Cancer-Related Pain: Understanding and Relief

Cancer-Related Pain: Understanding and Relief

Pain that persists, preventing you from sleeping or enjoying time with loved ones during your cancer journey. If this is what you're experiencing, you are not alone. Between 55% and 70% of people with cancer live with pain at some point during their treatment.¹ It's normal to seek solutions, and that's why you're here.

Here's the good news: Cancer-related pain can be relieved. Studies show that physiotherapy improves the quality of life for the vast majority of oncology patients,² and effective options exist to help you regain comfort and independence. What science teaches us:

• Exercise is safe and beneficial: Contrary to popular belief, adapted physical activity helps even during active treatments like chemotherapy.³
• Pain has multiple causes: Tumor, treatments, muscle tension—each source responds to different approaches.
• A holistic approach works: Combining physiotherapy, education, and exercise yields better results than medication alone.⁴

In this guide, you will discover the types of oncological pain, available relief options, and how physiotherapy can help you at every stage of your journey.

What is cancer-related pain?

Cancer-related pain is discomfort caused directly by a tumor, metastases, or oncological treatments. It can be acute or chronic and significantly impacts the quality of life for people with cancer, affecting their sleep, work, and relationships.

A Common Reality

Oncological pain differs from "ordinary" pain due to its persistence, variable intensity, and profound impact on daily life. It affects approximately 55% of patients undergoing active treatment and persists in 40% of long-term survivors.¹ In advanced cancers, this figure can reach 70 to 90%.

Impact on Your Daily Life

Living with oncological pain affects several areas of your life:

• Disrupted Sleep: Nighttime pain prevents restorative rest
• Difficulty at Work: Reduced concentration, more frequent absences
• Social Isolation: Less energy for activities with loved ones
• Increased Fatigue: Chronic pain exhausts both body and mind
• Increased Anxiety: Uncertainty about pain causes stress

Rest assured: understanding your pain is the first step towards relief. To better target interventions, it's helpful to know the different types of cancer pain.

What are the different types of cancer pain?

Cancer pain is divided into three main types: nociceptive (tissue damage), neuropathic (nerve damage), and mixed (a combination of both). Identifying the type of pain helps in choosing the best relief strategies tailored to your situation.

Nociceptive pain

Nociceptive pain results from the activation of pain receptors (nociceptors) in the tissues. It is divided into two subtypes:

Somatic Pain: This pain originates from bones, muscles, joints, or skin. It is generally well-localized and described as dull, sharp, or throbbing. Common examples include bone metastases, post-surgical pain, and muscle tension. Visceral Pain: This pain originates from internal organs. It is often diffuse, difficult to pinpoint, and may be accompanied by nausea. A tumor compressing an organ is a typical example.

Good news: nociceptive pain generally responds well to anti-inflammatory medications and manual physiotherapy.

Neuropathic pain

Neuropathic pain results from damage or dysfunction of the nervous system. It presents characteristic sensations:

• Burning or fiery sensation
• Tingling or numbness
• Electric shock-like sensations
• Numbness
• Hypersensitivity to touch

Chemotherapy-induced peripheral neuropathy is a common example, typically affecting the hands and feet.

Mixed Pain

Mixed pain combines nociceptive and neuropathic elements. It is common in advanced cancers or when a tumor invades nerve structures. This complexity requires a multimodal approach combining several treatment strategies.

Understanding the origin of your pain helps in targeting the right interventions. Let's now look at the main causes of pain in cancer patients.

What are the causes of pain in cancer patients?

Cancer pain comes from three main sources: the tumor itself, which compresses tissues, medical treatments and their side effects, as well as the physical consequences of the disease, such as muscle deconditioning.

Tumor-Related Pain

The tumor can cause pain in several ways:

• Compression of Nerves or Organs: A growing tumor can put pressure on surrounding structures
• Bone Invasion: Bone metastases are a common cause of pain, especially in breast, prostate, and lung cancers
• Obstruction: A tumor can block digestive or urinary tracts
• Local Inflammation: The presence of the tumor triggers an inflammatory response

Treatment-Related Pain

Each type of treatment can lead to specific pains:

Chemotherapy:

• Peripheral neuropathy (hands, feet): affects 30 to 40% of patients depending on the protocols⁵
• Joint and Muscle Pain
• Mucositis (inflammation of the mouth and throat)

Radiotherapy:

• Fibrosis of irradiated tissues
• Joint stiffness in the treated area
• Local skin or muscle pain

Surgery:

• Acute post-operative pain
• Scars and tissue adhesions
• Post-mastectomy pain syndrome
• Lymphedema (swelling of a limb)

Immunotherapy and Hormone Therapy:

• Joint pain (common with aromatase inhibitors)
• Muscle fatigue

Pain related to the consequences of the disease

Cancer and its treatments often lead to changes that intensify pain:

• Physical deconditioning: Muscles weaken, creating tension and pain
• Pain-avoiding postures: Holding your body in a certain way to avoid pain can create new pain
• Anxiety and muscle tension: Chronic stress amplifies physical tension
• Fatigue that amplifies pain: When the body is exhausted, the perception of pain increases

Given these multiple causes, physiotherapy offers a tailored and personalized response. Let's discover how it can concretely help you.

