How do integrative experts manage pain?
Both medical groups and integrative experts provide recommendations for managing pain. Learn more about the approaches and meanings of recommendations.
Clinical practice guidelines
Recommendations:
Acupuncture as adjunct therapy to treat pain among patients with inadequate control of symptoms (weak recommendation)
Massage therapy as part of a multi-modality cancer supportive care program to treat pain when not controlled by usual care
Moderate recommendation for treating chronic pain:
- Cognitive behavioral therapy
- Guided imagery
- Mindfulness
- Relaxation
Weak recommendation for treating chronic pain:
- Acupuncture
- Massage
- Music therapy
- Peripheral nerve stimulation
- Spinal cord stimulation
- Transcutaneous electrical nerve stimulation
- Transcranial stimulation
Chinese Integrative Therapy of Primary Liver Cancer Working Group
Recommendations:
External therapy using traditional Chinese herbal medicines (such as Chanwu powder, Chanwu cataplasma and modified Jinhuang powder/paste) for mild to moderate cancer pain and reduce dependence on painkillers (weak recommendation)
Acupuncture (including wrist-ankle acupuncture and electroacupuncture) and moxibustion to relieve pain (weak recommendation)
Several specific herbal blends are recommended to manage pain, depending on the pain pattern.
Specific acupuncture points are recommended to manage pain for all pain patterns.
International Trustworthy Traditional Chinese Medicine Recommendations (TCM Recs) Working Group
Acupuncture for cancer pain: an evidence-based clinical practice guideline ›
A strong recommendation for the treatment of acupuncture rather than no treatment to relieve pain in patients with moderate to severe cancer pain
A weak recommendation for the combination treatments with acupuncture/acupressure to reduce pain intensity, decrease the opioid dose, and alleviate opioid-related side effects in moderate to severe cancer pain patients who are using analgesics
A strong recommendation for acupuncture in breast cancer patients to relieve their aromatase inhibitor-induced arthralgia
These guidelines list these options for managing pain:
Physical activity
- Pain (arthralgias, myalgias)
- Bone (skeletal) pain related to vertebral compression
- Myofascial paina chronic pain disorder in which pressure on sensitive points in muscles (trigger points) causes pain in the muscle and sometimes in seemingly unrelated parts of the body
Aquatic therapy
- Pain (arthralgias, myalgias)
Psychosocial support
- Neuropathic pain
- Chronic pain syndromes
Cognitive-behavioral therapy (CBT)
- Pain
Hypnosis
- Neuropathic pain
Behavioral treatment
- Chronic pain syndromes
Yoga
- Pain (arthralgias, myalgias)
Acupuncture
- Neuropathic pain
- Myofascial pain
- Arthralgias, myalgias
Acupressure
- Myofascial pain
Massage
- Pain (arthralgias, myalgias)
- Myofascial pain
Transcutaneous electrical nerve stimulation (TENS)
- Neuropathic pain
- Chronic pain syndromes
NSAIDs and acetaminophen
- Pain
Cold, heat
- Neuropathic pain
- Pain (arthralgias, myalgias)
Ultrasonic stimulation
- Pain (arthralgias, myalgias)
- Myofascial pain
Recommendations for treating pain:
Grade C: recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences
Acupuncture
Healing touch
Hypnosis
Music therapy
Insufficient evidence
Vitamin D2
Cognitive and behavioral therapy
Electrical nerve stimulation
Massage
Myofascial release
Reflexology
Strong recommendation
Acupuncture when pain is poorly controlled
Energy therapies including Therapeutic Touch, healing touch, reiki, polarity therapy, external qigong, and electromagnetics
Massage delivered by an oncology-trained massage therapist as part of multimodality treatment
Mind-body therapies including meditation, yoga, tai chi, autogenic training hypnosis, relaxation techniques, imagery, music therapy, other forms of expressive arts therapies as part of a multidisciplinary approach to reduce chronic pain
Psychosocial therapies including support groups, supportive/expressive therapy, cognitive-behavioral therapy, and cognitive- behavioral stress management as part of a multidisciplinary approach to reduce chronic pain
Weak recommendation
Acupuncture for pain after thoracotomy
Researchers from these organizations came to consensus on these recommendations.
For general cancer pain or musculoskeletal pain:
- Acupuncture may be offered to patients experiencing general pain or musculoskeletal pain from cancer (moderate recommendation).
- Massage may be offered to patients experiencing chronic pain following breast cancer treatment (moderate recommendation).
- Reflexology or acupressure may be offered to patients experiencing pain during systemic therapy for cancer treatment (moderate recommendation).
- Guided imagery with progressive muscle relaxation may be offered to patients experiencing general pain from cancer treatment (weak recommendation).
