Research Paper
Research Paper
Research Paper
Ms. Heasley
April 6, 2022
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NON-PHARMACOLOGICAL MEASURES FOR CANCER PAIN
Intro
Throughout the research conducted, it was discovered that a lot of new techniques for
cancer pain relief are on the rise. The topic of cancer pain patients who experience pain or severe
side effects that use holistic or non-pharmacological care compared to chemotherapy to increase
the patient’s outcomes was extensive throughout the research found using multiple reliable
research, and findings including their effectiveness, their betterness compared to others, the need
for more research, etc. Out of the thousands of articles that popped up when we searched
non-pharmacological measures for cancer pain we found eight very good ones to support our
thesis statement. The articles that we used were located in the following journals and websites:
Complementary Therapies in Clinical Practice and Cancer control. The key works that we
searched were, Cancer AND (Pain OR Discomfort) AND (meditation OR yoga OR exercise OR
Cognitive-Behavioral Interventions
psychological pain and adverse effects is due to the malignancy itself or the adverse effects of
opioids, chemotherapy, or radiation. It is no secret that cancer patients not only go through pain
physically, but also psychologically. According to Cancer Control, the subjective portion of pain
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is thought to be influenced by distorted or irrational thoughts that create exaggerated feelings and
an increase in the perception of pain. Literature shows that asking patients to track their pain,
thoughts, and the emotions they experience, prescribed by their physician for specific times, or
after pain flare-ups, has been proven to be useful for cancer pain patients (Menefee et al., 2005).
Cognitive-behavioral therapy has been proven to be effective not only in chronic pain, but also
beneficial cost-wise (Maindet et al., 2019). Two studies on online interventions of acceptance
and commitment therapy discovered that lower physiological distress led to greater outcomes in
pain-related interference and found no association between baseline depression diagnosis and
outcomes (Maindet et al., 2019). However, it has also been shown that using mindfulness-based
interventions with patients with higher psychological distress or a history of depression tends to
Although there are some studies that show cognitive-behavioral interventions are used to
improve the psychological status of cancer pain patients, there is also a cognitive-behavioral
intervention known as catastrophizing that has been shown to negatively affect cancer pain
cognitive coping strategy that involves cancer pain patients to make negative cognitive and
emotional evaluations of their pain or the circumstances they are under. On top of this,
catastrophizing has been shown to be associated with depression and increased pain intensity. As
if cancer pain patients do not deal with enough life-altering obstacles with pain, catastrophizing
can also interfere with life activities secondary to pain and anxiety. Due to the amounts of
different research and findings, it is clear that cognitive-behavioral therapy has a lot of room for
Acupuncture
Acupuncture has been an up-and-coming technique over the years. Acupuncture is a treatment
that involves needles being planted into pressure points or areas of pain on the body (Bardia et
al., 2006, p. 5458). Research studies have been done to test the effectiveness of acupuncture on
cancer patients' pain. Multiple studies have shown benefits to many of the symptoms most cancer
patients face. According to the Journal of Clinical Oncology, Alimi et al reported the
effectiveness of acupuncture when it is being used for cancer pain. This study had participants go
through two sessions that were 1 month apart from each other. This research study showed the
pain. Journal of Clinical Oncology also commented on the need for more studies on acupuncture
to learn more about the effectiveness of cancer patients' pain and further side effects of treatment.
The Journal of Osteopathic Medicine included information about chronic cancer pain and the
Chronic pain in cancer survivors is often not alleviated by conventional treatments and is
the most common reason acupuncture treatment is sought (Menefee et al., 2005). A
Chronic cancer pain cannot always be managed by opioids due to the possibility of becoming
dependent on them. Acupuncture gives cancer patients with chronic pain a nonpharmacological
way to deal with their pain. Cancer Control analyzed other research studies on acupuncture and
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found that acupuncture therapy, when used alone, is not as effective as conventional drug
therapy. In their literature review, they did comment on acupuncture still giving cancer patients
less pain and a better quality of life without the adverse effects that pain-relieving medications
have. Overall, Elizabeth Thomas’s article in Cancer Control came to the conclusion that
acupuncture is more beneficial when used in multimodal therapies for cancer pain. Acupuncture
has been proven to have a beneficial effect on cancer patients' pain. Chronic cancer pain patients
may benefit from this therapy due to the downsides to them using certain pain medications. Even
if pain medication is used by a cancer patient, acupuncture can help alleviate more of the pain
using multimodal therapies. Acupuncture still needs to go through more research to find further
evidence to support this therapy in treating cancer pain, but this nonpharmacological treatment is
very promising according to the studies that have been completed and reviewed.
