What Are the Newest Guidelines for Nonpharmacologic Management of Cancer Pain?

I did not copy the entire article, but there is a hyperlink if anyone wants to read the whole “piece of pain mis-management for cancer pts “


What Are the Newest Guidelines for Nonpharmacologic Management of Cancer Pain?


Clinical Context

Pain is a leading, disabling symptom among patients with cancer,

resulting from tumor burden or invasion of bones, muscles, or nerves. Many cancer treatments, including surgery, chemotherapy, radiotherapy, immunotherapy, or hormonal therapy can result in acute and chronic pain conditions, including aromatase inhibitor (AI)-induced joint pain or chemotherapy-induced peripheral neuropathy (CIPN) pain.

The Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO®) panel included experts in integrative, medical, radiation, surgical, and palliative oncology; social sciences; mind-body medicine; nursing; and patient advocacy. Literature search identified 227 relevant studies (systematic reviews, meta-analyses, and randomized controlled trials [RCTs] from 1990 to 2021 to inform consensus- and evidence-based recommendations.

Study Synopsis and Perspective

New guidelines highlight the role that integrative pain management techniques, such as massage, acupuncture, and music therapy, can play in relieving certain types of cancer pain in adults.

The recommendations,[1] published earlier this month in the Journal of Clinical Oncology, represent a joint effort between the American Society of Clinical Oncology (ASCO®) and the Society of Integrative Oncology (SIO) to guide cliniciansicians how to best weave various nonpharmacologic pain management strategies into cancer care.

“Pain is a clinical challenge for many oncology patients and clinicians, and there’s a growing body of evidence showing that integrative therapies can be useful in pain management,” Heather Greenlee, ND, PhD, explained in a press release.[2]

Still, clear clinical guidance as to when and when not to use these approaches is lacking, said Greenlee, co-chair of the SIO Clinical Practice Guideline Committee.

Previous guidelines from ASCO® on managing chronic cancer-related pain[3] largely focused on diagnosing pain and on pharmacologic interventions, and they only touched on evidence related to nonpharmacologic options.

The new guideline[1] “takes a deeper dive on the use of integrative therapies, which is important because clinicians and patients need to have access to the latest evidence-based information to make clinical decisions,” Jun H. Mao, MD, SIO-ASCO® panel co-chair, noted.

In the guidance, the expert panel addresses 2 core questions: What mind-body therapies are recommended for managing pain experienced by adult and pediatric patients diagnosed with cancer, and what natural products are recommended for managing pain experienced by adult and pediatric patients diagnosed with cancer?

The panel conducted a literature search and identified 227 relevant studies. They included systematic reviews and randomized controlled trials published between 1990 and 2021 that evaluated outcomes related to pain intensity, symptom relief, and adverse events. After reaching a consensus, the expert panel made recommendations on the basis of the strength of the available evidence.

Regarding modalities for which there was stronger evidence, the panel highlighted several recommendations regarding acupuncture, reflexology, hypnosis, and massage.

The panel determined, for instance, that acupuncture should be offered for aromatase-related joint pain in patients with breast cancer and that it can be offered for general or musculoskeletal pain from cancer. It recommended reflexology or acupressure for pain experienced during systemic therapy for cancer.

Hypnosis is an option for patients experiencing procedural pain in cancer treatment or diagnostic workups, and massage is an option for pain experienced during palliative or hospice care or after breast cancer treatment.

These recommendations were considered moderate in strength and were based on intermediate levels of evidence that demonstrated that the benefits outweighed risks.

The panel added several recommendations it deemed to be weak in strength and that were based on low-quality evidence. These include Hatha yoga for patients experiencing pain after treatment for breast or head and neck cancers, and music therapy for patients experiencing pain from cancer surgery.

The experts also identified areas “potentially relevant to cancer care but needing more research,” such as the safety and efficacy of natural products, including omega-3 fatty acids and glutamine, and determined that there is insufficient or inconclusive evidence to make recommendations for pediatric patients.