- Hatha yoga may be offered to patients experiencing pain after treatment for breast or head and neck cancers (weak recommendation).
- Insufficient evidence to make a recommendation regarding aromatherapy, music therapy, or virtual reality therapy
For Aromatase inhibitor–related joint pain:
- Acupuncture should be offered to patients experiencing AI-related joint pain in breast cancer (moderate recommendation).
- Yoga may be offered to patients experiencing AI-related joint pain in breast cancer (weak recommendation).
For chemotherapy-induced peripheral neuropathy (CIPN):
- Acupuncture may be offered to patients experiencing chemotherapy-induced peripheral neuropathy from cancer treatment (weak recommendation).
- Reflexology or acupressure may be offered to patients experiencing chemotherapy-induced peripheral neuropathy from cancer treatment (weak recommendation).
- Insufficient evidence to make a recommendation regarding glutamine, omega-3 fatty acids
For procedural or surgical pain:
- Hypnosis may be offered to patients experiencing procedural pain in cancer treatment or diagnostic workups (moderate recommendation for adults,but insufficient evidence for recommendation with children)
- Acupuncture or acupressure may be offered to patients undergoing cancer surgery or other cancer-related procedures such as bone marrow biopsy (weak recommendation)
- Music therapy may be offered to patients experiencing surgical pain from cancer surgery (weak recommendation for adults,but insufficient evidence for recommendation with children)
- Insufficient evidence to make a recommendation regarding aromatherapy, guided imagery with progressive muscle relaxation, massage, meditation, reflexology, or virtual reality therapy
For oral mucositis:
- Insufficient evidence to make a recommendation regarding botanical teas, chamomile, curcumin, glutamine, mouthwash, or propolis.
For pain during palliative care:
- Massage may be offered to patients experiencing pain during palliative and hospice care (moderate recommendation).
- Insufficient evidence to make a recommendation regarding aromatherapy, guided imagery with progressive muscle relaxation, hypnosis, meditation, or music therapy
For pain during radiation therapy:
- Insufficient evidence to make a recommendation regarding hypnosis
Published programs and protocols
These protocolsa package of therapies combining and preferably integrating various therapies and practices into a cohesive design for care, programs, and approaches by leaders in integrative cancer care provide guidance for managing pain.
We do not recommend specific integrative protocols or programs but provide information for you to evaluate with your healthcare team.
Lise Alschuler, ND, FABNO, and Karolyn Gazella
Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010
Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions including pain.
Keith Block, MD
Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.
The integrative Block Program has recommendations to people who are at different places along the cancer continuum:
- Those who’ve been recently diagnosed
- Those in treatment
- Those who’ve concluded treatment and need to remain vigilant to prevent recurrence
Barbara MacDonald, ND, LAc
MacDonald B. The Breast Cancer Companion—A Complementary Care Manual: Third Edition. Self-published. 2016.
Naturopathic physician Barbara MacDonald provides information about breast cancer, its conventional treatment, and natural approaches to enhancing treatment, managing side effects, reducing risk of recurrence, and healthy living after cancer treatment is completed.
Neil McKinney, BSc, ND
McKinney N. Naturopathic Oncology, Fourth Edition. Victoria, BC, Canada: Liaison Press. 2020.
This book includes descriptions and uses of many natural and complementary protocols for cancer in general and for specific cancers. It also includes information on integrative support during conventional cancer treatment.
Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO
Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Medicatrix Holdings Ltd. 2020.
This book provides information on the treatment of 24 cancers, plus the most effective treatments of the most common symptoms affecting cancer patients while they undergo chemotherapy, radiotherapy, or surgery.
Traditional medicine
Practitioners of traditional Chinese medicine offer therapies and approaches to manage pain, some of which are recommended in this section under both clinical practice guidelines and other recommendations.
Ayurvedic medicine includes therapies and approaches to treat pain.
Other recommendations
Conditionally recommended supplements and dietary ingredients:
- Avocado soybean unsaponifiables
- Capsaicin
- Curcuma
- Ginger (as a food source)
- Glucosamine
- Melatonin
- Polyunsaturated fatty acids
- Vitamin D
No recommendation regarding use:
- Boswellia
- Ginger (as a dietary supplement)
- Rose hip
- S-adenosyl-L-methionine
Recommendation against use:
- Collagen
- Creatine
- Devil’s claw
- L-carnitine
- Methylsulfonylmethane
- Pycnogenol
- Willow bark extract
- Vitamin E
A survey of experts in Hong Kong
A group of experts evaluated hyperthermia plus Gui-dan-san-zi-san herbal mixture for pain in patients undergoing radiotherapy. Consensus for a recommendation was not reached due to concerns regarding safety of applying hyperthermia.