Visual Reality
Visual reality is a technology that is used for entertainment which has now been used in
the treatment for cancer pain. Visual reality is when technology goggles are used to create a
simulated experience. This simulated experience can be anything such as a beach or a forest.
According to Caroline Maindet’s article (Maindet et al., 2019), visual reality has been used for
cancer patients going through painful procedures such as chemotherapy and port access. These
procedures can be very painful for the patient and many times, certain pain medications cannot
patients with an easy way to treat the pain. This therapy is not only convenient but also has been
VR has been used with success in rehabilitation systems to treat cancer survivors coping
reduced pain levels, general distress/ unpleasantness, and a desire to use VR again during
Patients with acute and chronic cancer pain are able to use this therapy to help relieve their pain
during and after painful procedures. Patients not only felt less pain after but wanted to use this
therapy again when having painful procedures done. This therapy is very promising and effective
Hypnosis
hypnosis has been studied to decrease pain in cancer patients. The definition of hypnosis is, “ . .
altered psychological state, and minimal motor functioning”(Menefee, Lynette A. and Monti,
Daniel A., 2005, p. 19). This nonpharmacological treatment, according to Caroline Maindet, has
shown benefits to using hypnosis in cancer-related pain from treatments and concomitant
disease. Supportive Care in Cancer also discusses hypnosis as the only non-invasive CIT
technique that is recommended by France. This recommendation by France is due to the many
studies that have all shown the effectiveness of hypnosis related to cancer pain. In Supportive
Care in Cancer, a study by Syrajala showed significant effectiveness in hypnosis therapy. In this
study, there were 4 groups. The study was set up as follows: group one had routine treatment,
group two had therapist attentional control, group three participated in hypnosis, and group four
had a cognitive-behavioral skills package. Results of the study by Syrjala show that the hypnosis
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group had significantly less posttransplant pain than any of the other therapies tested. This shows
a significant benefit to cancer patients and pain relief. According to The Journal of Osteopathic
Medicine, the NIH Technology Assessment Panel found, “strong evidence for use of hypnosis in
reducing pain, including that associated with cancer” (Menefee, Lynette A. and Monti, Daniel
A., 2005, p. 19). Hypnosis was found by this pannel to have successfully relive not only pain but
the side effects such as nausea and vomiting that are associated with the use of chemotherapy.
Hypnosis has had multiple credible studies and literature reviews that have proven the
to have a better effect on pain than cognitive behavioral skills and therapist attentional control.
Cancer has been a prevalent topic for many years now and is only becoming more
significant due to all the research being done on it. According to the Department of Hematology
and Medical Oncology, “more than 14 million cases of cancer were diagnosed worldwide in
2012 and by 2025 the number is expected to reach more than 20 million” (2017, para. 1).
Unfortunately what comes along with cancer is cancer pain. Cancer pain has continued to evolve
bringing more awareness when patients come to the hospital for their treatments. It is one of the
patients’ biggest fears when they are first diagnosed with cancer because everyone has a different
pain tolerance and most patients don’t know how much they can take.