“With improved oncology treatments such as immunotherapy and targeted therapy, more patients diagnosed with cancer are living longer; therefore, pain and symptom management is critical for improving quality of life,” Mao, chief of integrative medicine at Memorial Sloan Kettering Cancer Center, New York, New York, told Medscape Medical News. “The SIO-ASCO clinical guideline will provide very timely recommendations for physicians to incorporate nonpharmacological treatments such as acupuncture and massage to improve pain management for patients impacted by cancer.”

Nonetheless, clinical uptake of such treatments “is always a concern,” said panel co-chair Eduardo Bruera, MD, of The University of Texas MD Anderson Cancer Center, Houston, Texas. “We are hoping that by showing the growing evidence that is out there, healthcare systems will start hiring these kinds of practitioners and insurance systems will start covering these treatments, because more and more, these are being shown to be effective at managing pain for cancer populations,” Bruera said.

6 Responses

  1. Music therapy for cancer that’s just as bad as being told aroma therapy via lighting a candle will cure all my intractable pain issues from EDS. Sometimes I want to just SLAP the piss out of the anti-opioid zealots.

  2. U know,thank god this is America,where we can agree to dis-agree.JMO,,I don’t think were ,”pill mills,” for the very reason of the word truth.Unless someone KNOWS the medical history of those whom those MEDICINE were prescribed from any pharmacy,,the truth is,,no-one can determine any as a ,”pill mill,”.Truth should matter!!!! I means its kinda like Kolodny making the assumption, we are all just addicts and opiates are the drug from hell.Unless that man knew every single one of our medical history,factually,truthfully he had no right to take our medicine away,along w./the dea etc and kill us….Truth shoud matter,,,not agenda..and by making statements like ,”pill mills,” w/out knowing the medical history of all those prescribed the medicine opiates,,jmo,,were just giving ,”them” ammo,,,against us,,based on a lies,or personal opinion,,not truth,,,,jmo,,maryw

  3. Not everyone has the time or money to participate in alternative treatment. Many may still want/need to work. Pain meds are the effective treatment. Maybe we should go back to the dr/patient relationship, and let the dr treat each individualized patient. Forcing alternative treatments on a patient is never good medicine.

  4. Despicable that safe fda approved pain medication is not mentioned with cancer patients! Goes to show how low medical community have sunk..No empathy to the patients they serve!! No new evidence here only more medical community being taught to ignore all pain patients

    • IMO… in my lifetime – I’m 75 y/o – the practice of medicine has drifted toward the science of medicine and the DEA was created in 1973 and they have taken advantage of such shift because even today .. our healthcare system has no tests that can determine if a pt is dealing with subjective diseases (pain, anxiety, depression, ADD/ADHD, various mental health issues).. When the mafia in the USA got out of the “drug business” and the Mexican cartels took over.. the cartels were known to shoot/kill anyone who messed with their business plan.. Congress doesn’t get any credit for assisting in the opiate crisis with their 2000 Decade of Pain Law that encouraged the proper treatment of pain. When it expired in 2010 the political party in majority of Congress had flipped and was not renewed.. That law probably caused a fair amount of lazy prescribing of opiates for pain and probably caused a even larger lacked oversight of refills of those prescriptions. Pill mills seemed to grow substantially, particularly in Florida, which did not have a PDMP at the time. The 2016 CDC opiate dosing guidelines gave the DEA a concept that they could declare what is a standard of care and best practices for treating pain.. and they seem to go after any doc that was prescribing pts greater than 90 MME/day… and apparently came to the conclusion that level of opiate prescribing was really being a pill mill … because the prescriber could not provide any tests/documentation that the pt actually needed that many MME/day… other than what the pt said their pain level was …. and seemingly the DEA has claimed that all chronic pain pts just exaggerate the intensity of their pain… to get pain meds – because they were all addicted.

      • Speaking of pill mills you should get on the Republican Party trail and follow Florida doctors who were there when “pill prescription drugsmills” were a big deal. It turns out that political favor brought the people substance abuse! Just in time before all those “pill mills” ran out of prescription drugs!

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