69 year-old patient with ER+ PR+ HER2+ breast cancer with skeletal metastases to the cervical, thoracic, and lumbar spine, ribs, pelvis, sacrum, and right femoral head.
A 69 year-old female with breast cancer metastatic to multiple skeletal sites presented with significant hip and low back pain, limited ROM, and gait impairment. She had previously undergone palliative radiation to the hip with minimal improvements. She was currently taking oxycodone and gabapentin for pain. The patient underwent a session of osteopathic manipulative treatment (OMT) including myofascial release and muscle energy. She reported immediate 30% improvement in pain and improved gait pattern. Her hip ROM improved in internal rotation, external rotation, and extension. Her posture improved with resolution of her previous anterior trunk lean. Although her pain medication utilization in the short term remained unchanged, her reported pain score improved by 60% at her subsequent treatment session.
This case demonstrates the potential use of OMT to treat chronic severe pain in cancer patients with osseous metastasis. The pain experienced by cancer patients has the potential to negatively impact mobility, function, emotions, and quality of life. It is imperative to optimize the treatment of cancer pain within a comprehensive and integrated care plan. Caring for patients with bone metastasis presents several clinical challenges including increased fracture risk, disease progression and decreased quality of life. Additionally, traditional treatments may be only partially effective. In this case OMT involving myofascial release and muscle energy was an efficacious adjuvant treatment.
Osteopathic manipulation involving myofascial release and muscle energy may be a safe and effective treatment modality for pain in cancer patients with osseous metastasis. OMT can be a valuable adjunct in the treatment plan to improve pain control and maximize function and quality of life. However, more research regarding treatment protocols and patient selection is needed.
Marla Petriello– Resident Physician, Georgetown University/ MedStar National Rehabilitation Hospital
Cristina Kline-Quiroz– Cancer Rehabilitation Fellow, MedStar Georgetown University Hospital / National Rehabilitation Hospital
Patrick Martone– Cancer Rehabilitation Medicine, MedStar National Rehabilitation Hospital