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Non Pharmacological Treatment Cancer

To understand the non pharmacological approaches to treating chronic cancer pain, it is important to first define the biopsychosocial model that has been applied to patients with cancer pain (1,2). This encompasses biological, psychological, and social aspects of care (2). The pain related quality of life includes physical well being, psychological well being (cognition, communication) and interpersonal well being (social support and role functioning) (1). The current model of pain, which is the gate control theory postulates that a mechanism that involves control from the spinal cord in the dorsal horn receives ascending and descending signals from nerve tracts and will balance the integration (1). The perception of pain is determined by a biological evaluation of these inputs (1). The descending cortical inputs that affect pain perception include psychological and psychosocial variables such as beliefs about pain, emotions, reactions to stress and cognitions (1). Therefore, the goal of the non pharmacological interventions is to target these factors and change the perception of pain (1).

The pain related quality of life consists of three important variables that correspond to the biopsychosocial model (1). They include 1) physical well being, 2) psychological well being (1).

Pain can cause a reduction in strength, vitality, activity tolerance and mobility (1).. Pain may reduce a person’s ability to care for themselves, to work or to participate in fulfilling activities and may also result in an overly sedentary lifestyle and avoiding activities (1). This can result in reconditioning, increasing muscular tension and increased perception of pain (1). Thus, rehabilitative treatment that optimizes the range of motion, strength, endurance and neuromuscular control reduce the amount of pain that is associated with instability and disuse (1). Another physical treatment is the application of heat or cold or a combination of both (1). This is used to alleviate postoperative pain and pain that are from the inflammatory processes that are associated with cancer (1). Therapeutic exercise and massage can be helpful in improving the range of motion and reducing muscle tension (1).

Psychological interventions are an important part of the pain management process (1). This is because cancer pain can be intensified by psychological distress, such as mood disturbance, depression, fear and anxiety (1). A common concern for patients is the fear of disease progression and a painful death (1). Cognitive behavior therapy, which involves asking the patients to track their pain, or record thoughts and emotions during prescribed periods of the day or follow exacerbations of pain and then discussing the content of their thoughts and the subsequent emotions with a therapist (1). This type of therapy is important because the most important maladaptive cognitive coping strategies related to the pain management is catastrophizing (1). This is when there is negative cognitive and emotional evaluation of the circumstances and pains. Example statements are, “This pain means that death is coming soon” (1). The problem with catastrophizing is that it is highly associated with depression and increased pain intensity (1). By meeting with a therapist, these dysfunctional automatic thoughts and beliefs could be recognized and then modified (1).

A randomized control trial of auricular acupuncture for patients with cancer found significant pain reduction in patients who were receiving acupuncture compared to those receiving placebo (1). The possible effects may be due to release of multiple endogenous substances (oxytocin, endorphins, steroids) that no single drug treatment could emulate (1).

Hypnosis

Hypnosis is a complex process of receptive and attentive concentration that is due to a modified, altered psychological state and minimal motor functioning (1). An NIH Technology Assessment Panel found strong evidence for the use of hypnosis in decreasing pain associated with cancer (1). The mechanism is thought to be due to cognitive distraction, muscle relaxation and altering perceptions (1).

Therapeutic Massage

This involves the physical manipulation of soft tissues of the body by rubbing, kneading, rolling, pressing or slapping, or a combination of these movements for relaxation of muscles, relief of pain and enhancing circulation (1). A review of 10 studies suggested that therapeutic massage increased relaxation and decreased levels of anxiety and cortisol (1). Two studies showed decreased pain and relaxation in male patients with cancer following an intervention with massage (1).

Medication and Mindfulness Based Stress Reduction

This is a process that stresses the moment to moment awareness from regular meditative practice. (1) The patients respond to their awareness, which includes negative emotional thoughts and moods in an accepting, relaxed and nonjudgmental manner (1). This has been shown to improve patients coping with prostate cancer and decreased stress and mood disturbances in patients with mixed types of cancers (1). Reductions in T1 pro inflammatory lymphocyte to T2 anti inflammatory lymphocyte ratio have been noticed in patients with breast cancer and patients with prostate cancer following an 8 week program (1).

References

  1. Menefee-Pujol LA, Monti DA. Managing cancer pain with nonpharmacologic and complementary therapries. J Am Osteopath Assoc. 2007;107(7):ES15-ES21.
  2. Repchinsky C, editor-in-chief. Therapeutic Choices. 6th ed. Canadian Pharmacists Association; 2011. 450-3.

Disclaimer

This information is presented for informational purposes only and is not meant to be a substitute for advice provided by qualified health care professionals. You should contact your qualified health care provider if you have or suspect any health problems. This article is not intended to provide medical advice for its readers


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