Current Topic:
The role of therapies in managing cancer-related pain
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Abstract
Patients with cancer may present with a wide range of pain problems, many of which can be complex and multi-dimensional. The prevalence of pain associated with cancer varies enormously and is dependant on many factors including the stage of disease and treatments undergone. Although cancer pain has traditionally been associated with progressive disease, there is increasing recognition and interest in a range of pain syndromes associated with cancer treatments e.g. chronic post-surgical pain or peripheral neuropathy secondary to chemotherapy.
The concept of ‘total pain’ was first introduced by Dame Cicely Saunders in 1967 to address the various dimensions of cancer-related pain and highlight that addressing only the physical aspects of pain is unlikely to bring about pain relief This concept emphasises the importance of a biopsychosocial approach and a skilled multi-disciplinary team.
Allied Health Professionals (AHPs) play an important role in cancer pain management and may encounter patients at various stages in the cancer ‘patient pathway’. Traditionally Occupational Therapists and Physiotherapists are the key AHPs involved in this process. There may be aspects of therapy assessment which are profession or discipline-specific (e.g. mobility traditionally assessed by a physiotherapist and washing and dressing by an occupational therapist) but both disciplines should:
• complete a detailed history-taking
• examine both physical and psycho-social factors and
• focus on a patient-centred approach.
Assessment is rarely possible over one interaction; it is an information gathering exercise which is ongoing and guides further management.
Therapy interventions focus on relieving pain wherever possible but also concentrate on reducing physical limitations and improving functional ability. Interventions can be classified as physical, psychosocial, lifestyle adjustment or educational approaches. Involving care-givers is also an important aspect of management. This module addresses the challenge for all AHPS to practice in an evidence-based way as many of the approaches commonly utilised lack convincing evidence for their effectiveness.
