On April 7, we hosted the first webinar in our 2021 Virtual Chordoma Community Conference (CCC) Series, entitled Options for comprehensive pain management. We know from your responses to our Chordoma Survivorship Survey that most chordoma patients and survivors experience pain at some point along their journey with the disease and, for many, that pain can be chronic or long-lasting. But you don’t have to accept pain as a normal part of having chordoma. Pain can be managed, and it is your right to get treatment for it.
Throughout this 60-minute webinar, pain management experts Maryam Jowza, MD, of the University of North Carolina, Sasha Knowlton, MD, of Massachusetts General Hospital and Harvard Medical School, and Staci Martin, PhD, of the National Cancer Institute, taught participants how to identify the type of pain they might be experiencing, understand the options for how to manage it, and find help to deal with it. During the final 20 minutes, the panelists answered live questions from the webinar participants.
Understanding different types of pain – Maryam Jowza, MD
There are two main types of pain — nociceptive and neuropathic. Nociceptive pain is caused by tissue injury, damage, or inflammation (for example, a stubbed toe or a cut finger) and will typically resolve when the injury heals. Neuropathic pain is caused by disease or damage to nerve tissue. It is sensitive to the touch and often lingers after the initial injury resolves.
Chronic pain, Dr. Jowza pointed out, is often a combination of nociceptive and neuropathic pain, and the best outcomes result from a multi-pronged approach to treatment. This usually means combining medications and procedures with physical medicine and rehabilitation, behavioral therapy, complementary treatments, and family support.
The first step in this process is getting a pain assessment from your doctor or specialist. Based on that assessment, Dr. Jowza explained, your doctor can help create a pain plan that works for you. Though there are no medications approved specifically for chronic, neuropathic pain, she outlined several medications approved for other conditions that are often used effectively for neuropathic pain, including anti-seizure medications, antidepressants, muscle relaxants, and prescription pain medications.
Physical medicine and rehabilitation – Sasha Knowlton, MD
Dr. Knowlton explained the role of a physiatrist in supporting patients’ pain management journey and explained how cancer rehabilitation (“rehab”) can help address pain, weakness, and sensation changes in a holistic way.
Physiatry is a specialty practiced by physicians who treat individuals with musculoskeletal conditions. It focuses on helping those individuals manage pain after an injury, disease, or surgery by applying broad medical expertise and multi-modal care to improve function and quality of life. Physiatrists, Dr. Knowlton explained, can serve as the “quarterback” of a pain management team, integrating physical medicine and rehabilitation into a pain management regimen that may also include traditional medication and complementary techniques for dealing with pain.
Dr. Knowlton went on to describe the differences between pain, weakness, sensation changes, and spasticity, and how understanding and addressing them early on can prevent more serious, long term effects such as wound healing issues, skin breakdown, and bone fractures.
Complementary techniques for dealing with pain – Staci Martin, PhD
Dr. Martin offered insights into approaches to pain management that complement medical intervention such as physical activity, Cognitive Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT). She explained how physical activity (e.g., yoga, tai chi, walking), performed at any level, can help improve ongoing headaches, back pain, and sleep issues. She also outlined the goals of CBT and ACT, describing how techniques such as progressive muscle relaxation, biofeedback, mindfulness, and goal setting can be integrated with traditional medical and surgical interventions to reduce pain and improve quality of life.
Thank you to everyone who joined us for this informative webinar and submitted questions to the panelists. If you have questions about chordoma, please contact our Patient Navigators. We are here to help!