Strategies of complementary and integrative therapies in cancer-related pain-attaining exhaustive cancer pain management

Author: Maindet C1, Burnod A2, Minello C3, George B4, Allano G5, Lemaire A6
1Pain management centre, Grenoble-Alpes University Hospital, Grenoble, France.
2Department of supportive care, Institut Curie, PSL Research University, Paris, France.
3Anaesthesia-intensive care department, Cancer Centre Georges François Leclerc, Dijon, France.
4Pain management unit, Saint-Louis Hospital, Paris, France.
5Pain management unit, Mutualist Clinic of la Porte-de-l'Orient, Lorient, France.
6Oncology and medical specialties department, Valenciennes General Hospital, Valenciennes, France.
Conference/Journal: Support Care Cancer.
Date published: 2019 May 11
Other: Special Notes: doi: 10.1007/s00520-019-04829-7. [Epub ahead of print] , Word Count: 274

PURPOSE: Complementary integrative therapies (CITs) correspond to growing demand in patients with cancer-related pain. This demand needs to be considered alongside pharmaceutical and/or interventional therapies. CITs can be used to cover certain specific pain-related characteristics. The objective of this review is to present the options for CITs that could be used within dynamic, multidisciplinary, and personalized management, leading to an integrative oncology approach.

METHODS: Critical reflection based on literature analysis and clinical practice.

RESULTS: Most CITs only showed trends in efficacy as cancer pain was mainly a secondary endpoint, or populations were restricted. Physical therapy has demonstrated efficacy in motion and pain, in some specific cancers (head and neck or breast cancers) or in treatments sequelae (lymphedema). In cancer survivors, higher levels of physical activity decrease pain intensity. Due to the multimorphism of cancer pain, certain mind-body therapies acting on anxiety, stress, depression, or mood disturbances (such as massage, acupuncture, healing touch, hypnosis, and music therapy) are efficient on cancer pain. Other mind-body therapies have shown trends in reducing the severity of cancer pain and improving other parameters, and they include education (with coping skills training), yoga, tai chi/qigong, guided imagery, virtual reality, and cognitive-behavioral therapy alone or combined. The outcome sustainability of most CITs is still questioned.

CONCLUSIONS: High-quality clinical trials should be conducted with CITs, as their efficacy on pain is mainly based on efficacy trends in pain severity, professional judgment, and patient preferences. Finally, the implementation of CITs requires an interdisciplinary team approach to offer optimal, personalized, cancer pain management.

KEYWORDS: Cancer pain; Complementary therapies; Mind-body therapy; Multimorphic pain; Pain management; Personalized management

PMID: 31076901 DOI: 10.1007/s00520-019-04829-7