Dealing with pain after cancer treatment

Nearly 48,000 Kenyans get cancer every year, many of whom are currently being treated and struggling to make sense of how to live with the side-effects of treatment. However, people with cancer can maintain and restore their physical and emotional well-being through cancer rehabilitation.

What is the goal of cancer rehabilitation?

It prevents or limits impairment. Pre-surgery or post-surgery rehabilitation plays a vital role in managing the physical, social, emotional capabilities of an individual.

Cancer rehabilitation comprises several therapies including speech and language, physical, occupational, and lymphedema, which is the swelling of arms or legs after surgery.

It also involves dealing with patients who problems with memory loss or paying attention or learning.

The role of specialists is to assist improve the body function and quality of life, and to ensure an individual does not get irreversible side-effects.

Absolute cure of lymphedema has not been proven. However, one can minimise the swelling and pain, depending on the stage. Mild cases can be reversible.

When one is healthy, the body manages the lymphatic load which consists proteins, water, cells, and fat. However, when the lymph nodes are damaged by radiation or removed surgically, the body’s capacity to process the extra volume of the fluid is diminished. If one seeks rehabilitation immediately, the lymphedema can be cured.

How early should one start lymphedema rehabilitation?

Seek treatment at the first signs because early diagnosis and treatment improves the condition.

What is the best treatment for lymphedema?

There is no one best way of treating lymphedema but there is a combination of management therapies.

These include different exercises, use of compression garments, complete decongestive therapy, and education on how to minimise the impact of lymphedema.

Can I go for a normal massage to help ease the swelling?

A person with lymphedema requires a specific therapy that is done by certified lymphatic drainage masseur or therapist. Lymphatic massage is done with minimal pressure to only reach the capillaries in the dermis or true skin to drain the fluid. While normal massage is done with pressure to reach the deep tissue.

After breast surgery, I feel like there is a cord around my armpit. What is it?

The cord-like structure is due to scarring, tissue injury, or removal of lymph nodes. This condition is called axillary web syndrome. It can be painful, cause neck or shoulder stiffness, and an abnormal sensation in the arms.

Exercises that involve moving the arms, neck, and shoulder, pain-relief modalities like the use of laser, shock-wave therapy, heat therapy, and professional kneading and manipulating the shoulder muscles will help to reduce the pain and stiffness.

Why do I feel tingling and numbness in my body after ovarian cancer treatment?

These are symptoms of neuropathy, which is a dysfunction of nerves. Cancer treatment can alter the normal activity of the nervous system, causing neurotoxicity. Bone marrow problems and neurotoxicity are major side effects of chemotherapy. Drugs such as Cisplatin, Carboplatin, Altretamine, and Paclitaxel cause significant neurotoxicity. Neuropathy can also develop due to invasion of the tumour or compression of the nerve tissues. Many people also feel weak, dizzy, experience balance problems, and constipation due to neuropathies. These effects can be minimised with medication, taking care of the skin, and other therapies.

A doctor has suggested wearing compression stockings, are there any specific types?

Compression stockings come in different levels of compression, which refer to the amount of pressure (measured in millimetres of mercury, or mmHg) applied to the leg.

The higher the number, the greater the compression. Compression stockings also differ for day and night and it should be graduating to impact the compression regularly for medical purposes. Mild or very light compression (under 15 mmHg) is for healthy people, such as pregnant women who have tired legs from sitting or standing. Moderate compression (15 to 20 mmHg) can prevent deep vein thrombosis in airline passengers or help with minor leg swelling. Higher compression levels (20 to 30 mmHg, 30 to 40 mmHg, or more than 40 mmHg), are sometimes referred to as medical grade.

Mostly, Class 2 stockings are prescribed which is give 23-32 mm of hg compression and can be used for lymphedema.

Why do most cancer patients lose their hair?

Hair, skin, bone marrow, digestive tissue lining normally divide constantly. Chemotherapy and radiotherapy compromise these processes. Cancerous cells also lose this ability and grow predominantly to form extra cell growth.

What is the best management for cancer pain?

Pain after cancer could be from different sources. Post-surgery stiffness, tissue damage, fatigue, neuropathies, lymphatic tissue issues, chemo/radiotherapy related, phantom pain, or general malaise. Pain management strategies depend on the causes. Stretching exercises, joint mobility exercises, lymphatic massage, specialised kinetic chair improvement exercises can help to regain functional capabilities. Laser, shockwave and compression therapies also help to reduce pain. Many patients also need drugs or surgery to ease the pain.

Why do I feel itchy at the site of surgery? The breast was cut off but I feel like it’s still there and some heaviness?

This described as phantom pain or phantom breast syndrome. After mastectomy, the brain continues to send signals to nerves in the breast area even though the breast is no longer there. Cognitional functional education helps to change and adapt the perception of the phantom breast.

Mr Bhavsar is a physical therapist at MP Shah Hospital who has specialised in cancer, neuro, stroke, and pain rehabilitation.

What kind of exercise is best for me as a cancer survivor?

Exercises minimise cancer-related effects and improve quality of life. Do a combination of flexibility, mobility, strength, endurance, and circulation exercises. According to the American Cancer Society guidelines, adults should engage in 150 to 300 minutes of moderate‐intensity physical activity per week, or 75 to 150 minutes of vigorous‐intensity physical activity. Let your therapist guide you on how to start with.