Nonpharmacological interventions with chronic cancer pain in adults

Experiences of cancer survivors with chemotherapy-induced peripheral neuropathy in the Netherlands: symptoms, daily limitations, involvement of healthcare professionals, and social support

PURPOSE

A significant proportion of cancer patients suffer from chemotherapy-induced peripheral neuropathy (CIPN). This descriptive study aimed to examine patients' experience of CIPN symptoms, daily limitations, involvement of healthcare professionals, and social support.

METHODS

Cross-sectional data have been collected in the Netherlands via a national online questionnaire comprising closed items only (February 2021).

RESULTS

Out of 3752 respondents, 1975 received chemotherapy only (i.e., without targeted therapy) and were therefore included. The majority (71.2%) reported symptoms in both hands and feet (e.g., tingling and loss of sensation or diminished sensation). Participants reported most limitations in household chores, social activities, hobbies, sports, walking, and sleeping and least in family/(taking care of) children, cycling, driving, self-care, eating and drinking, and sexuality and intimacy. Many patients indicated that their healthcare professionals informed them about the possibility of CIPN development before treatment (58.4%), and they paid attention to CIPN during and after treatment (53.1%). However, many patients (43%) reported a lack of information on what to do when CIPN develops. Few participants (22%) visited their general practitioner (GP) for CIPN. In general, patients' social environments sometimes to always showed empathy to patients.

CONCLUSIONS

Symptoms of CIPN are frequently reported and can result in various daily limitations. Support from professionals and peers is crucial in managing CIPN, which is sometimes lacking. Appropriate guidance and support should be provided to patients to decrease the impact of CIPN on daily life. Future research should investigate differences in chemotherapeutic agents and the resulting symptoms and consequences.

Efficacy of Essential Oils in Relieving Cancer Pain: A Systematic Review and Meta-Analysis

Over 80% of patients affected by cancer develops cancer-related pain, one of the most feared consequences because of its intractable nature, particularly in the terminal stage of the disease. Recent evidence-based recommendations on integrative medicine for the management of cancer pain underline the role of natural products. The present systematic review and meta-analysis aims at appraising for the first time the efficacy of aromatherapy in cancer pain in clinical studies with different design according to the most updated Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 recommendations. The search retrieves 1002 total records. Twelve studies are included and six are eligible for meta-analysis. The present study demonstrates significant efficacy of the use of essential oils in the reduction of the intensity of pain associated with cancer (p < 0.00001), highlighting the need for earlier, more homogeneous, and appropriately designed clinical trials. Good certainty body of evidence is needed for effective and safe management of cancer-related pain using essential oils by establishment of a step-by-step preclinical-to-clinical pathway to provide a rational basis for clinical use in integrative oncology. PROSPERO registration: CRD42023393182.

Topical Traditional Chinese Medicines for Cancer Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND AND OBJECTIVES

Safe and effective management of cancer-related pain is a worldwide challenge. In the search for treatment options, natural products used in Chinese herbal medicines (CHMs) have received attention in clinical studies for their effects on cancer-related pain. The objective of this systematic review is to evaluate the clinical evidence for topically applied CHMs as adjunctive treatments for cancer pain management.

METHODS

Nine biomedical databases and 4 clinical trial registries were searched for randomized-controlled trials (RCTs) that reported measures of pain and/or quality of life. Risk of bias was assessed using the Cochrane tool. Meta-analysis employed mean difference (MD) with 95% confidence intervals (random effects).

RESULTS

Twenty (20) RCTs (1636 participants) met the inclusion criteria. Meta-analyses were grouped based on the comparisons and outcome measures. For pain intensity, there was a greater reduction in the topical CHM group versus placebo (MD -0.72 [-1.04, -0.40]), no difference when compared to tramadol (MD -0.15 [-0.38, 0.08]), and a greater reduction when topical CHMs were combined with conventional analgesic medications (MD -0.67 [-0.93, -0.40]). Analgesic onset time was reduced in the CHM group compared to tramadol (MD -26.02 [-27.57, -24.47] minutes), and for CHMs combined with conventional medications (MD -19.17 [-21.83, -16.52] minutes). When CHMs were combined with analgesic medications, improvements were found for duration of analgesia (MD 1.65 [0.78, 2.51] hours), analgesic maintenance dose (MD -31.72 [-50.43, -13.01] milligrams/day), and quality of life.

CONCLUSION

Addition of topical CHMs to conventional analgesic medications was associated with improved outcomes for pain intensity, some other pain-related outcomes, and measures of quality of life. Limitations included methodological issues in some studies and considerable heterogeneity in some pooled results.

