Overview of physiatric approaches to cancer pain

The role of the rehabilitation team in the management of the cancer patient with pain is not well understood by either oncologists or physiatrists. Readily available analgesic interventions at the rehabilitationist's disposal may be easily employed in this population as part of a multi modality and interdisciplinary approach to pain. This article describes the role of the rehabilitation team and highlights techniques which are appropriate for cancer pain management. Benefits realized in addition to analgesia from physiatric intervention are also described.Cancer, in all its varieties, is inherently destructive and thereby, a potentially disabling process.1,2 Typical examples of the deleterious physical consequences associated with cancer include primary and metastatic disease of the bone and brain, epidural spinal cord compression, and invasion or compression of nerves by malignant spread.Options available for the treatment of cancer, including radical surgery, cytotoxic chemotherapy, and radiotherapy, administered individually or in combination, are also noxious to native tissues. Therefore, antineoplastic therapies may also lead to, or exacerbate, physical impairments. Examples include surgical amputation of a limb, chemotherapy induced peripheral neuropathy, and radiation osteonecrosis.Pain is one of the most common causes of disability in the cancer population.3,4 Thirty to 50% of all cancer patients suffer pain, and 70 to 90% of terminal patients have pain. Pain contributing to functional impairment has been noted in 44% of patients seen on a cancer rehabilitation service.5 The World Health Organization has developed clear guidelines for the assessment and recommended treatment of cancer pain.6 Pharmacologic and anesthetic interventions, as well as ablative and electro-stimulatory neurosurgical procedures, provide significant pain relief in the majority of cancer patients.7 These techniques, employed by a cogent multidisciplinary team including supportive and palliative care specialists, psychiatric liaison, and rehabilitation professionals may be the most efficacious approach in optimizing pain relief for this population.8-11This article will review options available to the physiatrist for the treatment of cancer pain and related disabilities.