Pain needs to be better treated in cancer survivors

After people have a heart attack, stroke or joint replacement, rehab is a routine part of their recovery plan. Cancer survivors, too, can have significant musculoskeletal issues during and after the acute illness. Yet cancer rehab programs are few and far between. Why is that?

For no good reason, rehab has not yet made it to the culture of survivorship. It’s time to do something about this.

Cure Magazine published an important article by physician-survivor Julie Silver in the online CURExtra Winter issue. “The goals [of cancer rehab] are the same–help someone function at the highest possible level by building up their strength and stamina, reducing pain and fatigue, improving problems with balance, gait swallowing, joint range of motion and a host of other problems.”

Dr. Silver points out a key issue for Healthy Survivors: “[I]t’s not fair to survivors to tell them to accept a new normal when there is proven medical care that can help.”

Too many patients — not just cancer survivors – receive high-tech interventions that help the original problem, but then they suffer with unaddressed residual pain or weakness. Accepting your “new normal” is counter to Healthy Survivorship unless all modes of therapy that might help have been tried. Many times it takes a combination of low-tech therapies, including rehab services.

Until rehab becomes a routine component of comprehensive cancer care, Healthy Survivors can contribute to their recovery by requesting a consult with a rehab expert experienced in the care of cancer patients.

Wendy S. Harpham is an internal medicine physician who blogs at Dr. Wendy Harpham on Health Survivorship and is the author of Only 10 Seconds to Care: Help and Hope for Busy Clinicians.

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  • Jeannette

    How true that is…I had radiation treatment years ago and the damage it did to me is unbelievable. My neck and upper chest were radiated. I have damage to the upper 3rd of both my lungs (fibrosed) and my thyroid that has since been removed due to radiation damage. Worst of all is the damage to my spinal cord that has left the transfer of nerve impulses somewhat erratic and has contributed to the pain I still have even though many years have past. It may have cured me but it also left a lot of damage in it`s wake.

    • Mark Schlesinger

      You need to see a good comprehensive pain clinic, not some little fly-by-night block shop or pill mill. We manage patients just like you. There are other clinics around the country who also do a good job at this type of work. The International Spine Intervention Society is a good resource for reputable practitioners or you can call us for a referral.

      • Jeannette

        Thank you very much for the reply. I actually live in Canada, so I would not be able to attend your clinic even if I had the ability to do so. I was however looking through your website and it is certainly impressive. We have precious few properly trained pain specialists here as well.

        I have been to a fairly good pain management program and it has helped a bit. I actually attended due to a workplace injury to my low back. As far as the ongoing post-cancer pain, I had never looked for treatment, I thought it was just something I had to live with… The treatment for the back injury has helped a fair amount with that and with the pain I have had for years and I am doing okay. I think it is awesome that you are helping those with pain as it is a horrible existence when one suffers 24/7. I am treated with narcotics presently, however I also do other techniques such as pacing activity, relaxation methods such as meditation, yoga and that sort of thing. It is a shame that so many people are suffering as I did for many years and still do at times. It is very sad that there are such ‘pill mills’ out there because frankly there is no pill that will solve the problem entirely. We need more pain centers and physicians like you in Canada. Keep up the great work!

  • Steve Ariens, PD

    Pain needs to be better treated in ALL PATIENTS… PERIOD !

  • Mike

    I have significant residual pain from my several cancer surgeries. I’ve learned, however, that if I mention any of it to my oncologist, I am immediately (and understandably) subjected to a battery of tests designed to detect a recurrence. Once he is satisfied that my cancer has not returned in the area of pain, he has no further interest in the fact that I still hurt. So I tend to not say anything about pain unless it becomes outrageous, since raising the subject just earns me intrusive tests but no resolution of the pain.

    • BobBapaso

      Maybe if you threatened to sue him for malpractice for not treating your pain, he would take an interest in it. With the attitude of many medical boards about the long term use of narcotics, it will take something like that to get most doctors interested in it.

      • Steve Ariens, PD

        There has been a few successful lawsuit against docs for failing to treat cancer pts pain… the docs were not sued for malpractice… it was for SENIOR ABUSE … this was early 90′s and award was for one million +.for the docs to cough up.

    • Mark Schlesinger

      Probably one quarter of my cancer work is treating pain in survivors. I’m not sure that your oncologist is unconcerned with your pain as much as simply unaware of what can be done about it. Most oncologists have never met a competent pain management physician and so have no idea what we can do. It may not be simple and may involve the use of pumps or stimulators, but most types of survivor pain are treatable. As I said in my response to Jeanette’s comment call ISIS or call us for a referral.

  • Steve Ariens, PD

    when you go to a specialist – they will look for what they know.. don’t go to a surgeon… with a complaint… unless you expect to get cut open… The nature of the system !

  • Tammy

    Title of this article is misleading, I believe. The word “Pain” is in it’s title when actually you are talking about Rehab. As a therapist, we can not treat the actual pain symptoms but we can work on stregnth/endurance, range of motion… to increase one’s functional activity. We ask client’s what their everyday goals are, things they like to do and address rehab from that standpoint. Pain is not something we treat. Also, as a therapist who has “marketed” doctors and educated residents re: role of Occupational Therapy I have found that they still do not use our services or really even pay attention during our meetings. Perhaps, the doctors should seek out the rehab centers and outpatient clinics and let the therapy staff (OT’s and PT’s ) know what their findings are post cancer treatment and develop a relationship that would benefit their patients and begin referring for our services. We are out there and MORE then happy to make a patient’s life better through PT and OT and speech therapy.

  • Jeannette

    Tammy, I do agree with you. I attended a program for several weeks with a PT and she helped with increasing my core strength that in turn helped me a lot. When it comes to just about any ailment, a multidisciplinary approach always helps!

    • Mark Schlesinger

      You are absolutely right, a multidisciplinary approach is always best, but it is also more work. The primary treating physician has to learn what OT and PT can do and what they can’t (most guys don’t really know) and then they have to take the time to find a good one. There are as many bad OTs and PTs out there as bad docs. That is one of the reasons why we have begun to bring some of this in-house. Otherwise there is no real way to control quality.

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