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Lower Back Pain and Cancer

Lower Back Pain and Cancer

Lower back pain is a common health issue that may be linked to cancer in rare instances. If cancer is present, an individual will typically experience distinct symptoms in addition to back pain. 

Furthermore, back pain linked to cancer may be the result of a tumor located in surrounding regions such as the spine, lungs, breasts, gastrointestinal tract, prostate, or colon. Significant changes in weight, bowel or urinary function, or energy levels that accompany worsening lower back pain usually warrant an evaluation from healthcare professionals, including a physician and physical therapist who can offer pain management.

Symptoms That May Indicate the Presence of Cancer

At times, unexpected symptoms that arise along with lower back pain may be disregarded as minor issues that might resolve on their own. However, certain changes may be linked to cancer. 

Signs that suggest cancer include:  

  • Extreme fatigue of an unknown origin
  • Dramatic changes in urinary or bowel function (e.g., loss of bladder control)
  • Blood in the stool or urine
  • Rapid and unexplained weight loss
  • Numbness, tingling, or weakness in the arms or legs
  • Lower back pain that is mainly experienced early in the morning upon waking or at night 
  • Lower back pain that gradually improves during the day or completely goes away
  • Lower back pain that does not appear to be associated with movement and does not worsen with movement 
  • Lower back pain that does not resolve after a physical therapy regimen or other medical treatments

Any other type of unexplained symptoms that impede daily activities should be evaluated. In addition, lower back pain does not have to be extreme to indicate the presence of cancer, and the pain can range in severity.

Common Causes of Cancer-Related Lower Back Pain

Although lower back pain is a common issue among older adults, medical reviews indicate that about 6% of adults are generally diagnosed with cancer-related lower back pain. In regard to individuals with known cases of cancer, bone metastases are usually the most prevalent, with the most common area of cancer growth being the axial skeleton. 

Furthermore, bone metastases frequently cause cancer-related pain and spinal fractures. In addition to the high prevalence of lower back pain due to bone metastases, cancer of the lungs, breasts, prostate, and other organs are also associated with back pain.

Several types of cancerous tumors that may develop in or near the spine may cause lower back pain. The following cancers are most often associated with back pain:

Spinal tumor — A spinal tumor is a frequent cause of bone metastasis as it can spread throughout spinal bone or into the protective membranes that surround the spinal cord. The axial skeleton, which includes bones in the head, spinal column, ribs, and breastbone, is a common region of bone metastases as the cancer typically arises in one location and spreads to different areas.

Lung cancer — This form of cancer is another common type that may spread to the spine. A tumor that develops on one of the lungs can also begin to compress the spine. If this occurs, excess pressure may alter nerve transmission in the lower back and cause back pain. An individual who has lung cancer may experience symptoms such as constant fatigue throughout the day, shortness of breath, and coughing that may produce bloody mucus in addition to lower back pain.

Breast cancer — Breast cancer is a rare but potential cause of lower back pain. At later stages of the disease, the cancer may metastasize to the back and trigger lower back pain. Similar to lung cancer, breast cancer can lead to tumor infiltration of the spine that begins to place pressure on spinal nerves.

Cancer of the gastrointestinal tract — For some individuals, cancer that develops in the stomach, intestines, colon, or rectum may be associated with lower back pain. The pain typically radiates from the site where the cancer is located to the lower back. An individual who has these types of cancer may also experience blood in the stool or sudden weight loss.

Additional types of cancer such as thyroid, ovarian, kidney, prostate, and blood or tissue cancers (e.g., lymphoma, melanoma, myeloma) may also lead to lower back pain.

Cancer-Related Fatigue and Lower Back Pain

Cancer-related lower back pain is typically linked to various additional symptoms, but a particularly troubling issue is fatigue. Cancer-related fatigue, also known as cancer fatigue, is an extreme form of exhaustion that dramatically reduces a person's ability to carry out daily activities or enjoy life. 

Furthermore, this type of extreme fatigue does not improve by resting or getting a good night's sleep. Certain types of cancer treatments such as radiation therapy or chemotherapy can make cancer-related fatigue worse, as can the stress or depression that may arise due to the disease.  

Cancer fatigue is a distinct side effect of cancer and conventional cancer treatment methods. Some individuals describe cancer fatigue as paralyzing. It may arise suddenly and is not due to exertion or activity. This causes physical, mental, and emotional exhaustion for extended periods of time.

Some people experience acute cancer fatigue that lasts for a few weeks or chronic cancer-related fatigue that persists for months or even years. Both types can disrupt an individual’s quality of life and about 80-100% of people with cancer are affected by cancer-related fatigue.

The exact cause of cancer fatigue is unknown, but it appears to be linked to a combination of factors such as increased immune system activity and cancer treatment side effects. Common cancer treatment side effects that are known to cause extreme fatigue include: 

  • Inflammation
  • Cellular changes
  • Hormone fluctuations
  • Nausea and dehydration   
  • Damaged cells and tissue   
  • Reduced blood counts (anemia)   
  • Increased production of cytokines (pro-inflammatory proteins)    

Additional issues such as the occurrence of lower back pain due to cancer may also worsen fatigue. If cancer-related fatigue is suspected, a healthcare professional should be contacted to schedule an assessment.

