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• Researchers say people with cancer who exercised regularly reported lower levels of pain.
• The findings are similar to research showing an association between exercise and pain mitigation among non cancer patients.
• Experts say that exercise should be used alongside medication to treat pain.

Engaging in intense exercise might not be the first thing that people fighting cancer think to do, but a new study reports that a workout can help ease cancer-related pain.

“It may feel counterintuitive to some, but physical activity is an effective, non-pharmacologic option for reducing many types of pain,” said Dr. Erika Rees-Punia, a study senior author and the American Cancer Society’s senior principal scientist for epidemiology and behavioral research, in a press statement. “As our study suggests, this may include pain associated with cancer and its treatments.”

In the study published in the journal Cancer, Rees-Punia and Dr. Christopher T.V. Swain, first study author and a fellow at the University of Melbourne in Australia, looked at 10,651 adults with a past cancer diagnosis and 51,439 adults without a history of cancer.

Participants were asked to rate their average pain level from 0 to 10, with 0 being no pain and 10 being the worst pain imaginable. They also were queried about their engagement in exercise.

The researchers reported that more physical activity was associated with lower pain intensity, whether or not individuals had a history of cancer.

Among those with a past cancer diagnosis, those exceeding the physical activity guidelines established by the U.S. government — getting 150 to 300 minutes a week of moderate-intensity exercise, or 75 to 150 minutes per week of vigorous-intensity aerobic physical activity — were 16% less likely to report moderate-to-severe pain compared to those who exercised less.

Less pain also was reported by those who were consistently active or became active as older adults compared to those who remained inactive, the researchers said.

“Cancer pain can be debilitating and most patients in palliative care, often require opioid-based pain medications like morphine just to get by,” Dr. Ryan Peterson, a pain medicine specialist and anesthesiologist at NuView Treatment Center, a Los Angeles-based addiction treatment program, told Medical News Today.

“While pharmacological interventions are good, I recommend non-pharmacologic therapies such as gradual exercise as tolerable when possible so as to prevent muscle atrophy and further pain. Exercise is also known to aid in the release of endorphins, which may be helpful in pain alleviation and tolerance,” said Peterson, who was not involved in the study.

Making exercise part of a cancer treatment plan

Dr. Jessica Cheng, a physiatrist at City of Hope Orange County in California who specializes in prehabilitation and rehabilitation told Medical News Today it is “important to maintain as much physical activity as possible before, throughout, and after the cancer journey.”

“There are many benefits of exercising for cancer patients including lowering depression, anxiety, [and] fatigue and the potential to improve survival rates in certain cancers,” she added.

“When starting exercise, discussion with the treating oncologist and an evaluation by a cancer rehabilitation specialist are encouraged,” said Cheng, who was not involved in the study. “Every individual has their own individual medical situation, abilities and preferences, and I always emphasize the importance of patients doing activities they find enjoyable. Shadow boxing, walking, swimming, dancing, cycling, and modified wheelchair Zumba are all great options.”

Despite the study’s correlation between pain reduction and vigorous exercise, healthcare professionals must walk a fine line when advising cancer patients about exercise, experts said.

“I always emphasize balance to my patients. There are times to rest and times to encourage physical activity,” said Cheng.

“Exhaustion from physical exertion can impact your body’s ability to fight malignancies because the body, when subjected to physical stress, reacts via inflammation, and this might be too much to handle for cancer patients whose normal physiologic adaptive responses are already blunted or compromised,” added Peterson.

“Low-impact exercises may be ideal for patients with cancer,” he noted. “These include light walks, yoga, swimming, or meditation through movement. Certain types of cancer affect bone density and increase the risk of falls and fractures, so it would be prudent for cancer patients to partake in monitored, low-impact exercises for their safety and well-being. Even light ambulation at the very least can aid in improving mobility.”

However, Dr. Jennifer Beebe-Dimmer, an epidemiologist at Wayne State University’s Barbara Ann Karmanos Cancer Institute in Michigan and principal investigator of the CAPABLE (Cross Training and Physical Activity: A Better Life Experience) study, told Medical News Today that “there is more and more evidence to suggest that higher intensity interval workouts combined with strength training is a great method to improve all sorts of short- and long-term [cancer] outcomes.”

“But some exercise is better than nothing at all,” said Beebe-Dimmer, who was not involved in the study. “Whatever form of exercise patients can tolerate, I suggest they stick with it.”

Exercise should be prescribed alongside pain-reducing medications for people with cancer, not in place of them, experts agreed.

“Broadly speaking, pain management benefits the patient the most when offered as part of an integrated approach to cancer care,” said Cheng.

“When it comes to pain management, the standard of care should be offered to cancer patients and that remains to be the pharmacological approach such as prescribing regulated morphine or other opioid-based medications,” Peterson said. “However, we can still offer non-pharmacological therapies such as low-impact exercises.”

Cancer creates a different kind of pain

Cancer pain can be different than other types of pain, Peterson said.

“Pain from cancer is on a different tier as we pain medicine specialists would call it,” he said. “Usually, pain from cancer, regardless of the type of malignancy, can be described as an unpleasant sensory experience due to systemic tissue damage as a consequence of cancer’s effects on the body. Aside from the cancer itself, pain can also come from the treatment and therapeutics that the patient is subjected to. Over 20 to 50 percent of cancer patients experience pain and the majority of it can be attributed to surgical and non-surgical therapies that they undergo.”

Some of the pain-reducing effect of exercise reported in the study could be the result of increased pain tolerance, according to Peterson.

“You usually adapt to certain pain levels over time, especially if you exercise, as muscle growth can allow you to perform better activities thus leading to less strain and pain,” he said. “Cancer patients have limited mobility at times, and so, it is probable that their [baseline] pain tolerance is low.”

Future research should focus on “the ideal levels of intensity and frequency of the exercises for alleviating pain and cancer and the type of low-impact exercises such as yoga and swimming, and if it can be a good adjunct in pain alleviation among oncologic patients receiving strong pain medication,” said Peterson.