Progressive Activity-Based Rehabilitation in Veteran Cancer Survivors with Chronic Pain

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Veterans are at a higher risk for lung cancer and so early detection, treatment, and symptom management are critical. Treatment for lung cancer in those with early stage local disease includes surgery and chemotherapy. However, persistent or chronic neuropathic pain, either post-thoracotomy persistent pain (PTPP) or chemotherapy-induced peripheral neuropathy (CIPN) occurs in a majority of patients. Thus, not only is this neuropathic pain widespread; there is no way to prevent its development, and long-term use of opioids for control of symptoms could result in addiction. Ultimately, PTPP and CIPN can lead to long-term suffering and disability during the post-treatment phase. Exercise, a non-pharmacologic intervention, holds promise as a new modality for reducing treatment- related neuropathic pain and functional decline resulting from PTPP and CIPN. There is very limited research examining the effects of exercise rehabilitation in those who have undergone lung resection for non-small cell lung cancer (NSCLC), which represents about 85% of lung cancer cases. Engaging cancer survivors with chronic post-surgical or post-chemotherapy neuropathic pain in this SPiRE meets a unique VA SPiRE directive and serves an understudied population. [We hypothesize that lung cancer survivors with chronic pain have reduced fitness and strength, poor muscle quality, and high levels of fatigue. Our global hypothesis is that activity rehabilitation will reduce pain symptoms; which will be associated with improved fitness, functional mobility, and reduced fatigue in lung cancer survivors with chronic pain compared to a delayed entry control period. Twenty-seven Veterans with a NSCLC history and either PTPP or CIPN will be enrolled in a 6-week delayed entry control period + 6-week VA Maryland Health Care System (VAMHCS) supervised exercise rehabilitation program.] Specific Aims: [1) To determine the feasibility of conducting an exercise rehabilitation intervention in Veterans with NSCLC and PTPP or CIPN. 2) To determine the effects of a VAMHCS-supervised activity rehabilitation program on chronic pain and sensory thresholds (thermal, static, and dynamic) compared to delayed control. 3) To assess changes in fitness, strength, physical function, fatigue, and quality of life (QoL) after activity- based rehabilitation compared to control period.] This is the first project of its kind and the potential impact of this research is large, because exercise training will be a prescription and the first approach for which NSCLC survivors can self-manage chronic neuropathic pain. The ultimate goal of our work is to reduce neuropathic pain for the growing population of cancer survivors while simultaneously reducing the need for problematic pharmacologic management. Therefore, results of this study have potential for high impact on symptom care because it will allow effective neuropathic pain treatment to be in full control of the Veteran, and likely restore function that is lost during the chronic pain experience.