How does physiotherapy help relieve cancer-related pain?

Physiotherapy relieves cancer-related pain through a combination of therapeutic exercises, manual techniques, and education. It improves mobility, reduces muscle tension, and helps patients regain confidence in their bodies during and after treatments.

A holistic approach to the individual

Cancer physiotherapy goes far beyond simply relieving pain. It aims to optimize your physical function and quality of life at every stage of your journey.

1. Personalized Assessment

Your physiotherapist begins by understanding your unique situation:

• Analysis of pain sources and their mechanisms
• Assessment of your mobility and strength
• Identification of your daily functional limitations
• Consideration of your treatment stage and current condition

2. Pain Relief

Several techniques can be used:

• Manual techniques tailored to your condition
• Scar tissue mobilization
• Releasing muscle tension
• Pain modulation through movement

3. Restoration of Function

The goal is to help you regain your abilities:

• Joint mobility exercises
• Progressive muscle strengthening
• Improved endurance
• Re-training for physical activity adapted to your goals

4. Education and Independence

Understanding your condition empowers you:

• Understanding pain mechanisms
• Daily self-management strategies
• Home exercise program
• Activity pacing techniques

What the research says

Scientific studies confirm the effectiveness of physiotherapy in oncology. A systematic review published in the National Institutes of Health archives shows that physiotherapy interventions significantly reduce pain, fatigue, and deconditioning while improving mobility and quality of life.²

Oncological rehabilitation is now recommended by major cancer organizations, both for preventing complications and treating side effects.⁶

Let's now look in detail at the specific techniques your physiotherapist can use to help you.

What physiotherapy techniques are used in oncological rehabilitation?

Oncological rehabilitation uses manual therapy, lymphatic drainage, therapeutic exercises, pain education, and fatigue management techniques. Each technique is adapted based on the type of cancer, treatment stage, and your specific needs.

Manual therapy

Manual therapy in oncology is adapted to your condition. It includes:

• Gentle joint mobilizations: For joints that have become stiff after surgery or radiation therapy
• Myofascial release: For accumulated muscle tension
• Scar work: To soften adhesions and prevent movement restrictions

Your physiotherapist always adjusts the pressure and techniques according to your tolerance and medical condition.

Manual lymphatic drainage

Lymphatic drainage is a gentle and specific technique used to treat lymphedema. It is part of a comprehensive approach called combined decongestive therapy, which also includes compression bandages and specific exercises.

This technique is especially important after surgeries that involve removing lymph nodes, such as in breast cancer.

Therapeutic exercise

Exercise has become a cornerstone of cancer care. Your physiotherapist will design a program tailored to:

• Your current physical condition
• Your type of cancer and treatment
• Your current side effects
• Your personal goals

Progress is always gradual and safe, with adjustments made according to your tolerance.

Exercise deserves special attention because it has become a central part of cancer care.

How can therapeutic exercise improve your quality of life?

Adapted therapeutic exercise reduces cancer-related fatigue, improves muscle strength, decreases anxiety, and speeds up recovery. Studies show it is safe even during active treatments like chemotherapy and radiation therapy.³

Proven Benefits of Exercise

Scientific research has documented many benefits:

• Reduced Fatigue: Regular exercise can reduce cancer-related fatigue by 25 to 30%⁷
• Improved Muscle Strength: Counteracts muscle loss caused by treatments
• Better Pain Control: Movement helps to modulate pain perception
• Reduced Anxiety and Depression: Positive effects on mental health
• Improved Sleep: Promotes more restorative rest

Exercise During Treatment: It's Possible

Contrary to what one might think, exercise is generally recommended even during active treatments. The American Physical Therapy Association and other organizations publish guidelines that confirm the safety and benefits of exercise in oncology.⁸

Some important principles:

• Adjust intensity daily: You won't have the same energy every day
• Progress gradually: Start gently and increase progressively
• Listen to your body: Respect your limits without unnecessary fear
• Work with a professional: A physiotherapist can guide you safely

Recommended Exercise Types

Aerobic exercises:

• Walking, stationary cycling, swimming, aqua fitness
• Goal: 150 minutes per week at moderate intensity
• Improve endurance and energy

Strengthening exercises:

• 2 to 3 sessions per week
• Work all major muscle groups
• Prevent muscle loss (sarcopenia)

Flexibility Exercises:

• Gentle daily stretches
• Adapted yoga or tai chi
• Maintain joint mobility

Important precautions

Certain situations require special precautions:

• Bone metastases: Low-impact exercises, avoid excessive loads
• Chemotherapy days: Reduce intensity or opt for gentle walking
• Fever or infection: Postpone exercise until recovery
• Severe thrombocytopenia: Avoid exercises with a risk of injury

Your physiotherapist will adapt your program based on these considerations.

