Treating cancer-related pain: Exploring the efficacy of physical medicine modalities
Effective treatment of cancer-related pain is essential if patients are to maintain their mobility and independence. In many cases, cancer-related pain is caused by one or more of the following: direct tumor invasion, maladaptive changes due to cancer treatment or local tumor effects, exacerbation of pre-existing musculoskeletal pain, and hypertonicity and spasm related to any of the above.
Finding effective treatments that are not associated with unwanted side effects can be challenging. It's been well-established that opiates and other medications commonly prescribed to alleviate cancer pain may cause a decrease in blood pressure, confusion, constipation and other significant side effects, especially in older patients.
Mayo Clinic physiatrist Andrea L. Cheville, M.D., asserts that basic rehabilitation medicine pain management techniques should be integrated into the care plan for cancer patients who experience pain. Dr. Cheville is a professor of physical medicine and rehabilitation, and she serves as the Physical Medicine and Rehabilitation research chair and chief of the Cancer Rehabilitation and Lymphedema Program at Mayo Clinic's campus in Minnesota.
"Rehabilitation medicine and physical modalities-based strategies offer a range of pain management options that may serve as beneficial adjuncts to the conventional systemic and interventional analgesic strategies used to control cancer-related pain," says Dr. Cheville.
Dr. Cheville acknowledges the fact that many traditional rehabilitation medicine strategies have not been thoroughly evaluated in the scientific literature as cancer pain management tools. In an article published in the Journal of Clinical Oncology, Dr. Cheville and colleagues outline four basic categories of physical medicine modalities available to manage pain and review the scientific literature.
Rehabilitation and physical modalities used to manage pain
- Modalities that modulate nociception, including topical heat, short wave diathermy, cold, transcutaneous nerve stimulation and interferential current therapy
- Modalities that stabilize or unload painful structures, including compensatory strategies and adaptive devices and orthotics
- Modalities that influence local physiological processes that indirectly influence nociception, including laser and light therapy and manual lymphatic drainage
- Modalities that reduce pain arising from muscles and connective tissues, including corticosteroid injections, trigger-point injections and dry needling, massage, therapeutic exercise, and manipulation
With pharmacotherapy positioned as the dominant tool for treating cancer-related pain, Dr. Cheville notes that many of the simpler and side-effect-neutral treatments that are overlooked may be particularly beneficial to patients with movement-associated pain. These include the use of heat and cold, desensitization, and the use of gait aids and assistive devices to reduce the load on painful joints and limbs.
"Although they have not been explicitly tested in cancer patients, many of these modalities are patient controlled, are free of adverse effects and have been validated for use with other diagnoses," explains Dr. Cheville. "Common sense and extensive experience help argue persuasively for their clinical effectiveness in cancer patients."
For more information
Cheville AL, et al. Role of rehabilitation medicine and physical agents in the treatment of cancer-associated pain. Journal of Clinical Oncology. 2014;32:1691.