Cancer Pain and Physical Modalities

Cancer pain can be quite debilitating, affecting not only quality of life and function, but mood and interpersonal social interactions as well. While pharmacologic interventions play a large role in managing cancer pain, patients may also benefit from physical modalities. Rehabilitation strategies often incorporate the use of physical modalities to reduce symptoms while improving or maintaining function through physical and occupational therapy. These modalities may be better tolerated than pharmacologic approaches alone. Side effects from pharmacologic therapy may limit the progression toward functional improvement in a rehabilitation program. The addition of physical modalities such as cryotherapy, massage, and therapeutic exercise should be considered for symptom relief. Modalities, also known as physical agents, can be categorized by properties: thermodynamic, mechanical, or electromagnetic. The use of modalities in individuals with cancer is highly controversial and not well studied. For example, using topical moist heat in an area with active cancer can provide pain modulation as heating tense or spastic muscles does help with relaxation. However, heat also increases blood flow, circulation, and thus blood volume to an area. This influx of volume might be contraindicated in an instance of lymphadenopathy. Also, with this influx of blood volume come protein, nutrients, and other metabolic catalysts that in theory could be providing an optimum environment for cancer cells to thrive. Again, the research is limited, and little can be said about the relationship between physical therapy modalities to cancer. There is limited literature on physical modalities for cancer-related pain; however, this chapter will review some options to consider.