A common concern after certain treatments is lymphedema. Let's see how to manage it effectively.

How to manage lymphedema and treatment after-effects?

Lymphedema is managed through manual lymphatic drainage, compression bandages, specific exercises, and compression garments. Early intervention by a trained physiotherapist prevents worsening and yields the best long-term results.

Understanding Lymphedema

Lymphedema is a buildup of lymphatic fluid that causes swelling, usually in an arm or leg. It occurs when the lymphatic system is damaged, often after:

• Removal of lymph nodes (lymph node dissection)
• Radiation therapy in an area containing lymph nodes
• Certain surgeries

Lymphedema can appear immediately after treatment or months, even years, later. Early detection and treatment are essential.

Complete decongestive therapy

Lymphedema treatment is generally carried out in two phases:

Phase 1: Intensive Reduction

• Manual lymphatic drainage: a gentle technique to help move fluid
• Multi-layer bandages: help maintain reduction between sessions
• Pumping exercises: promote lymphatic circulation
• Skin care: helps prevent infections

Phase 2: Long-Term Maintenance

• Custom compression garments
• Regular maintenance exercises
• Self-drainage techniques
• Ongoing monitoring

Other common after-effects and their management

Scars and Adhesions

After surgery, scars can become stiff and restrict movement. Physiotherapy can help through:

• Scar tissue mobilization
• Specific scar massage
• Mobility exercises to prevent restrictions

Axillary Web Syndrome

This common phenomenon after breast surgery appears as tight "cords" under the skin of the arm. Treatment involves:

• Specific stretches
• Gentle Manual Therapy
• Progressive mobility exercises

Peripheral neuropathy

Numbness and tingling in the hands and feet can persist after chemotherapy. Physiotherapy can provide:

• Balance exercises to compensate for loss of sensation
• Sensory stimulation
• Adapting daily activities

Knowing when to see a physiotherapist is essential for optimizing your recovery.

When should you consult a physiotherapist?

Consult a physiotherapist as soon as you receive a cancer diagnosis to prepare your body for treatments, during treatments to manage side effects, and afterward to optimize your recovery and return to normal activities.

Before treatments: prehabilitation

Prehabilitation involves preparing your body before surgery or other treatments. The benefits are well-documented:

• Assessment of your baseline physical condition
• Preventive Strengthening Program
• Better surgical outcomes⁹
• Faster recovery after the procedure

During Treatments

Physiotherapy during treatments helps you to:

• Manage side effects such as fatigue, pain, and stiffness
• Maintain your mobility and strength
• Prevent physical deconditioning
• Support your daily quality of life

After Treatments

Post-treatment rehabilitation aims to:

• Regain your optimal physical function
• Gradually return to your normal activities
• Manage long-term effects
• Prevent future problems

Signs that indicate you should consult

Consider consulting a physiotherapist if you experience:

• Persistent pain or pain that increases despite medication
• Swelling in an arm or leg (possible lymphedema)
• Difficulty moving a joint normally
• Fatigue that doesn't improve with rest
• Loss of balance or strength

Warning signs: consult your doctor immediately

Certain symptoms require urgent medical attention:

• Sudden and intense bone pain (risk of pathological fracture)
• Rapid loss of sensation or strength in a limb
• Pain accompanied by fever (risk of infection)
• Difficulty breathing
• Confusion or altered mental state

These situations are rare, but it is important to recognize them.

Understanding the treatment process will help you know what to expect.

How does oncological physiotherapy treatment work?

Treatment begins with a comprehensive assessment, followed by a personalized plan that includes in-clinic treatments and home exercises. Follow-up care is tailored to your progress and coordinated with your oncological medical team.