Increased pain catastrophizing longitudinally predicts worsened pain severity and interference in patients with chronic pain and cancer: A collaborative health outcomes information registry study (CHOIR)

OBJECTIVE

Little is known about how changes in psychosocial factors impact changes in pain outcomes among patients with cancer and chronic pain. This longitudinal cohort study of cancer patients investigated the relationships between changes in psychosocial factors and changes in pain severity and interference over time.

METHODS

Data from patients with cancer and chronic pain (n = 316) treated at a tertiary pain clinic were prospectively collected. At their baseline visit (Time 1), patients provided demographic and clinical information, and completed validated psychosocial and pain assessments. Psychosocial and pain assessments were repeated at a follow-up visit (Time 2), on average 4.9 months later. Change scores (Time 2-Time 1) were computed for psychosocial and pain variables. Multivariable hierarchical linear regressions assessed the associations between changes in psychosocial factors with changes in pain outcomes over time.

RESULTS

Participants were an average age of 59 years, were 61% female, and 69% White. Overall, a decrease in pain severity (p ≤ 0.001), but not pain interference, was observed among the group over time. In multivariable analyses, increased pain catastrophizing was significantly associated with increased pain severity over time (β = 0.24, p ≤ 0.001). Similarly, increased pain catastrophizing (β = 0.21, p ≤ 0.001) and increased depression (β = 0.20, p ≤ 0.003) were significantly associated with increased pain interference over time. Demographic and clinical characteristics were not significantly related to changes in pain outcomes.

CONCLUSIONS

Increased pain catastrophizing was uniquely associated with increased chronic pain severity and interference. Our findings indicate that cancer patients with chronic pain would likely benefit from the incorporation of nonpharmacological interventions, simultaneously addressing pain and psychological symptoms.

Are nurses utilizing the non-pharmacological pain management techniques in surgical wards?

The non-pharmacological pain management therapies have a valuable effect in managing moderate to mild pain intensity, especially if demonstrated in the pre-operative phase. The study aimed to explore the nurses’ practice toward using non-pharmacological pain management techniques in surgical wards. In a cross-sectional research design, a convenient sample of 47 nurses in the surgical wards in Egyptian hospital (Third Level) participated in the study. Data gathered using modified Non-pharmacological Methods Questionnaire. Results of the study indicated that nurse’s perception regarding applying the cognitive-behavioral methods as a distraction and Positive reinforcement techniques were more common (68.1%,53.2%), whereas most of them used emotional support (93.6%) and preferred to demonstrate physical methods. Meanwhile, nurses addressed the barriers to apply nonpharmacological pain management as lack of time, patient unwillingness, and patients’ health beliefs. Nevertheless, nurses reported the non-pharmacological pain management is less expensive and has fewer side effects than medication and can demonstrated post-discharge. Nurses play a key role in applying effective and different non-pharmacological therapies in surgical wards. Thus, nurses should be encouraged to demonstrate the non-pharmacological pain management therapies with patients undergoing surgical procedures.

Nonpharmacological Interventions for Pain Management in Lung Cancer Patients: A Systematic Review

Background:

The presence of lung cancer is almost always associated with pain, a symptom that causes severe distress in patients. Although many pharmacological methods are available to manage pain in this oncologic population, the medications often cause undesirable sideeffects and inadequate relief. Nonpharmacological interventions can be used as adjuvants to pharmacological interventions in reducing pain and increasing quality of life.

Objectives:

The purpose of this review is to compare the efficacy of nonpharmacological interventions in reducing pain in lung cancer patients.

Materials and Methods:

This is a systematic review study guided by the Preferred Reporting Items of Systematic reviews and Meta-Analysis Protocol. Interventions identified in the present systematic review have been categorized as physical treatment, technologybased, cognitive behavioral, coping, and coaching.

Results:

Results indicate that the nonpharmacological interventions such as physical treatment interventions, selfmanagement and coaching interventions, cognitive behavioral interventions, and technologybased interventions or coping skills interventions had limited and shortterm effects on alleviating pain among the patients. However, previous studies have provided limited evidence regarding nonpharmacologic therapy due to the lack of a comparison group, small sample sizes, and lack of longterm followup periods to determine whether sustained effects are feasible.

Conclusion:

Healthcare professionals should consider additional research on the added advantage of utilizing the nonpharmacological interventions as an adjunct option while managing pain in lung cancer patients.

