Psychological and Non-Pharmacologic Treatments for Pain in Cancer Patients: A Systematic Review and Meta-Analysis

CONTEXT

Pain is the most fearful symptom in cancer. Although there is a relationship between psychosocial variables and oncologic pain, psychological and non-pharmacological treatments for pain management in cancer patients are not very widespread.

OBJECTIVES

To analyze the efficacy of psychological and non-pharmacological treatments for reducing pain in cancer patients.

METHODS

We performed a systematic review following the PRISMA protocol. In January 2021, data were extracted from PubMed, Web of Science and Scopus, including randomised controlled trials (RCT) published in the last five years (from 28 January, 2015 to December 15, 2020), in the English language and whose sample was patients with cancer pain. The database search used the following keywords: cancer, cancer-related pain, psychological intervention, non-pharmacologic intervention. The Cochrane risk of bias assess ment for randomised trials (RoB 2) was used for quality appraisal.

RESULTS

After the inclusion and exclusion criteria were applied, ten papers were fully screened. The evidence suggested that the most effective interventions to reduce cancer pain were mindfulness-based cognitive therapy, guided imagery and progressive muscle relaxation and emotional and symptom focused engagement (EASE). Music therapy and brief cognitive behavioral strategies (CBS) require more research, while coping skills training and yoga did not show positive effects. Overall, we obtained a moderate size effect (d = 0.642, 95% CI: 0.125-1.158) favourable to psychological and non-pharmacologic treatments at post-treatment, which increased at follow-up (k = 5, d = 0.826, 95% CI: 0.141-1.511).

CONCLUSION

This study provides insight into psychological interventions which might be applied and contribute to cancer-related pain reduction in adults. Although the results are not completely consistent, they may shed light on psychology applications in the oncology environment.

The Multiple Uses of Guided Imagery

Guided imagery is a therapeutic approach that has been used for centuries. Through the use of mental imagery, the mind-body connection is activated to enhance an individual's sense of well-being, reduced stress, and reduced anxiety, and it has the ability to enhance the individual's immune system. There are research and data to support the use of guided imagery for these patient outcomes.

Mental Imagery as a Rehabilitative Therapy for Neuropathic Pain in People With Spinal Cord Injury: A Randomized Controlled Trial

BACKGROUND

Pain of neuropathic origin in spinal cord injury (SCI) is unbearable and challenging to treat. Research studies conducted in the past have shown that mental imagery (MI) techniques have a significant impact on the reduction of symptoms of central neuropathic pain in people with SCI.

OBJECTIVES

The objective of this study was to evaluate the effect of MI training on pain intensity, neuropathic pain symptoms, and interference of pain with function in SCI.

METHODS

A total of 42 SCI participants with central neuropathic pain (duration 6-12 months) were recruited and randomly allocated to MI or control groups. A MI training protocol was administered to MI group and for 30 min/d for 5 days. Outcome measures were assessed at baseline and at the end of 4 weeks.

RESULTS

There was significant reduction in differences of mean [95% CI] scores of numeric rating scale (-2.1 [CI -2.78 to -1.41]; P < .001) between groups. Mean [95% CI] total scores of Neuropathic Pain Symptom Inventory declined in MI group as compared with control group (-4.52 [CI -5.86 to -3.18]; P < .001). Similarly, Brief Pain Inventory interference scale total dropped significantly (P < .001) in MI group. Majority of participants in the MI group (55%) reported improvement in scores of Patients' Global Impression of Change scale as compared with control group where most of the participants (52%) reported no change.

CONCLUSIONS

This study shows the effectiveness of the MI protocol developed as a rehabilitative approach in improving central neuropathic pain in SCI. Trial Registration. Clinical Trials Registry-India under Indian Council of Medical Research; CTRI/2018/07/014884. Registered July 16, 2018.

Mind-Body Interventions for Rehabilitation Medicine: Promoting Wellness, Healing, and Coping with Adversity

Physical medicine providers work to cure organic aspects of disease while simultaneously enhancing quality of life and well-being. Mind-body interventions are evidence-based, cost-effective approaches to serve these aims. This article enhances provider knowledge and acceptance of the most effective and prevalent mind-body modalities: meditation, guided imagery, clinical hypnosis, and biofeedback. The scientific evidence is strongest for mind-body applications for chronic pain, primary headache, cardiac rehabilitation, and cancer rehabilitation, with preliminary evidence for traumatic brain injury and cerebrovascular events. Mind-body interventions are well-tolerated by patients and should be considered part of standard care in physical medicine and rehabilitation settings.

Mental imagery training for treatment of central neuropathic pain: a narrative review

Mental imagery is a quasi-perceptual experience in the absence of external stimuli. This concept has intrigued psychologists, sportspersons, neurologists and other scientists for over a decade now. Imagery has been used in rehabilitation and the results have been promising. Researchers refer to this as healing the body through the mind. However, the challenge is lack of standardized protocols, homogeneity and consistency in application of mental imagery in different populations. The purpose of this review is to discuss and understand the role of mental imagery in the treatment of central neuropathic pain (CNP). Treatment options of CNP are inadequate and their benefits are short lived. We conducted an extensive search on various databases using combinations of different keywords and reviewed the available literature in this area. We were able to finalize twelve studies where mental imagery was used for treating CNP in spinal cord injury (SCI), stroke and multiple sclerosis. However, the methodology and techniques of mental imagery training used in these studies were non-homogeneous and inconsistent. This review provides a guiding framework to further explore the different techniques of mental imagery and their roles in treating CNP.

Nonpharmacologic Pain Interventions: A Review of Evidence-Based Practices for Reducing Chronic Cancer Pain

BACKGROUND

Pain is a common issue for patients with cancer and can be challenging to manage effectively. Healthcare professionals need to be knowledgeable about evidence-based nonpharmacologic interventions.
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OBJECTIVES

This systematic review critically appraises the strength and quality of the empirical evidence for nonpharmacologic interventions in reducing chronic cancer pain.
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METHODS

Intervention studies were critically appraised and summarized by an Oncology Nursing Society Putting Evidence Into Practice team of RNs, advanced practice nurses, and nurse scientists. A level of evidence and a practice recommendation was assigned to each intervention.
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FINDINGS

Based on evidence, recommended interventions to reduce chronic cancer pain are celiac plexus block for pain related to pancreatic and abdominal cancers and radiation therapy for bone pain. Although psychoeducational interventions are considered likely to be effective, the effective components of these interventions and their dose and duration need to be determined through additional research.