Pain

How do integrative experts manage pain?

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

Chinese Integrative Therapy of Primary Liver Cancer Working Group

Clinical practice guidelines for the treatment of primary liver cancer with integrative traditional Chinese and Western medicine ›

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:

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment ›

Recommendations for treating pain:

Grade C: recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences

Insufficient evidence

Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals ›

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

Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions including pain.

Keith Block, MD

Barbara MacDonald, ND, LAc

Neil McKinney, BSc, ND

Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO

Traditional medicine

Other recommendations

Conditionally recommended supplements and dietary ingredients:

No recommendation regarding use:

Recommendation against use:

A survey of experts in Hong Kong

Development of evidence-based Chinese medicine clinical service recommendations for cancer palliative care using Delphi Approach based on the evidence to decision framework ›

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.

Resources

Keep reading about pain