Review: acupuncture and mind-body therapies may be effective for cancer related pain
Q Are complementary and alternative therapies effective for reducing cancer related pain?
Medline, CINAHL, EMBASE/Excerpta Medica, AMED, and Cochrane Library (all to August 2005); PubMed; and reference lists.
Study selection and assessment:
randomised controlled trials (RCTs) that evaluated complementary and alternative therapies (defined by the US National Center for Complementary and Alternative Medicine) for cancer related pain. Studies assessing procedural or post-surgical pain were excluded. 18 RCTs (n = 1499) met the selection criteria. Quality of individual trials was assessed using the Jadad scale, which considered randomisation method, blinding, and dropouts.
No meta-analysis was done because of the heterogeneity of interventions and outcomes. The results of individual trials are shown in the table. Evidence from individual studies showed that acupuncture, support groups, hypnosis, and relaxation/imagery decreased cancer related pain. Massage and healing touch had short term benefits only.
Some evidence exists that acupuncture and mind-body interventions (eg, support groups, hypnosis, and relaxation/imagery) relieve cancer related pain.
- Eric Staples, RN, MSN, ACNP, DNP
The systematic review by Bardia et al provides a snapshot of current evidence related to the efficacy of complementary and alternative medicine (CAM) therapies for cancer related pain. The included RCTs varied widely in quality.
CAM therapies are not presently considered an integral part of conventional medicine for several reasons: practices are multi-modal, therapies are of short and long term duration, CAM practices are not regulated, and preparation of CAM practitioners is varied and only sometimes scrutinised. Healthcare professionals are often ambivalent about CAM approaches, partly because of lack of knowledge, but also because of a belief that good practice should be based on scientific evidence of efficacy and safety. This ambivalence has led to a communication breakdown in the triad of healthcare provider, CAM provider, and patient. In turn, this lack of communication has been compounded by a paucity of rigorous multi-institutional RCTs, as found by Bardia et al in their systematic review. Despite the lack of evidence of efficacy for many CAM therapies, patients with cancer related pain continue to be disappointed with traditional pain practices and increasingly seek CAM therapies.
Nursing has a leadership role in continuing to establish evidence-based practice in CAM therapy through synthesis of evidence of its efficacy and safety, concurrent use with conventional therapies, and long term use. However, as credible as the evidence-based approach is, the healthcare community may be weighing in too heavily on the lack of evidence, summarily dismissing CAM therapy, even in the absence of evidence for or against the therapies. Involvement of patients as partners in pain management and professional openness to integrative approaches using CAM therapies for which positive evidence or no evidence of harm exists may provide a clinical solution until definitive evidence becomes available.
For correspondence: Dr T J Moynihan, Mayo Clinic College of Medicine, Rochester, MN, USA.
Source of funding: no external funding.