31 Cancer-Related Pain

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.

Pathophysiology

Cancer-related pain is pain that is due to cancer or its treatment, such as chemotherapy.

Examination

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)

Treatment

Education

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).

Self-Management Strategies

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).

Prognosis

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., 2016Calcagni 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.

Key Takeaways

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)

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