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Pain is the most common and upsetting symptom observed in oncology practice. Pain has a significant effect on the quality of life of cancer patients, their view of the effectiveness of treatment, disease progression, and survival (Bhatnagar & Gupta, 2015). According to Bhatnagar and Gupta (2015), stubborn cancer pain that does not respond to analgesics endorsed by the World Health Organization (WHO) distresses 10 to 15% of cancer patients experiencing pain. Therefore, this kind of pain calls for the use of additional pain relieving measures apart from the conventional analgesics to enhance patient comfort. The PICOT question is In cancer patients who are experiencing pain, does the use of complementary and alternative medicine compare to conventional medicine for better pain control? This paper reviews the available literature to answer the practice problem of pain management in cancer patients.
Findings
Various studies have been conducted to determine the most effective pain management strategies for cancer patients (Caraceni, Pigni, & Brunelli, 2011; Running & Turnbeaugh, 2011; Bhatnagar & Gupta, 2015; Naga, 2015; Singh & Chaturvedi, 2015). As a result, clinical practice guidelines have been developed to guide clinicians towards effective pain management endeavors for their patients. For example, Bhatnagar and Gupta (2015) summarized interventional pain management techniques in oncology pain. Pain management strategies for the alleviation of severe, intractable pain can be grouped into two categories of neuroablative and neuromodulation methods. Different neurolytic methods such as chemical, thermal, or surgical neurolysis can be used in the ablation of distinct nerve fibers or intrathecalneurolysis in patients with resilient pain and short life-expectancy.
The most common neuromodulation approach entails the neuraxial administration of medications in addition to spinal cord stimulation to change pain awareness. However, the intensity of cancer pain has called for the introduction of complementary and alternative pain-relieving measures before the commencement of conventional opioid therapy. These options can also be used alongside standard opioid therapy. However, before initiating these alternatives, the patient should have received all analgesics as recommended by the WHO analgesic ladder and confirmed to be recalcitrant or have developed adverse side effects that limit their continued use (Bhatnagar & Gupta, 2015; Naga, 2015). Thorough investigations should be conducted to determine the etiology of the pain, localization, neurological deficits, and prognostics. The authors also recommend that patients should also receive informed consent that includes details concerning the procedure, expected costs, and potential side effects (Bhatnagar & Gupta, 2015).
Similarly, Running and Turnbeaugh (2011) recommend the use of complementary approaches to pain management in cancer, for example, acupuncture, reflexology, massage therapy, therapeutic touch, meditation, and hypnosis. These alternative therapies have been reviewed for their effects on various types of oncology pain. Massage, acupuncture, and therapeutic touch relieved bone pain on a short-term basis. However, acupuncture was associated with bruising, blood loss, and pain, whereas massage therapy was linked to short-lived muscle discomfort and swelling. Acupuncture was reported to provide long-term relief of neuropathic pain with effects lasting between 24 and 48 hours.
Singh and Chaturvedi (2015) also examined the impact of complementary and alternative medicine on the quality of life of cancer patients. Additional complementary and alternative approaches as reported by Singh and Chaturvedi (2015) include guided imagery, biofeedback, and herbal remedies. Non-pharmacological therapies target affective, behavioral, socio-cultural, and cognitive dimensions of cancer pain. These methods are relatively cheaper than pharmacological interventions.
Other studies have examined the effectiveness of conventional pharmacological methods of pain management in cancer. For example, Caraceni et al. (2011) examined whether morphine was still the preferred opioid in the management of cancer pain by conducting a systematic review of controlled trials published between 2003 and 2009 were reviewed. The review confirmed the shortcomings of morphine on cancer patients who had never used it before as well as those who had been treated with the drug. These findings indicated that oral doses of morphine, oxycodone, and hydromorphone produced similar efficacy and toxicity levels in the described population. This paper provides useful data for cancer pain management. However, the studies reviewed may be considered outdated because current studies on the practice problem have been conducted in the recent years.
Naga (2015) provided updated evidence on the practice problem of oncology pain management by conducting a systematic review of articles published between 2007 and 2013. The goal was to determine evidence-based standards of cancer pain management. It was noted that commonly used pharmacological agents for pain management in cancer patients include drugs such as tetrodotoxin, ketamine, bisphosphonates, and non-steroidal anti-inflammatory drugs in combination with opioids. The use of analgesics for pain management should adhere to the WHOs three-step analgesic ladder. Naga (2015) also recommends non-pharmacological pain management measures such as transcutaneous electrical nerve stimulation (TENS), massage, acupuncture, and exercise interventions among others. The author asserts that holistic pharmacological and non-pharmacological approaches to cancer pain management yield optimal outcomes by allowing healthcare providers to manage pain appropriately.
Overall, there were no inconsistencies in the studies reviewed. All authors agreed that pain was a major problem in oncology practice and that pharmacological interventions were insufficient to manage the pain effectively. Complementary therapies were effective in providing pain relief. However, clinicians were not supposed to use them on their own. Therefore, a combination of pharmacological and alternative approaches was necessary to ensure optimal outcomes. Another observation that was common to all studies reviewed was clinicians should consider patient preferences when selecting a pain relief method.
Conclusion
Several preliminary conclusions can be made from the findings of the current review of the literature. The use of pharmacological and non-pharmacological (alternative) approaches to pain management yields optimal outcomes in cancer patients. Non-pharmacological or alternative pain management can be used to complement the conventional pain management strategies. The evidence is sufficient to warrant a practice change to embrace the use of complementary and alternative treatments alongside pharmacological interventions.
References
Bhatnagar, S., & Gupta, M. (2015). Evidence-based clinical practice guidelines for interventional pain management in cancer pain. Indian Journal of Palliative Care, 21(2), 137-147. Web.
Caraceni, A., Pigni, A., & Brunelli, C. (2011). Is oral morphine still the first choice opioid for moderate to severe cancer pain? A systematic review within the European palliative care research collaborative guidelines project. Palliative Medicine, 25(5), 402-409. Web.
Naga, B. B. (2015). Evidence-based standards for cancer pain management. Middle East Journal of Family Medicine, 13(7), 41-46.
Running, A., & Turnbeaugh, E. (2011). Oncology pain and complementary therapy. Clinical Journal of Oncology Nursing, 15(4), 374-379. Web.
Singh, P., & Chaturvedi, A. (2015). Complementary and alternative medicine in cancer pain management: A systematic review. Indian Journal of Palliative Care, 21(1), 105-115. Web.
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