Pain can be a significant challenge for some people undergoing cancer treatment. It can interfere with daily activities, sleep, and overall quality of life. It may even impact whether someone can proceed with their treatment plan and impact their treatment outcomes. Effective pain management is crucial for improving comfort and well-being. Understanding pain and being aware of possible strategies to help manage symptoms can be empowering and essential.
Understanding Cancer Pain
According to the International Association for the Study of Pain, the definition of pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Pain is always a personal experience that is influenced to varying degrees by biological, psychological and social factors”.
Put more simply, pain is a message sent from an area of the body to the brain to highlight something abnormal that is causing or could cause harm. It is an important protective mechanism that is essential for survival and serves a very useful, functional biological purpose to keep us safe.
Pain can be categorised by various characteristics, including duration, source or sensation.
Duration may be acute (short-term) or chronic (long-term). Acute pain lasts up to 3 months and usually has a clear cause, serves a clear purpose and follows an expected trajectory of healing, for example, wound recovery after surgery or a broken bone. Chronic pain tends to last longer than 3-6 months and does not correlate directly with actual tissue damage and no longer serves a useful biological purpose, for example chronic back pain with no clear cause.
Source relates to where the pain is originally biologically. Some people may even present with multiple sources of pain, which can be broken down as below:
Nociceptive: Pain caused by tissue damage or inflammation, such as from a paper cut, infection, broken bone, or osteoarthritis - this can feel sharp, pricking, dull, or aching.
Neuropathic: Pain caused by peripheral (outside of spine and brain) nerve damage, such as from diabetic neuropathy, shingles, or chemotherapy - this can feel like burning, tingling, shooting, or electric shocks.
Nociplastic: Pain caused by changes in how the nervous system processes pain, such as from fibromyalgia, irritable bowel syndrome, or chronic low back pain.
Radicular: Pinching of a nerve at the root in the spinal column, causing pain along the distribution of the peripheral nerve, such as a herniated disc or compression from a tumour.
Visceral: Pain caused by internal organs, such as heart, lungs or pancreas - this can feel like pressure, aching, squeezing or cramping.
Sensation can vary significantly, depending on the source of pain. Describing pain to others can be very difficult, but your choice of words can be very useful in determining the best pain management. Some of the words commonly used to describe pain may include:
Burning Sharp Dull Intense Aching
Cramping Tender Prickly Shooting Numb
Stabbing Gnawing Gripping Pressure Heavy
Not everyone with cancer will experience pain. Cancer Research reports around 30% of those with cancer experience moderate to severe pain. In those with more advanced cancer, around 55% will experience such; therefore pain is more likely in advance disease.
Pain may be caused by the tumour itself, inflammation (in an organ or soft tissue), infection, tissue damage (surgical wounds, radiotherapy burns), nerve damage (injury, surgery), joint pain (inactivity, hormone therapy), bone pain (osteoporosis, bone metastases) and muscle spasm.
While pain is a universal human experience, the impact it has on each individual may vary greatly. Other factors such as stress, anxiety and fatigue can also influence our pain perception.
Total pain is a concept used within palliative care, coined by Dame Cicily Saunders which identifies the relation between pain and physical, social, spiritual and psychological influences. It demonstrated that pain is very complex and that we must adopt a holistic view in order to treat pain effectively.
Managing Pain
In order to effectively manage pain, we must first consider the above and identify the real cause of our symptoms. Without knowing exactly what is contributing to the pain burden, it is more challenging to manage.
Once you know what the cause is, you can be clearer on whether the symptom is reversible, the expected timeline and the best options for management:
Optimise pharmacological management with medical and pharmacy team, including pain relief, anti-inflammatories and neuropathic (nerve pain) medications, anti-depressants and anticonvulsants.
Optimise non-pharmacological management, such as physiotherapy, occupational therapy, complementary therapy and other allied health professions.
Optimise your physical activity, as much as your symptoms allow, to maintain the body’s strength, movement and function.
Explore opportunities for psychological support on a 1:1 or group basis, to optimise coping strategies and support network.
Consider any lifestyle changes, such as smoking and alcohol, that may be negatively impacting your pain.
Communicate with your loved ones about what you are experiencing and the strategies that help you to cope.
Keep a pain diary to identify any patterns in your symptoms and communicate transparently with your healthcare team to ensure they understand your experience
How can physiotherapy help pain?
Physiotherapists are experts in the human body, how it works and how to restore normal function as much as possible. A holistic approach to pain is most useful, to help address the physical, psychological, social and spiritual elements that could be at play.
Using movement and exercise, alongside non-pharmacological pain management techniques, will help you to feel more in control of your body and your pain. It can help improve relationships with your body and gain a deeper understanding of what it is going through and how the pain you are feeling is aiming to protect you. Reframing and exploring these relationships with your body can be powerful and transformative.
Non-pharmacological techniques such as massage, hot or cold therapy, TENS machines, stretching, strengthening, exercises, equipment and aids, psychological support, relaxation and complementary therapy can all help to minimise pain.
Summary
You don't have to and shouldn’t suffer from cancer pain. By working closely with your healthcare team and exploring various pain management strategies, you can find relief and improve your overall quality of life.
If you have any other questions about managing cancer pain with physiotherapy, please do not hesitate to get in contact with Hannah by email or online for support.
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