Pharmacological treatments have been Doctors' first mechanism of action when treating
any pain, especially cancer pain. Opioids have been the main treatment of cancer pain but, “their
role in treatment has been evolving largely due to a growing understanding of their adverse
effects associated with chronic use. This is especially important in the context of longer survival
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in cancer and improving survival rates'' (Chwistek, 2017, para. 35). Just because it is
pharmacological does not mean it is always the best thing to do, so researchers have found
healthier and more beneficial ways to treat cancer pain without using medication. One of the
or chemical alteration of signal transmission within the nervous system by using implanted
devices or- increasingly- non-invasive techniques, which result in modulation of pain signals
leading to analgesia” (Chwistek, 2017, para. 64,67,68). This study was focused on the different
The first category of neuromodulation is spinal cord stimulation. “Spinal cord stimulation
is a minimally invasive outpatient technique that involves the placement of electrodes in the
epidural space” (Chwistek, 2017, para. 69,70). At the beginning of the study, they connect the
electrodes to a pulse generator that is placed under the buttocks area. The main goal of the
treatment is based on the electrical stimulation of the dorsal root ganglion which will suppress
the transmission of stimuli from the nociceptive nerve fibers, overall decreasing pain. Spinal
cord stimulation is also very beneficial because it goes hand in hand with peripheral nerve
stimulation which is rapidly evolving in the oncology field. Upon reviewing these findings, “
The case and observational studies of the clinical use of PNS present it as an attractive modality
for treatment of neuropathic pain states due to peripheral nerve injuries, nerve entrapments, or
therapies” (Chwistek, 2017, para. 65,84). Spinal cord stimulation allows the stimulation to reach
the majority of the patient's body allowing it to take the edge off the pain the cancer is causing
day-to-day lives. According to the study done by the American Cancer Society, “ A recent
systematic review of relevant published data located 26 surveys of cancer patients from 13
countries including five from the US. The average prevalence of CAM use across all studies was
31%” (Cassileth, 1999). This shows the prevalence of this therapy and how the whole world is
using it to treat the different effects of pain, not just the United States. Another effective CAM
therapy is Herbal remedies. This category consists of homeopathy, acupuncture, and folk
remedies to help ease the patient’s pain. According to The American Cancer Society, “Herb sales
in drugstores and food stores increased 35% from 1993 to 1994 totaling $106.7 million for the
year” (Cassileth, 1999). The even better thing with CAM therapies is that health insurance covers
it. “ More than 30 major insurers, half of them Blue plans, cover more than one alternative
therapeutic method” (Cassileth, 1999). These numbers are very good compared to other medical
therapies and give cancer patients more reassurance to do this type of therapy. When (you) give
patients another option besides traditional pills it allows them to explore the different therapies
and see that there is more out there than traditional medicine. Herbal medicine and spinal cord
stimulation are all effective ways to treat cancer pain with many benefits to them.
Reflexology
Reflexology has been used as a complementary and alternative therapy for many years.
They have used this methodology to decrease levels of anxiety, depression, pain, and overall
improving the quality of life of patients undergoing reflexology therapy. Reflexology is utilizing
various pressure points in the foot to stimulate a brain response. Reflexology is described to
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work by “increasing neural stimulation and blood flow. It is also assumed that it increases the
release of dopamine and endorphin hormones by stimulating the immune system, endocrine
system, and neuropeptides. These hormones are likely to prevent pain transmission, provide
relaxation, reduce stress, and increase peace.” (Turkcu & Ozkan 2021)
A recent study was performed by Sinem Goral Turkcu and Sevgi Ozkan on the effects of
reflexology on women undergoing chemotherapy for gynecological cancers. The study consisted
of sixty-four patients undergoing chemotherapy, and they were divided into two groups of
thirty-four. One group was the intervention group and received reflexology treatment, compared
to the non-intervention group which did not receive any additional treatment. The intervention
group received reflexology treatments three times a week for two weeks with thirty to
thirty-five-minute sessions. All sixty-eight participants of the study took a personal information
form during the first two weeks of the trial along with the fourth week of the trial. The personal
information form scored each participant's level of anxiety, depression, and quality of life and
● “ Anxiety levels of the intervention group significantly decreased at the end of the
reflexology sessions (on the second week) and two weeks after the intervention (on the
fourth week) compared to their anxiety levels before the reflexology intervention”.
● “Depression levels of the intervention group also significantly decreased at the end of the
reflexology session (on the second week) and two weeks after the sessions (on the fourth
week) compared to their depression levels before reflexology. However, there was a
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significant increase in the depression levels of the intervention group in the fourth week
● “The global quality of life of the intervention group significantly increased at the end of
the end of reflexology sessions (on the second week) and two weeks after the session (on
the fourth week) compared to the global quality of their life before reflexology sessions.
Overall even though some of the benefits of reflexology are not long-lasting, there are positive
Conclusion
Overall, the non-pharmacological measures that could be used for patients receiving
cancer treatments are endless. Patients undergo a variety of horrific symptoms following cancer
treatment with the most common being pain and discomfort. We found in our research that pain
isn't always physical but could also be mental. From our research, it's evident that
interventions, and hypnosis all positively affected patients undergoing cancer treatment. The
effects of these therapies included a decrease in pain mentally and physically, and also gave the
Reference Page
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