Non-pharmacological approaches may contribute to effective analgesia and are often well accepted by patients. Some simple measures which are sometimes recommended (eg, hot or cold packs) have not been well studied. Complementary therapies for pain may also be sought out by patients, and require evaluation for their potential role in the palliative care setting.
What is known
- The role of TENS (transcutaneous electrical nerve stimulation) has been studied in chronic pain, [1] andin cancer pain. [2] In chronic pain there was not enough evidence to support the use of TENS, because the studies were of poor quality, and provided little information about the stimulation parameters needed to give pain relief. A lack of Suitable RCTs meant that it was not possible to assess the value of TENS in cancer patients
- A systematic review of acupuncture for cancer related pain [3] found only one good quality study, and so no recommendations can be made about the effectiveness of acupuncture for cancer pain at this stage.
- Hypnosis is sometimes used to reduce procedure related pain in children. A systematic review which studied the use of hypnosis for this type of pain [2] found it is beneficial, however there were methodological problems with many of the studies identified.
- Aromatherapy and massage have been reviewed to assess their impact on palliative care patients. A systematic review [3] showed that these therapies can have beneficial short-term effects on psychological wellbeing, but the evidence for improvements in other physical symptoms, including pain, was not strong. Further studies are needed. Touch therapies such as reiki and therapeutic touch are the subject of a separate, ongoing Cochrane review.
What it means in practice
The role of non-pharmacological approaches to pain management is evolving, and it is likely that some non-pharmacological and complementary therapies may have an important contribution to make to holistic patient care. However there is no strong evidence to support their analgesic effectiveness, particularly in cancer pain. Palliative care patients with anything more than mild pain should therefore be treated with appropriate analgesics and adjuvants, using an evidence-based approach.
Finding out more
CAM on PubMed
Related CareSearch pages
Assessment tools
Health service issues in pain management
Opioids
Radiotherapy and adjuvants
References
- Carroll D, Moore RA, McQuay HJ, Fairman F, Tramèr M, Leijon G. Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Cochrane Database Syst Rev. 2001;(3):CD003222.
- Robb KA, Bennett MI, Johnson MI, Simpson KJ, Oxberry SG. Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006276.
- Lee H, Schmidt K, Ernst E. Acupuncture for the relief of cancer-related pain--A systematic review. Eur J Pain. 2005 Aug;9(4):437-44. Epub 2004 Nov 11.
- Richardson J, Smith JE, McCall G, Pilkington K. Hypnosis for procedure-related pain and distress in pediatric cancer patients: a systematic review of effectiveness and methodology related to hypnosis interventions. J Pain Symptom Manage. 2006 Jan;31(1):70-84.
- Fellowes D, Barnes K, Wilkinson S. Aromatherapy and massage for symptom relief in patients with cancer. Cochrane Database Syst Rev. 2004;(2):CD002287.
This page was created on 23 May 2008
Last updated 4 May 2009