The Initial Assessment

During your first visit, your physiotherapist will take the time to fully understand your situation:

• Discussion about your medical journey and treatments
• Detailed assessment of your pain and function
• Mobility, strength, and balance tests
• Identifying your priority goals and needs

The treatment plan

Following the assessment, your physiotherapist will develop a tailored plan that includes:

• Realistic and measurable goals
• Recommended session frequency
• A home exercise program
• Necessary communication with your medical team

The Treatment Sessions

Each session is tailored to your condition on the day:

• Techniques selected based on your current needs
• Progression of exercises at your own pace
• Ongoing education on managing your condition
• Adjustments based on your tolerance and feedback

At Physioactif

Our physiotherapists are trained to support individuals living with cancer. Our approach is distinguished by:

• Training in oncological rehabilitation and pain science
• A comprehensive approach that considers all aspects of your condition
• Coordination with your oncology care team
• An environment tailored to your specific needs

To find one of our clinics in Greater Montreal, visit our pages:

• Physioactif Ahuntsic and Villeray
• Physioactif Blainville South and Rosemere
• Physioactif Chomedey
• Physioactif St-Eustache
• Physioactif Vaudreuil-Dorion

You probably still have questions. Here are the answers to the most frequently asked ones.

What are the most frequently asked questions about cancer-related pain?

Is massage safe for people with cancer?

Yes, adapted therapeutic massage is safe and beneficial for most oncology patients. Your physiotherapist will adjust the pressure and techniques based on your condition. Certain precautions apply in cases of bone metastases, risk of bleeding, or recently irradiated areas. The important thing is to consult a professional trained in oncology who can adapt their approach.

Can I exercise during chemotherapy?

Yes, moderate-intensity exercise is generally recommended even during chemotherapy. Studies show that it helps combat fatigue, maintain strength, and improve overall well-being. Adjust the intensity according to the day: you will likely have less energy on the day of treatment and the days following. Consult your medical team and work with a physiotherapist for personalized recommendations.

How long does pain last after cancer treatments?

The duration varies considerably depending on the type of treatment and the individual. Some pains, like post-surgical pain, disappear within a few weeks. Others, such as peripheral neuropathy or lymphedema, can persist for months or years. Physiotherapy can help reduce the intensity and better manage long-term pain, even when it becomes chronic.

Is physiotherapy covered by insurance in Quebec?

Most private insurance plans cover physiotherapy, with varying amounts depending on your contract. The CNESST covers care if your cancer is work-related (professional exposure), and the SAAQ covers care related to a road accident. Check your specific coverage with your insurer or employer.

How often should I see a physiotherapist?

The frequency depends on your condition and your goals. At the start of treatment or for an acute issue, 1 to 2 sessions per week are common. The frequency generally decreases as you progress and gain independence with your home exercise program. Your physiotherapist will adjust the frequency based on your progress.

What is oncology rehabilitation?

Oncology rehabilitation is a specialized approach that helps people with cancer optimize their physical function and quality of life. It includes physiotherapy, occupational therapy, nutrition, and other services tailored to the specific challenges of cancer and its treatments. The goal is to help you maintain or regain your independence and participate in activities that matter to you.

In summary

Cancer-related pain is common, but it is not inevitable. With the right support, you can find relief and significantly improve your quality of life.

What to Remember:

• Cancer pain can be relieved through several complementary approaches
• Physiotherapy offers effective and safe solutions at all stages of your journey
• Adapted exercise improves quality of life even during active treatments
• Early intervention yields the best results

You don't have to go through this alone. Physioactif physiotherapists are trained to support individuals living with cancer, using an approach based on pain science and paying special attention to your unique needs.

Make an appointment to discuss your situation with one of our physiotherapists.

References

1. van den Beuken-van Everdingen MH, et al. Update on Prevalence of Pain in Patients With Cancer. J Pain Symptom Manage. 2016;51(6):1070-1090. doi:10.1016/j.jpainsymman.2015.12.340

1. Stout NL, et al. A Systematic Review of Exercise Systematic Reviews in the Cancer Literature. PM R. 2017;9(9S2):S347-S384. doi:10.1016/j.pmrj.2017.07.074

1. Campbell KL, et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019;51(11):2375-2390. doi:10.1249/MSS.0000000000002116

1. Pergolizzi JV Jr, et al. Cancer Pain Management Guidelines. Pain Pract. 2021;21(1):61-86.

1. Staff NP, et al. Chemotherapy-induced peripheral neuropathy: A current review. Ann Neurol. 2017;81(6):772-781. doi:10.1002/ana.24951

1. Silver JK, Baima J. Cancer préhabilitation: an opportunity to decrease treatment-related morbidity. Am J Phys Med Rehabil. 2013;92(8):715-727. doi:10.1097/PHM.0b013e31829b4afe

1. Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2012;11(11):CD006145. doi:10.1002/14651858.CD006145.pub3

1. American Physical Therapy Association. Exercise for People With Cancer: A Clinical Practice Guideline. 2021.

1. Carli F, et al. Prehabilitation to enhance perioperative care for cancer surgery. Br J Surg. 2020;107(2):e68-e79.

1. Professional Order of Physiotherapy of Quebec (OPPQ). Cancer and Physiotherapy. 2023.

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