The Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) recently updated their guidelines for using integrative medicine to treat cancer pain. These guidelines, developed under the leadership of Jun Mao, MD, MSCE, an integrative medicine specialist at Memorial Sloan Kettering Cancer Center, were published in the Journal of Clinical Oncology.
The guidelines are based on a systematic review of 227 articles published from 1990 to 2021 that compared integrative therapies to a comparison group and had pain as a primary outcome. A multidisciplinary expert panel of researchers compared studies based on what type of pain each intervention sought to address (e.g., surgical pain versus peripheral neuropathy). Because the ways pain was measured largely differed between studies, the researchers could not compare the statistical results of the studies. Instead, they qualitatively compared these findings and analyzed both the rigor of the available studies and rated how strong each recommendation was.
Based on their systematic reviews, the guideline recommendations for adults include:
Patients taking aromatase inhibitors and experiencing joint pain
- The quality of the nine included articles was intermediate, and the strength of the recommendation is moderate.
- Yoga for patients taking aromatase inhibitors and experiencing joint pain. The quality of the one included article was low, and the strength of the recommendation is weak.
Patients experiencing general cancer pain or musculoskeletal pain
- The quality of the eight included articles was intermediate, and the strength of the recommendation is moderate.
- Reflexology or acupressure (if patient is receiving systemic treatment). The quality of the seven included articles was intermediate, and the strength of the recommendation is moderate.
- Massage (if patient is experiencing chronic pain after breast cancer surgery). The quality of the two published syntheses was low, and the strength of the recommendation is moderate.
- Hatha yoga (if patient finished treatment for either breast or head and neck cancer). The quality of the two published studies was low, and the strength of the recommendation is weak.
- Guided imagery with progressive muscle relaxation (if patient finished treatment for either breast or head and neck cancer). The quality of the four published studies was low, and the strength of the recommendation is weak.
Chemotherapy-Induced Peripheral Neuropathy
- The quality of the nine published studies was low, and the strength of the recommendation is weak.
- The quality of the two published studies was low, and the strength of the recommendation is weak.
Surgical or Procedural Pain
- The quality of the five published studies was intermediate, and the strength of the recommendation is moderate.
- Acupuncture or acupressure. The quality of the 12 published studies was low, and the strength of the recommendation is weak.
- Music therapy. The quality of the three published studies was low, and the strength of the recommendation is weak.
Pain from Survivorship and Palliative Care
- The quality of the 15 published studies was intermediate, and the strength of the recommendation is moderate.
Of note, only one integrative therapy had enough evidence that the expert panel said clinicians “should” use it: acupuncture for treating aromatase-inhibitor muscle pain. For all other recommendation, the expert panel concluded that clinicians “may” offer the therapy to patients. Also, the expert panel considered studies in the pediatric population, but found insufficient or inconclusive evidence for any integrative therapy.
Several integrative therapies either lacked conclusive evidence or the evidence was conflicting that it improved general cancer pain. These therapies included music therapy, virtual reality, and aromatherapy. Other integrative therapies that did not have strong evidence for procedures or surgical pain included meditation, hypnosis, reflexology, and massage. Likewise, for pain experienced by individuals receiving palliative care, neither music therapy, guided imagery, meditation, nor hypnosis had strong enough evidence.
Pain is one of the most prevalent and debilitating symptoms experienced by individuals with cancer. Having evidence-based mind-body therapies to complement pharmacological and cognitive behavioral based treatment can improve patients’ quality of life and health.
Oncology nurses should be familiar with these guidelines, and as appropriate work with other clinicians and patients to determine if these evidence-based treatments would provide benefit with minimal harm. By using these guidelines in shared decision-making about pain management, nurses can support patients in having optimal pain management throughout their cancer experience.
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