Submission Form
World Conference on Medical Rehabilitation in Rural and Low-Resource Regions
Dhaka, Bangladesh, December 1-4, 2012
CANCER PAIN MANAGEMENT
Gulseren AKYUZ
Academic Title: M.D., Prof., P.M.&R. and Pain Medicine Specialist, President of
Turkish Society of P.M.&R.
Institution: Marmara University, School of Medicine, Dept. of Physical Medicine and
Rehabilitation, Istanbul, TURKEY
e-mail : gulserena@gmail.com;
Tel: +902167254657; Fax: +902164500077; GSM: +905324957700
ABSTRACT:
Cancer is increasingly being viewed as a chronic illness requiring long-term
management, and there is a growing need for evidence-based rehabilitation
interventions for cancer survivors. There are immobilization, central/peripheral
nervous system involvement, myopathy, bone invasion, lymphedema, anemia,
psychosocial and sexual problems among the reasons of disabilities seen regarding
to cancer. The population is aging and the prevalence of cancer is increasing.
Cancer patients need comprehensive care designed to relieve symptoms of pain,
fatigue, and muscle weakness. They need education to help support their ability to
reach functional independence and maintain quality of life. Rehabilitation
professionals must be trained to manage problems associated with cancer and its
treatment. It is known that interdisciplinary working, permissive approach, education
and early treatment increase the success in cancer treatment. Physical activity has
become a focus of cancer recovery research because it has the potential to reduce
treatment-related burden and to optimize health-related quality of life. Cancer pain is
present in 51% of patients (74% in advanced stage) and it effects quality of life and
functionality negatively. It has psychiological, cognitive and behavioural components.
In 7-20% of patients with cancer pain thought of suicide is dominant as a result of
depression and anxiety. In cancer patients, a) pain related with direct tumoral
involvement (bone invasion, compression or invasion of peripheral nerves); b) pain
related with cancer treatment (postoperative, postchemotherapy and postradiation
problems) can be seen. Medical treatment in cancer pain differs according to
intensity of pain. In mild degree of pain, simple analgesics (acetaminophen,
paracetamol) and non steroidal anti-inflammatory drugs (NSAIDs) are given. In this
stage, physical therapy modalities (TENS; high voltage galvanic stimulation,
diadynamic currents e.g.), general therapeutic massage, biofeedback and relaxation
excersises are very helpful. In moderate painful situations, weak opioids (codein,
tramadol, oxicodon, hydrocodon) should be preferred. When it is necessary for
functionality, ROM excersises, muscle stretching and strengthening excersises,
balance and coordination excersises are added to treatment programme. In severe
pain, strong opioids (morphine, hydromorphine, methadon) are used and additionally
adjuvant drugs (tricyclic antidepressants, anticonvulsants) are given. In stiuations
unresponsive to treatment as well as spinal opioid administrations and invasive
techniques (nerve blockages, stellate and lomber ganglion blocks in ANS
involvement), other interventions (dorsal root rhizotomy, tractotomy, cordotomy,
myelotomy) are tried. Although pain is a symptom that should be overcome,
sometimes therapy can get hard and it can delay the return of patient to daily life.
Potential, perceived, or real conflicts of interest that might relate to the material of this
presentation: NONE