Physical Therapy for Cancer-Related Lower Back Pain

For people with lower back pain who are diagnosed with cancer, physical therapy often becomes a beneficial pain management approach that accompanies cancer treatment. Cancer-related lower back pain poses unique challenges for physical therapists who strive to make optimal treatment decisions that can help improve the quality of life for people suffering from this type of health issue.

The following issues are unique to providing physical therapy for individuals with cancer-related lower back pain: 

  • The progression and potential recurrence of the disease is of utmost concern as this must be considered throughout the duration of physical therapy.
  • The potential need for frequent diagnostic imaging procedures such as magnetic resonance imaging to assess whether the progression of the disease is linked to the onset of new pain. 
  • Determining how often diagnostic imaging is required because in cases of recurrence, identifying the exact location or progression of a tumor or metastases can help physical therapists adjust treatment regimens.
  • Assessing whether weight-bearing therapeutic exercises need to be modified to lower the risk of fracture.
  • Determining whether an assistive device may be necessary to reduce stress on the lower back and affected lower extremities. 
  • Monitoring an individual’s emotional and psychological state it may impact rehabilitation outcomes.
  • Assessing mobility status, spinal precautions, and levels of resting pain, as certain techniques performed during a lumbar spine examination such as spinal motion palpation or range of motion assessment may need to be modified.
  • Monitoring signs of decreased mobility and function as the disease or cancer treatment may cause: excess fatigue, chemotherapy-related nerve damage (chemotherapy-induced peripheral neuropathy, CIPN), impaired balance, surgical scarring, deconditioning, treatment-related heart damage, and radiation fibrosis (tissue scarring).

Overall, physical therapists must plan treatment regimens based on each individual’s specific case, physiological status, and what each person believes is important or relevant to improve quality of life. 

Physical Therapy Treatment for Lower Back Pain Due to Cancer

For physical therapists who are working with individuals who have cancer, one of the most important rehabilitation interventions is patient education. More specifically, individuals receive education regarding spinal precautions that can help prevent further injury of structures in the spine and back. Physical therapists also provide education about ways to practice bed mobility, cardiovascular endurance, and careful movements during daily activities.  

Additionally, physical therapists conduct thorough examinations that help guide treatment management decisions. A carefully structured and well-monitored physical therapy regimen is a beneficial approach that targets body pain associated with cancer, including lower back pain. Therapeutic exercise is a frequently used intervention for adults with lower back pain and reports indicate that isometric core stability exercises are beneficial for people with cancer-related back pain.

In particular, this form of exercise helps target the side effects of radiation therapy, which is a common treatment for spinal metastases. Accordingly, a number of individuals undergoing radiation therapy who completed at least two weeks of isometric core exercises under the supervision of a physical therapist reported significantly less pain and pain reliever use. This is in contrast to individuals undergoing radiation therapy who performed respiratory exercises, as they reported little to no improvement in pain. 

These findings clearly demonstrate the benefits of performing carefully guided therapeutic exercises that are taught by a well-trained physical therapist. It also indicates that the longer an individual with cancer-related back pain works with a physical therapist, the more likely long-term health benefits will be experienced.

Physical therapists typically employ a wide array of therapeutic techniques such as neurodynamic and soft tissue mobilization during sessions to promote overall improvement. However, the primary goal of therapy is to reduce pain (e.g., lower back pain), lessen inflammation, improve mobility, increase range of motion, recover vertebral and muscle function, and target potential nerve damage. By focusing on a number of different factors, the therapeutic regimen can help enhance the quality of life.

Certain devices that provide support for the lower back and torso may also be recommended by a physical therapist. One such device is a support belt that can help reduce pain by stabilizing the lower region of the spine where nerve, tissue, or cell damage may be contributing to the back pain. The use of such a device may be also beneficial for an individual who has experienced or is susceptible to a fracture due to the location of the cancer (e.g., axial skeleton). 

Furthermore, the application of soft tissue mobilization during therapy along with the use of a support belt after the session is a beneficial approach for people suffering from cancerous tumors in the axial skeleton. Indeed, this approach has been shown to boost mood, reduce pain, and improve resting muscle tone. Similarly, neurodynamic mobilization techniques are effective at decreasing pain in individuals whose cancer has caused radicular (nerve root) symptoms such as tingling, numbness, and muscle weakness or pain in the lower back or extremities.

The key to experiencing noticeable improvement is working closely with healthcare professionals, including physical therapists, who can monitor the effects of the therapy as well as changes in an individual’s condition and modify the therapeutic treatment accordingly.

Summary

Lower back pain is a common problem for adults, particularly those who are older. However, a number of people experience lower back pain that has developed due to cancer in a certain organ or part of the body as opposed to cancer in the back. Furthermore, most people may initially assume that their lower back pain is related to other health issues such as a serious back injury (e.g., car accident, fall), improper lifting techniques, spinal disorders, or age-related changes in the spinal structure instead of cancer. This may delay medical consultation, diagnosis, and treatment.

An important point to remember is that symptoms such as unexplained fatigue, a dramatic change in bowel control, blood in the stool or urine, excessive night sweats, difficulty sleeping, and unexplained weight loss in addition to lower back pain may indicate the presence of cancer. These signs indicate that a serious underlying condition, including cancer, might be the cause of the back pain.

If an individual is diagnosed with cancer-related lower back pain, physical therapy is a beneficial approach to pain management that is often combined with cancer treatment. The physical therapists at FYZICAL provide specialized treatment plans and modifications that can help improve overall well-being for people with cancer-related lower back pain. Please contact us today for a consultation.