B. M., Schwartz, A. L., Morris, G. S., … Matthews, C. E. (2019). Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA: a cancer journal for clinicians, 69(6), 468–484. doi:10.3322/caac.21579
Sohl, S. J., Borowski, L. A., Kent, E. E., Smith, A. W., Oakley-Girvan, I., Rothman, R. L., & Arora, N. K. (2015). Cancer survivors’ disclosure of complementary health approaches to physicians: the role of patient-centered communication. Cancer, 121(6), 900–907. doi:10.1002/cncr.29138
Stuiver, M. M., Ten Tusscher, M. R., & McNeely, M. L. (2017). Which are the best conservative interventions for lymphoedema after breast cancer surgery?. BMJ (Clinical research ed.), 357, j2330. doi:10.1136/bmj.j2330
Thomas, R. J., Kenfield, S. A., & Jimenez, A. (2017). Exercise-induced biochemical changes and their potential influence on cancer: a scientific review. British journal of sports medicine, 51(8), 640–644. doi:10.1136/bjsports-2016-096343
Yang, S., Park, D. H., Ahn, S. H., Kim, J., Lee, J. W., Han, J. Y., … Kim, W. (2017). Prevalence and risk factors of adhesive capsulitis of the shoulder after breast cancer treatment. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 25(4), 1317–1322. doi:10.1007/s00520-016-3532-4