Kingsbrook Jewish Medical Center

Centers of Excellence

STAR Program® Survivor Education

When to Worry About Pain

Anytime you have pain it can cause you to worry. When you are dealing with a cancer diagnosis and treatment, you may feel that it is even harder to determine what is expected pain and discomfort and what is not. Below are some “rules” about when you should worry about pain.

Two-Week Rule

Your doctor should check any pain that lasts for more than two weeks. Often pain that lasts for two weeks is muscular or skeletal, and not a serious threat to your health. Many doctors use the “two-week rule” because musculoskeletal pain will often resolve within a two-week period. Also, a two-week delay in diagnosis is very unlikely to change someone’s prognosis, even if the pain is due to cancer. Though the two-week rule applies to most pain, sometimes you should ignore this rule and seek treatment sooner (see Rules 2, 3 and 4).

Acute Trauma Rule

A doctor should immediately check all pain associated with acute trauma, such as a car accident or a fall from a ladder. Usually people aren't overly worried about cancer if they have trauma that results in immediate or even slightly delayed pain. However, the pain, treatment and recovery associated with that trauma could affect your cancer prognosis, treatment and time to recovery.

Worst Pain of My Life Rule

Any severe pain that doesn't allow you to move about normally should be checked sooner rather than later. Often this type of pain is not cancer but may be the result of something serious such as a heart attack, appendicitis or ruptured blood vessel (aneurysm).

I Can’t Sleep Rule

Talk to your doctor about any pain that keeps you awake at night. Sometimes night pain is more serious than pain that occurs during the day with normal activities. However, keep in mind that musculoskeletal pain often bothers people at night. Hip bursitis or shoulder tendinitis often keeps people awake if they lie on the affected side. If you have cancer, don't take any chances-report your symptoms to your doctor.

Radiation-Induced Brachial Plexopathy

Radiation-Induced Brachial Plexopathy (RIBP) may affect the shoulder, arm and hand. Symptoms can include pain, numbness, tingling and weakness. Sometimes it is associated with lymphedema. RIBP is caused by radiation treatment and often presents years after treatment. Although there is no cure for RIBP, rehabilitation measures can help people to function better by reducing discomfort and disability.

Questions to Ask Your Doctor

  1. Do I need any further testing?
  2. Will cancer rehabilitation help me feel better and/or recover faster?
  3. Are there any medications or other treatments that you recommend?

How to Protect Your Arm

Maintain your upper extremity range of motion as much as possible.

RIBP can result in limited motion and even development of contractures in your arm (often referred to as a “frozen shoulder”). When this happens, it becomes more difficult to use your arm for normal activities. Your doctor or physical/occupational therapist can give you specific range of motion (ROM) exercises to help maintain or improve the motion at the joints that have limitations.

Avoid activities that increase pain, especially if the pain last more than a few minutes.

During your daily activities, you will probably find that some things cause pain more than others. If possible, try and avoid activities that cause pain, particularly if the pain lasts more than a few minutes. This is also true of any exercises that you do. When you stretch, you may feel some uncomfortable pulling or tightness, which is normal. But the discomfort should stop within a few minutes of completing the exercises. If you have an increase in pain that lasts for a long time (more than 20 minutes) after completing your exercises, let your healthcare team know. Sometimes a physical or occupational therapist will recommend using modalities, such as heat (e.g., a “hot pack”) and/or cold (e.g., an “ice pack”) in conjunction with your ROM exercise program. When used properly, these can help promote stretching, as well as reduce pain and inflammation.

Improve your sleep.

RIBP may be keeping you awake at night. If so, ask your doctor about the possibility of medications to reduce pain and promote a good night’s rest. Sometimes sleeping positions may help. Keeping your shoulder and arm in a good position at night is important to protect your shoulder and to decrease pain. It can also help to reduce swelling. Supporting your arm on pillows is one option. If you sleep on your back, try supporting your arm with a pillow placed across your abdomen. If you sleep on your side, you can “hug” a pillow between your arms.

Reduce the stress on your arm at home.

