Treating pain with integrative medicine, the new guidelines from the US
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Not everyone feels it, but many do: cancer pain, sometimes disabling and always feared, is felt by 30-50% of patients, and in the most advanced stages of the disease by 70-90%. In most cases, 70%, the pain is caused by the tumor and its metastases that compress or infiltrate organs, bones or nerve endings, while less frequently it is due to therapies and treatments. Cancer pain is at the center of new guidelines published jointly by the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) on the use of integrative therapies.
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The document, published on Journal of Clinical Oncology, is designed to provide evidence-based recommendations to physicians and all those dealing with cancer regarding pain management not with drugs (which, remember, very often effectively keep pain at bay) but with integrative approaches, such as acupuncture, reflexology, massage, hypnosis. For each recommendation the levels of quality and strength are indicated. These are important concepts, because they actually describe a hierarchical scale of evidence value.
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Patients and the search for non-pharmacological solutions
“Patients often seek integrative medicine because they perceive that conventional medical treatment does not fully meet their needs, because they fear the side effects of drugs, because they prefer a holistic approach,” the authors say. Many of these patients when they try to ask their doctor for information, they are told: ‘why not? Try it, maybe it’s better and nothing more.
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The recommendations: how they are born and what they say
To help physicians respond in the most appropriate way, SIO and ASCO have assembled a multidisciplinary panel of experts in medical, integrative, radiation, surgical, palliative oncology, social sciences, mind-body medicine, nurses and of representatives of patient associations. The group, after beating published literature from 1990 to 2021 on cancer pain intensity, symptom relief, and adverse events, identified 227 publications. The result is 13 recommendations supported by randomized studies and systematic reviews, and guided by clinical experience.
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Not valid for pediatric patients
“Although many of the recommendations are weak and based on low-quality evidence, the interventions are of clinical relevance, with a favorable benefit / harm ratio,” said the authors of the guidelines, which, it should be noted, are valid for adults with cancer not for children and adolescents, because “there is insufficient evidence or it is inconclusive to make recommendations for pediatric cancer patients.”
For drug-related joint pain
Acupuncture should be offered to breast cancer patients who suffer from joint pain related to aromatase inhibitor treatment in breast cancer. Yoga can also be offered to those suffering from joint pain related to these therapies in breast cancer.
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For general or musculoskeletal cancer pain
Acupuncture may be offered to patients experiencing general pain or musculoskeletal pain from cancer.
Reflexology, acupressure and massage can be offered to patients experiencing pain during systemic therapy for cancer treatment.
Hatha yoga can be offered to patients who experience pain after treatment for breast or head and neck cancers (type: evidence-based, benefits outweigh harm; quality of evidence: low; strength of recommendation: weak).
The technique of visualizations or guided visual images with progressive relaxation can be offered to patients who experience general pain due to cancer treatment.
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For chemotherapy-induced peripheral neuropathy
Acupuncture can be offered to patients suffering from cancer treatment chemotherapy-induced peripheral neuropathy.
Reflexology or acupressure may be offered to patients suffering from cancer treatment chemotherapy-induced peripheral neuropathy.
For pain from medical or surgical procedures
Hypnosis can be offered to patients who experience procedural pain during cancer treatment or diagnostic tests.
Acupuncture or acupressure may be offered to patients undergoing cancer surgery or other cancer-related procedures such as bone marrow biopsy.
Music therapy can be offered to patients suffering from surgical pain.
For pain during palliative care
Massage can be offered to patients experiencing pain during palliative and hospice care.
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