Mechanism-based Classification and Physical Therapy Management of Persons with Cancer Pain: A Prospective Case Series

Best-Evidence Rehabilitation for Chronic Pain Part 2: Pain during and after Cancer Treatment

Pain during, and especially after, cancer remains underestimated and undertreated. Moreover, both patients and health care providers are not aware of potential benefits of rehabilitation strategies for the management of pain during and following cancer treatment. In this paper, we firstly provided a state-of-the-art overview of the best evidence rehabilitation modalities for patients having (persistent) pain during and following cancer treatment, including educational interventions, specific exercise therapies, manual therapies, general exercise therapies and mind-body exercise therapies. Secondly, the findings were summarized from a clinical perspective and discussed from a scientific perspective. In conclusion, best evidence suggests that general exercise therapy has small pain-relieving effects. Supporting evidence for mind-body exercise therapy is available only in breast cancer patients. At this moment, there is a lack of high-quality evidence to support the use of specific exercises and manual therapy at the affected region for pain relief during and after cancer treatment. No clinically relevant results were found in favor of educational interventions restricted to a biomedical approach of pain. To increase available evidence these rehabilitation modalities should be applied according to, and within, a multidisciplinary biopsychosocial pain management approach. Larger, well-designed clinical trials tailored to the origin of pain and with proper evaluation of pain-related functioning and the patient’s pain experience are needed.

Modern pain neuroscience in clinical practice: applied to post-cancer, paediatric and sports-related pain

•

Generalized hypersensitivity in post-cancer, sports-related and pediatric pain.

•

Rationale for pain education, stress management and cognition targeted exercises.

•

Need to change from a biomedical or psychosocial to an integrated approach.

In the last decade, evidence regarding chronic pain has developed exponentially. Numerous studies show that many chronic pain populations show specific neuroplastic changes in the peripheral and central nervous system. These changes are reflected in clinical manifestations, like a generalized hypersensitivity of the somatosensory system. Besides a hypersensitivity of bottom-up nociceptive transmission, there is also evidence for top-down facilitation of pain due to malfunctioning of the endogenous descending nociceptive modulatory systems. These and other aspects of modern pain neuroscience are starting to be applied within daily clinical practice. However, currently the application of this knowledge is mostly limited to the general adult population with musculoskeletal problems, while evidence is getting stronger that also in other chronic pain populations these neuroplastic processes may contribute to the occurrence and persistence of the pain problem. Therefore, this masterclass article aims at giving an overview of the current modern pain neuroscience knowledge and its potential application in post-cancer, paediatric and sports-related pain problems.

Pain following cancer treatment: Guidelines for the clinical classification of predominant neuropathic, nociceptive and central sensitization pain

BACKGROUND

In addition to fatigue, pain is the most frequent persistent symptom in cancer survivors. Clear guidelines for both the diagnosis and treatment of pain in cancer survivors are lacking. Classification of pain is important as it may facilitate more specific targeting of treatment. In this paper we present an overview of nociceptive, neuropathic and central sensitization pain following cancer treatment, as well as the rationale, criteria and process for stratifying pain classification.

MATERIAL AND METHODS

Recently, a clinical method for classifying any pain as either predominant central sensitization pain, neuropathic or nociceptive pain was developed, based on a large body of research evidence and international expert opinion. We, a team of 15 authors from 13 different centers, four countries and two continents have applied this classification algorithm to the cancer survivor population.

RESULTS

The classification of pain following cancer treatment entails two steps: (1) examining the presence of neuropathic pain; and (2) using an algorithm for differentiating predominant nociceptive and central sensitization pain. Step 1 builds on the established criteria for neuropathic pain diagnosis, while Step 2 applies a recently developed clinical method for classifying any pain as either predominant central sensitization pain, neuropathic or nociceptive pain to the cancer survivor population.

CONCLUSION

The classification criteria allow identifying central sensitization pain following cancer treatment. The recognition of central sensitization pain in practice is an important development in the integration of pain neuroscience into the clinic, and one that is relevant for people undergoing and following cancer treatment.

Exercise-based interventions for cancer survivors in India: a systematic review

Existing literature suggests that cancer survivors present with high rates of morbidity due to various treatment and disease induced factors. Research globally has shown exercise to be beneficial in improving treatment outcomes and quality of life. India has a high prevalence of cancer and not much is known about exercise interventions for cancer survivors in India. This review was planned to review the state of exercise based interventions for cancer survivors in India. A comprehensive literature search was performed in PubMed, CINAHL, EMBASE, Scopus, Cochrane Library, PEDro, IndMed, and Shoda Ganga. The search results were screened and data extracted by two independent reviewers. All eligible studies were assessed for methodological quality rating using Downs and Black checklist. Data was extracted using a pilot tested pro forma to summarize information on site and stage of cancer, type of exercise intervention and outcome measures. The review identified 13 studies, published from 1991 to 2013, after screening 4060 articles. Exercise interventions fell into one of three categories: (1) yoga-based, (2) physiotherapy-based and (3) speech therapy based interventions; and exclusively involved either breast or head and neck cancers. Studies were generally of low to moderate quality. A broad range of outcomes were found including symptoms, speech and swallowing, and quality of life and largely supported the benefits of exercise-based interventions. At present, research involving exercise-based rehabilitation interventions in India is limited in volume, quality and scope. With the growing burden of cancer in the country, there is an immediate need for research on exercise based interventions for cancer survivors within the sociocultural context of India.

CT-guided microinvasive intervention in treating refractory carcinous pain

OBJECTIVE

To evaluate the analgesic effect of CT-guided microinvasive intervention on refractory carcinous pain.

METHODS

A total of 23 patients with poor response to drug therapy for carcinous pain were selected: 6 patients underwent CT-guided neurolytic celiac plexus block (NCPB), 5 patients underwent CT-guided(125)I implantation and 12 patients underwent combined CT-guided NCPB and CT-guided(125)I implantation.

RESULTS

After 1 week of treatment, 6 patients exhibited complete remission, 13 patients exhibited partial remission and 4 patients exhibited no changes in condition. The treatment efficiency rate was 82.6%. After 1 month of treatment, 5 patients exhibited complete remission, 14 patients exhibited partial remission and 4 patients exhibited no changes in condition. Treatment efficiency rate was 82.6%. After 3 months of treatment, 4 patients exhibited complete remission, 9 patients exhibited partial remission, 5 patients exhibited no changes in condition and 5 patients died. Treatment efficiency rate was 72.2%. After 6 months of treatment, 3 patients exhibited complete remission, 6 patients exhibited partial remission, 3 patients exhibited no changes in condition and 11 patients died. The treatment efficiency rate was 75.0%. No severe postoperative severe complications, such as bleeding, biliary fistula and pancreatic fistula, were reported.

CONCLUSION

CT-guided microinvasive intervention clearly demonstrated an analgesic effect on refractory carcinous pain with less trauma and few complications. Therefore, this method provides effective relief for carcinous pain.