Nonpharmacological Interventions With Chronic Cancer Pain in Adults
Nonpharmacological Interventions With Chronic Cancer Pain in Adults
Background: Pain is often poorly controlled in cancer patients. Chronic pain affects adult patients at all stages of cancer management. Optimal pain management may require attention to psychosocial variables and the inclusion of nonpharmacological techniques.
Methods: Three nonpharmacological strategies that are effective in reducing pain caused by cancer patient psychoeducation, supportive psychotherapy, and cognitive-behavioral interventions are reviewed. Recommendations for physicians to facilitate a mental health referral are also discussed.
Results: Effective treatment of cancer pain begins with assessing the severity, characteristics, and impact of pain. Emotional distress (especially anxiety, depression, and beliefs about pain) has emerged as predictive of patient pain levels. Appropriate pain management may require a multidisciplinary approach.
Conclusions: Patient psychoeducation has empowered patients to actively participate in pain control strategies. Supportive psychotherapy can assist patients in managing the stressors associated with cancer, and cognitive-behavioral therapy helps patients to recognize and modify the factors that contribute to physical and emotional distress.
Physical pain is perhaps one of the most feared consequences for patients with cancer. Available estimates suggest that chronic pain affects 60% of adult patients with newly diagnosed or intermediate-stage cancer and up to 95% of patients with advanced disease. Indeed, the magnitude of the problem is so great that some reports indicate that 25% of individuals may actually die in significant pain.
Ninety percent of cancer patients are believed to be manageable with relatively simple medical interventions. However, in practice, less than 50% experience effective pain relief. To account for this discrepancy in pain management, a number of psychosocial factors have been implicated in the literature. While some researchers have focused on inadequacies related to health care providers or health care systems (eg, an emphasis on prolonging life or achieving cure rather than alleviating suffering), others have identified issues involving the patients themselves. That is, patients experience difficulty assessing and communicating about pain, are reluctant to report pain, have limited expectations for relief, and generally lack knowledge about current therapeutic approaches. Even when pain is addressed medically, patients may be noncompliant with treatment due to concerns about drug tolerance, addiction, side effects, or respiratory depression.
Of all of the psychosocial factors, emotional distress (particularly anxiety, depression, and beliefs about pain) has consistently emerged as predictive of patient pain levels. Spiegel and Bloom found that the site of metastases in women with advanced breast cancer was not reliably associated with pain; rather, emotional distress and the belief that pain signaled a worsening of their condition predicted the reporting of pain. Similarly, Daut and Cleeland found that cancer patients who attributed their pain to a cause other than cancer reported the least interference with activities of daily living and pleasure. Further, Ahles et al compared cancer patients with and without pain and demonstrated that patients with pain scored higher on measures of depression, anxiety, hostility, and somatization. Thus, attention to the psychosocial variables of the cancer patient through nonpharmacological intervention seemingly provides an additional and viable avenue for the treatment of cancer-related pain.
This article focuses on three of the most common approaches employed by mental health professionals: patient psychoeducation, supportive psychotherapy, and cognitive-behavioral therapy. The basic principles behind these methods are explained and relevant research studies are discussed. Only those studies that have methodically strong designs are included in order to critically examine the efficacy of these approaches.
Background: Pain is often poorly controlled in cancer patients. Chronic pain affects adult patients at all stages of cancer management. Optimal pain management may require attention to psychosocial variables and the inclusion of nonpharmacological techniques.
Methods: Three nonpharmacological strategies that are effective in reducing pain caused by cancer patient psychoeducation, supportive psychotherapy, and cognitive-behavioral interventions are reviewed. Recommendations for physicians to facilitate a mental health referral are also discussed.
Results: Effective treatment of cancer pain begins with assessing the severity, characteristics, and impact of pain. Emotional distress (especially anxiety, depression, and beliefs about pain) has emerged as predictive of patient pain levels. Appropriate pain management may require a multidisciplinary approach.
Conclusions: Patient psychoeducation has empowered patients to actively participate in pain control strategies. Supportive psychotherapy can assist patients in managing the stressors associated with cancer, and cognitive-behavioral therapy helps patients to recognize and modify the factors that contribute to physical and emotional distress.
Physical pain is perhaps one of the most feared consequences for patients with cancer. Available estimates suggest that chronic pain affects 60% of adult patients with newly diagnosed or intermediate-stage cancer and up to 95% of patients with advanced disease. Indeed, the magnitude of the problem is so great that some reports indicate that 25% of individuals may actually die in significant pain.
Ninety percent of cancer patients are believed to be manageable with relatively simple medical interventions. However, in practice, less than 50% experience effective pain relief. To account for this discrepancy in pain management, a number of psychosocial factors have been implicated in the literature. While some researchers have focused on inadequacies related to health care providers or health care systems (eg, an emphasis on prolonging life or achieving cure rather than alleviating suffering), others have identified issues involving the patients themselves. That is, patients experience difficulty assessing and communicating about pain, are reluctant to report pain, have limited expectations for relief, and generally lack knowledge about current therapeutic approaches. Even when pain is addressed medically, patients may be noncompliant with treatment due to concerns about drug tolerance, addiction, side effects, or respiratory depression.
Of all of the psychosocial factors, emotional distress (particularly anxiety, depression, and beliefs about pain) has consistently emerged as predictive of patient pain levels. Spiegel and Bloom found that the site of metastases in women with advanced breast cancer was not reliably associated with pain; rather, emotional distress and the belief that pain signaled a worsening of their condition predicted the reporting of pain. Similarly, Daut and Cleeland found that cancer patients who attributed their pain to a cause other than cancer reported the least interference with activities of daily living and pleasure. Further, Ahles et al compared cancer patients with and without pain and demonstrated that patients with pain scored higher on measures of depression, anxiety, hostility, and somatization. Thus, attention to the psychosocial variables of the cancer patient through nonpharmacological intervention seemingly provides an additional and viable avenue for the treatment of cancer-related pain.
This article focuses on three of the most common approaches employed by mental health professionals: patient psychoeducation, supportive psychotherapy, and cognitive-behavioral therapy. The basic principles behind these methods are explained and relevant research studies are discussed. Only those studies that have methodically strong designs are included in order to critically examine the efficacy of these approaches.