Knowledge and Attitude Towards Non-Pharmacological Pain Management and Associated Factors Among Nurses Working in Benishangul Gumuz Regional State Hospitals in Western Ethiopia, 2018

BACKGROUND

Millions of people worldwide are suffering from pain. Non-pharmacological therapy has an important role in the treatment of pain and is recognized as a valuable, simple help to lower the dosage of analgesic drugs needed, decreasing the side effects, reducing drug dependency and reducing health care costs; however, knowledge and attitude of nurses greatly affect the use of non-pharmacological pain management methods.

OBJECTIVE

The study aimed to assess knowledge and attitude towards non-pharmacological pain management and associated factors among nurses working in Benishangul Gumuz Regional State Hospitals, western Ethiopia, 2018.

METHODS

Institution-based cross-sectional study was conducted from April 1st to May 1st, 2017. Two hundred sixteen nurses were selected by using simple random sampling. Data were collected by using a pretested self-administered structured questionnaire. Collected data were checked, coded and entered to Epi-Info version 7 and exported to SPSS version 20 for further analysis. Bivariable and multivariable logistic regression was used.

RESULTS

A total of 209 professional nurses participated in the study, a 96.7% response rate. This study shows that 51.2% (95% CI: 51.1-51.3) of nurses had adequate knowledge and 47% (95% CI: 46.9-47.06) of nurses had a favorable attitude towards non-pharmacological pain management. The findings reveal that level of qualification (AOR=12.2 (3.05, 48.4)), taking educational courses (AOR=7.5 (2.7, 21.24)), nurse to patient ratio (AOR=4.9 (1.64, 14.55)) and work experience were factors significantly associated with knowledge. Findings also show that nurse to patient ratio (AOR=10.36 (2.8, 38.4)), training (AOR=4.6 (1.4, 15.4)) and knowledge of non-pharmacological pain management (AOR=4.3 (1.74, 10.56)) were significantly associated with nurses' attitude to non-pharmacological pain management.

CONCLUSION AND RECOMMENDATIONS

Nurses in Benishangul Gumuz regional state hospitals have unfavorable attitude, but they have relatively adequate knowledge about non-pharmacological pain management. Work experience, level of education, nurse to patient ratio and taking educational courses were associated with nurses' knowledge, and nurse to patient ratio, training, and knowledge of non-pharmacological pain management were associated with nurses' attitude. Therefore, efforts should focus on innovative educational strategies for nurses, training and achieving a 1:6 nurse to patient ratio.

Risk of prolonged opioid use among cancer patients undergoing curative intent radiation therapy for head and neck malignancies

OBJECTIVE

Patients undergoing radiation treatment (RT) for head and neck malignancies often suffer significant disease- and treatment-related pain requiring opioids for effective management. However, the prevalence and associated risk factors of prolonged opioid use in this population remain poorly characterized. We sought to quantify the rate of prolonged opioid use among opioid naïve patients receiving curative-intent RT for head and neck malignancies and to identify associated risk factors.

METHODS

We retrospectively identified patients who had undergone RT for head and neck malignancies at our institution between Jan 2011 and Sept 2017. Our primary endpoint was persistent opioid use 6-months following completion of RT. Patients were included if they were opioid-naïve, underwent curative intent RT, had adequate follow-up, and did not have residual or recurrent disease within our follow-up period. Univariable and multivariable logistic regression was utilized to identify risk factors for prolonged opioid use.

RESULTS

We identified 311 patients meeting our inclusion criteria; 40 (12.9%) continued to use opioids 6-months following RT. Univariable analysis found current smoking, alcohol abuse, RT dose, treatment to the bilateral necks, induction chemotherapy, concurrent chemotherapy, PEG tube, daily milligram morphine equivalents, and adjuvant analgesic medication use to be positively associated with prolonged opioid use; prior surgery was negatively associated with prolonged opioid use. Delivery of induction chemotherapy (OR 2.86, CI (95%) 1.32-6.21) and alcohol abuse (OR 3.75, CI (95%) 1.66-8.47) remained statistically significant on multivariable analysis.

CONCLUSION

The prevalence of prolonged opioid use in previously opioid naïve patients undergoing curative intent head and neck RT was just under 13%. Patients with history of alcohol abuse and those who undergo induction chemotherapy were most at risk.

