An Evidence Based and Whole Body Approach to Pain Management in Cancer Survivors

March 21, 2010

Pain is a frequent complication of cancer and its treatment. Experts note that the symptom of pain is often under reported, under diagnosed and under treated.  There are estimates that 30-50% of cancer patients experience pain while undergoing acute cancer treatment, even more frequently in patients with metastatic disease. Pain is a significant determinant to a patient’s quality of life and function with cancer.  A 2009 study in JAMA found that nearly 50% of breast cancer patients have persistent pain 2-3 years after treatment.

Wendy Farnen Price PT MS CPI was featured in a recent article about pain, Treating the Whole Person, Exploring an Interdisciplinary Approach to Pain Management, in Rehab Management magazine.  The article reviews different approaches to pain assessment and noninvasive pain management.  Wendy is a physical therapist and founder of Healthcore Physical Therapy & Pilates Studio in Woodbridge, CT. She is also a consultant and training specialist for Oncology Rehab Partners, an innovative company founded by Dr. Julie Silver, an assistant professor at Harvard Medical School, and herself a breast cancer survivor. Oncology Rehab Partners has developed a comprehensive program for rehabilitation in cancer treatment and survivorship called the STAR program. The STAR program utilizes an evidence-based approach to assessing and treating pain. Wendy Price is the first STAR certified physical therapist.

Wendy uses standardized tools to assess level of pain and how pain is affecting a patient’s function.  In cancer patients, a thorough understanding of the nature and etiology of a patient’s pain is important. For example, in a breast cancer patient with shoulder pain, does this result from musculoskeletal shoulder impingement from mastectomy surgery, radiation-induced post-mastectomy pain, or chemotherapy-induced peripheral neuropathy?  Pain may also be a symptom of inflammation, infection or lymphedema.

Pain in cancer survivors has a significant impact on the patient’s psychosocial well-being.  Does pain mean metastatic disease or relapse of the cancer or merely musculoskeletal discomfort? As a therapist, the accurate assessment and treatment of a patient’s musculoskeletal pain may be of great psychological benefit.  At the same time, a low threshold for referring patients back to their physician must be kept in these complex patients.   If there are any questions regarding the etiology of the pain or the lack of response to physical therapy interventions, prompt referral back to the treating physician is mandatory.

After the etiology of the pain is identified, the next goal is to educate patients on managing their pain through discussion of techniques and interventions to alleviate and prevent worsening of their pain.  Patients are provided with a guidebook to take home as a reference.  The STAR guidebook provides survivors with the ability to track their goals, as well as giving them additional information on healing and regaining optimal function following acute cancer treatment.

Wendy also brings her expertise as a Certified Polestar Pilates Rehabilitation Practitioner in her approach to pain management.  She specializes in Pilates-based rehab, which advocates pain-free movement and exercises in physical therapy treatment. She focuses on the patients having a “positive movement experience” using a whole body approach.  She believes that patients need to “move” in order to function and tries to achieve this in the most pain-free way possible. Pilates equipment allows her to develop programs for patients to reduce stress on the body, to maintain proper alignment, and utilize gravity to safely progress patients. Pilates excels in the mind–body connection, postural re-education and muscle-balancing necessary to recover from the physiological and psychological side effects of cancer treatment.  In addition, the gentle and non-impact features of Pilates make it a great rehab and wellness tool for cancer survivors. She finds Pilates, in combination with manual therapy and lots of patient education to manage pain, has helped her patients reduce their pain levels considerably.

Healthcore Physical Therapy & Pilates Studio also offers several times throughout the year free Pilates mat classes and workshops for cancer survivors.  The next one is scheduled on May 1, for Pilates Day. Healthcore is located in a LEED certified building on 245 Amity Road in Woodbridge, Connecticut.  For more information: (203)298-4582, wwww.healthcorestudio.com

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