There are many ways to make things easier around the house and for leisure activities. Here are some examples:

  • Use tools that are easy to hold. Large, non-slip handles will be easier to use (e.g., large-handled knives; large handled utensils and cooking equipment, etc.)
  • Substitute electric appliances for manual ones whenever possible. For example, an electric rather than manual can opener.
  • Try non-skid liners/mats on counters and tables to steady plates or bowls when cooking or eating. These can also aide you in opening jars.
  • Use voice-activated software for computer use or a one-handed key pad.
  • Explore voice activated “smart phones” for making calls, and using the Internet. Use a hands-free device as well.
  • Avoid holding heavy books and instead try an electronic book reader or use a book stand/holder.
  • Purchase smaller grocery and household items in order to avoid having to use both hands to carry things.
  • Use assistive devices such as zipper pulls, dressing sticks, and button hooks which can make dressing easier.
  • Velcro straps and elastic laces help make putting on and taking shoes off easier.
  • Use of Velcro® Style Button Aids or magnetic buttons can make fastening clothes easier
  • Try a blow dryer stand, so you don’t have to hold your blow dryer.

What to Do After a New Cancer Diagnosis

A cancer diagnosis can be overwhelming news to anyone, but cancer survivors shouldn’t feel alone or helpless. Our focus is on patient-centered care which means that we want survivors (our patients) to be partners with us in their care. We want to empower newly diagnosed cancer survivors by encouraging them to become an active participant in their treatment and recovery. Below are some suggestions that may help you or someone you care about do just that.

Ten Things You Can Do Right Now

  • Find doctors that you trust and reach out to them and other members of your healthcare team for medical advice.
  • Reach out to friends for emotional support, not medical advice.
  • Ask your healthcare team about cancer rehabilitation so that, as you go through treatment and afterward, you have access to the medical support you need to feel as well as possible.
  • Keep a written log of every phone call and appointment-include the names and contact information of everyone you speak to.
  • Gather your medical information including laboratory, imaging, and biopsy reports. Also get copies of the actual films and pathology slides to bring to your initial appointments with oncologists.
  • Cut back on alcohol. If you can eliminate alcohol, that’s best.
  • Exercise. Get a pedometer and try to take at least 10,000 steps each day.
  • Sleep as well as possible. If you can’t sleep, talk to your doctor.
  • Read excerpts from What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope(published by the American Cancer Society and available in your hospital’s patient resource library, your local community library, bookstores or

Remember that there are more than 13 million cancer survivors in the United States, and the vast majority of them were not diagnosed at the earliest possible stage. There are excellent cancer treatments available and many reasons to maintain hope.

Can Cancer Rehabilitation Help Me?

Cancer and cancer treatments sometimes cause problems. They can cause you pain, make you feel tired and keep you from doing the things that you need or want to do. Cancer rehabilitation can help. Our goal is to reduce these troubling effects and help you have the best quality of life possible. Below are the answers to some frequently asked questions that will help you learn more about cancer rehabilitation and how it might help you cope with your cancer and/or cancer treatment(s).

1. What is cancer rehabilitation?

Cancer rehabilitation is much like other forms of rehabilitation that happen after a serious illness or injury such as a stroke or car accident. Medical services may include appointments with and treatments recommended by medical professionals, including physiatrists (doctors who specialize in rehabilitation medicine); nurses; physical, occupational and/or speech therapists; and mental health professionals.

2. What types of problems can be treated with cancer rehabilitation?

Rehabilitation professionals can help you cope with a wide variety of cancer and/or treatment-related conditions and their symptoms. These might include, but are not limited to, pain, weakness, tiredness (fatigue), shoulder problems, balance and walking (gait) problems, memory and concentration issues, swallowing and speech problems, swelling (lymphedema) as well as anxiety and/or depression.

3. How will I know if cancer rehabilitation can help me?

If you have any problems that you didn’t have before your diagnosis, especially if they interfere with your ability to do the things that you need or want to do, cancer rehabilitation can likely help you.

4. Will my insurance cover cancer rehabilitation?

If the cancer rehabilitation care is provided by professionals with healthcare degrees and licenses in rehabilitation medicine then medical insurance should cover some or all of the costs. These covered items usually include appointments with and treatments recommended by physiatrists, physical therapists, occupational therapists and even speech therapists. Other services that your insurance will usually cover, at least in part, include those provided by nurses and mental health professionals. As with all insurance issues, check with your carrier about deductibles, co-pays and limits.

5. What is special about this cancer rehabilitation program?

This program is part of the STAR Program network of certified cancer rehabilitation programs. STAR Program Certified is a nationally recognized cancer survivorship accreditation that means that the program is focused on improving the lives of survivors who suffer from the side-effects caused by cancer and its treatments. Certified STAR Programs offer coordinated cancer rehabilitation care that is supported by a team of specially trained medical professionals. As a STAR Program patient, you will receive complete and individualized cancer rehabilitation treatment that has been designed to improve the issues affecting your daily life.

