PT Classroom - An Interdisciplinary Approach to Treating Cancer Related Pain ׀ by Jay Hurh, MD, MPH & Chai Rasavong, MPT, MBA

Patients with cancer not only have to worry about the disease, but may also have to deal with the pain that may be associated with the malignant disease itself, or subsequent to treatments, such as surgery, chemotherapy or radiation therapy (1). The pathophysiology of pain due to cancer may be complex and include a variety of nociceptive, inflammatory, and neuropathic mechanisms (1). Health care providers of patients’ with cancer should work closely together as an interdisciplinary team in order to achieve the best possible results for the patient. This team can include physicians, physical therapists, occupational therapists, nurses, psychologists, counselors, etc. Being able to control the pain in a sufficient manner requires that frequent reassessment be conducted by all disciplines (2).

The reassessment should include the following dimensions of pain: location, intensity, factors influencing its occurrence (i.e., what makes it better or worse), observed behaviors during pain, psychosocial variables (e.g., attitudes, situational factors), effects of pain, effects of therapy, functional limitations, patterns of coping and the patient’s goal for pain relief (3).

Appropriate current treatments for cancer related pain include a valid therapeutic role of non-opioid and opioid analgesics, adjuvants -such as gabapentin, biphosphonates, palliative radiation therapy and radiopharmaceutical compounds, and interventional pain therapy (including neuraxial drug infusion and verterbroplasty for spine metastases) in selected patients (1). Physical therapy intervention including exercise, functional training, postural training, myofascial release, lymphedema management, electric stimulation, heat, cold, etc. can also be utilized to help the patient manage pain.

Treating the patient with cancer related pain should be on an individual basis as each patient’s condition and situation will be specific to that patient. Additional variables or side effects to consider when working with the cancer patient can include cancer related fatigue, over sedation, and acute immobilizing pain (2). As a result of these variables, it may prove difficult for the patient to participate in physical therapy. Therefore, it will be even more essential for the therapists to work closely with the interdisciplinary team in order to help the patient manage the pain.

Only working together as an interdisciplinary team and understanding not only the disease and the treatment options available will we be able to help our patients achieve the best possible outcome for pain management and function.

Last revised: July 11, 2009
by Jay Hurh, MD, MPH & Chai Rasavong, MPT, MBA