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Cancer Pain Management - Page 2

© David Olle

Nonpharmacological strategies

Although pharmaceutical interventions help to control the physical source of the pain, the emotional and psychological state of the patient can have a large influence on the severity of the pain as perceived by the patient. Drs. Thomas and Weiss 5 have provided three areas of psychosocial intervention that social workers and psychologists should implement soon after a diagnosis of cancer, and concurrently with pharmacological treatment. In order to increase patient acceptance of these services, the physician should frame the referral for these services in a way that facilitates patient involvement.

1. Patient psychoeducation - Education of patients and family members who may be caregivers is essential to assure that they have proper attitudes and beliefs regarding pain management. This education informs the patient what to expect from the pain medication, and can include topics such as drug addiction, tolerance, side effects, respiratory depression, nausea, and constipation. Results from the application of education indicate that patients have reduced levels of anxiety and enhanced sleep. They report a reduction in pain intensity and in the perception of pain severity. The patients and their caregivers are more likely to adhere to the proper use of medication on a consistent basis.

2. Supportive psychotherapy - In this model, the therapist provides emotional support, encourages expression of feelings and thoughts, and assists in strengthening and developing coping skills. The emphasis is on social interaction instead of introspection. Spiegel and co-workers reported on a study with women with metastic breast cancer. After one year, women receiving supportive psychotherapy were significantly less tense, depressed, fatigued, and confused, compared with patients that had not received such treatment. Although there were no differences between the groups in terms of the frequency or duration of pain experiences, the treated group reported a decrease in the sensation of pain.

3. Cognitive-behavioral therapy - This model focuses on recognizing and modifying the thoughts, feelings, and behaviors that contribute to physical and emotional distress. Behavioral strategies include progressive muscle relaxation, relaxation training, and hypnosis. Cognitive strategies include guided imagery, distraction, thought monitoring, coping self-statements, and problem solving. There is actually some confusion in terms among researchers, in that hypnosis is considered relaxation-guided imagery in some studies. This technique, by the way, consistently produces a positive and large effect on cancer pain. The use of live instruction and audiotapes appear to provide additional benefits in the method.

References

1. Cleary, J. Cancer Pain Management. Cancer Control, Vol. 7, No. 2, pp. 132-141 (2000)

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