6. How can I receive more information about Kingsbrook Rehabilitation Institute STAR Program?

For appointments and/or additional information, call Kingsbrook Rehabilitation Institute at 718-604-5341. A provider referral is usually needed before therapies can begin.

Chemotherapy-Induced Peripheral Neuropathy

Patient Information

Chemotherapy-induced peripheral neuropathy (CIPN) is a side-effect of some chemotherapy drugs. However, the precise mechanism of injury to the nerves remains unclear. Often, the symptoms of CIPN will improve over time, especially if the chemotherapy was given fairly recently and has now been discontinued.

Typical symptoms of CIPN may include pain, numbness, tingling, weakness and/or clumsiness. The symptoms may be present in the feet and/or the hands. When present in both, its presence is often described as a “stocking-glove distribution". A more detailed description of the symptoms of CIPN includes:

  • Discomfort or pain
  • Pins & needles or tingling
  • Sensitivity to light touch or pressure
  • Numbness or decreased sensation
  • Balance problems
  • Weakness in the hands and/or feet
  • Difficulty with fine motor skills (e.g., buttoning a shirt, typing, etc.)

Nerve injuries may take up to two years to heal after chemotherapeutic treatment has been discontinued. Even if CIPN symptoms have been present for more than 1-2 years, there are quite a few things that can be done to reduce your discomfort and/or disability.

Questions to Ask Your Doctor

  1. Do I need any further testing?
  2. Are there any medications or treatments that you recommend?

Your Feet: Reducing Discomfort and Improving Function

The following guidelines may help you reduce the discomfort that you feel in your feet and improve your overall function:

  • To prevent injuries, avoid going barefoot.
  • Try using “rocker-bottom” shoe soles and/or soft shoe inserts (orthotics). These footwear modifications can help reduce pressure on your feet. Most shoes (except high heels and some sandals) can be taken to a shoe repair shop to have rocker bottom soles installed. There are also several commercially available rocker bottom sole shoes. Ask at your local shoe store or search for them online. Be sure to try a gentle rocker slope at first so that the shoes do not pitch you to far forward.

Postmastectomy pain syndrome

Postmastectomy pain syndrome (PMPS) is chronic pain that occurs following surgery to the breast, such as a lumpectomy, mastectomy, axillary lymph node dissection, breast reconstruction, and/or breast augmentation. There are many causes of PMPS, including phantom breast pain, pain from neuromas, incisional pain, and neuralgia (pain along the course of a nerve). The goal when treating PMPS is to decrease discomfort and disability.

Questions to Ask Your Doctor

  1. Do I need any further testing?
  2. Will cancer rehabilitation help me feel better and/or recover faster?
  3. Are there any medications or other treatments that you recommend?

Rehabilitation Interventions that May Help


Once your incision has healed, gently massage the scar area. You should massage 3-5 times per day. Your doctor or your physical or occupational therapist may recommend a cream to soften the skin and promote healing. The goal is to soften the adhesions that can cause the incision to “stick” to the underlying tissues. These adhesions may cause restrictions and pain with movement. Be careful not to rub too vigorously-you do not want to injure the healing area.


Lightly rub the areas that are sensitive (this may be at the incision, or other areas in the chest or arm) with a soft fabric or cotton or gentle massager 3 to 5 times per day. Rub for as long as you can tolerate it, with the goal to increase the time you rub by 10-15 seconds each session. Don’t be discouraged if you are not always able to increase the time. This is normal. The key is to keep trying and to gently rub several times per day.

Range of Motion

PMPS can result in limited shoulder motion. When this happens, it becomes more difficult to use your arm for normal activities. Your doctor or physical/occupational therapist can give you specific range of motion (ROM) exercises to help improve movement at the joints that have limitations. It is important that you follow the guidelines for doing these exercises. You do not want to do too little or too much. You may feel some uncomfortable pulling or tightness as you do your exercises, which is normal. But the discomfort should stop within a few minutes of completing the exercises. If you have an increase in pain that lasts for a long time (more than 20 minutes) after completing your exercises, let your doctor or therapist know right away. You may be instructed to use heat and/or cold in conjunction with your ROM exercise program.