The Society of Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) issued a joint guideline that provides evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer.
“Among patients with advanced cancer, pain can be a result of tumor burden or invasion of bones, muscles, or nerves,” guideline authors wrote in The Journal of Clinical Oncology. “In addition, many conventional cancer treatments such as surgery, chemotherapy, radiotherapy, immunotherapy, or hormonal therapy can result in both acute and chronic pain conditions such as aromatase inhibitor (AI)-induced joint pain or chemotherapy-induced peripheral neuropathy (CIPN) pain.”
Because of this, effective pain management “is of critical importance throughout the cancer care trajectory.”
The two societies convened a panel of multidisciplinary experts who conducted a literature search for studies or reviews looking at pain intensity, symptom relief, and adverse events. This evidence, plus informal consensus, were used to develop recommendations. The experts noted that although many of the recommendations have weak or low-quality evidence, they do have clinical relevance and favorable benefit-to-harm ratios.
For women with breast cancer and AI-related joint pain, acupuncture or yoga should be offered.
For patients with general cancer pain or musculoskeletal pain, acupuncture may be offered. For those experiencing pain during systemic therapy for cancer treatment, reflexology or acupressure may be offered.
Massage may help relieve pain to patients experiencing chronic pain after breast cancer treatment. Hatha yoga may be offered to those with pain after treatment for breast or head and neck cancers. Guided imagery with progressive muscle relaxation may also be used for general pain from cancer treatment.
For patients experiencing procedural or surgical pain, hypnosis, acupuncture, acupressure, or music therapy may be offered.
Finally, massage could be offered to patients with pain during palliative and hospice care.
The published guideline offers evidence and reasoning behind the recommendations, and provides additional resources that health care providers can turn to for assistance with pain management.
“SIO and ASCO believe that cancer clinical trials are vital to inform clinical decisions and improve cancer care, and that all patients should have the opportunity to participate in these trials,” they wrote. “As this guideline has identified scientific gaps in a number of mind-body interventions (eg meditation, yoga, and music) for pain management in specific populations (eg, postsurgical, radiation, and pediatric), careful intervention development, testing, and well-designed and executed RCTs are needed to increase the evidence base.”