Knowledge on Nonpharmacological Methods of Pain Management among Nurses at Bindura Hospital, Zimbabwe

This study is a quantitative descriptive study, which was conducted with an aim to assess the knowledge on nonpharmacological methods of pain management among registered general nurses at Bindura Hospital. This is because most nurses focus more on pharmacological pain management than nonpharmacological therapies which are given less attention or accord. This study used a descriptive study design, which is a nonexperimental research design so as to obtain information about registered nurses knowledge on nonpharmacological pain management. A convenience sampling technique was utilised to select a sample of seventy-five participants. Data were collected by the researcher who distributed self-administered questionnaires to available registered nurses after obtaining informed consent at Bindura Provincial Hospital. The mean knowledge score for this study was 48.6% and was below a pass mark of 50% and far below 80% which is the minimal acceptable level of knowledge on the Nurses Knowledge and Attitude Scale. A minimum knowledge score of 16% was obtained from participants showing lack of knowledge on indications of nonpharmacological pain therapies and a maximum knowledge score of 97.3% was shown on knowledge on nonpharmacological techniques. The following conclusion was drawn from the research findings; the study showed that the nurses have poor knowledge regarding nonpharmacological pain management as indicated by mean knowledge score of 48.6%. The researcher therefore recommends that the nursing practice should take an initiative in ensuring that all practicing nurses practice the highest possible pain management nursing care and that opportunities should be made available for nurses to be educated in effective pain management utilising nonpharmacological therapies.

Strategies of Coping with Pain in Cancer on the Basis of Lung, Breast, Colorectal, and Prostate Carcinoma

BACKGROUND

The selection of an illness coping strategy has a major effect on the quality of life preconditioned by health status.

OBJECTIVES

The objective of the study was to assess the influence of the primary site and socioeconomic factors on strategies of coping with pain in patients diagnosed with breast, lung, colorectal, and prostate carcinoma.

METHODS

The study included 902 patients treated at the outpatient's department of the Maria Sklodowska-Curie Memorial Cancer Center-Institute of Oncology in Warsaw. A questionnaire included demographic-type questions and the Coping Strategy Questionnaire (CSQ) designed to assess patient use of strategies of coping with pain.

RESULTS

The best results in six of the seven CSQ subscales were observed in the colorectal patient group. The lowest scores in all CSQ subscales were recorded in patients with prostate as the primary site. Results in individual patient groups were further juxtaposed with a chemotherapy variable. The only differences were found in the colorectal primary site patient group.

CONCLUSIONS

A strategy the patient selects in order to cope with disease considerably mediates both pain sensation and the quality of patient life. The study findings demonstrate that CSQ scores are significantly differentiated by the primary site, education, and income.

General Practitioners and Chronic Non-Malignant Pain Management in Older Patients: A Qualitative Study

Chronic non-malignant pain (CNMP) is commonly managed by General Practitioners (GPs) in primary care. Analgesics are the mainstay of CNMP management in this setting. Selection of medications by GPs may be influenced by micro factors which are relevant to the practice setting, meso factors which relate to the local or regional environment or macro factors such as those arising from national or international influences. The aim of this study is to explore influences on GP practises in relation to pain management for older adults with CNMP. Semi-structured interviews were conducted with 12 GPs. Transcripts were organised using the Framework Method of Data Management while an applied thematic analysis was used to identify the themes emerging from the data. Clinical considerations such as the efficacy of analgesics, adverse effects and co-morbidities strongly influence prescribing decisions. The GPs interviewed identified the lack of guidance on this subject in Ireland and described the impact of organisational and structural barriers of the Irish healthcare system on the management of CNMP. Changes in practice behaviours coupled with health system reforms are required to improve the quality and consistency of pharmacotherapeutic management of CNMP in primary care.

Psychological treatment for pain among cancer patients by rational-emotive behavior therapy--efficacy in both India and Iran

The aim of the present study is to find out the influence of rational-emotive behavior therapy (REBT) on pain intensity among cancer patients in India and Iran. The study followed a quasi-experimental, pre-post test, carried out with a sample of 88 cancer patients, aged 21-52 years, referred to the Baharat cancer hospital of Mysore in India and Shahidzade hospital of Behbahan in Iran. They were randomly assigned to the experimental (n=India 21; Iran 22) and control (n=India 22; Iran 23) groups. Pain was measured with the McGill Pain Questionnaire- MPQ (1975), the intervention by REBT has given to the experimental group for 45 days (ten sessions) and at the end of intervention, the pain of patients was again evaluated. Concerning to hypothesis of the study, two independent sample T test and three ways mixed ANOVA is used to analyze the data. Results showed that the experimental group in post test had less pain than the control group, but there were no statistically significant differences between Indian and Iranian patients in pain perception. With respect the outcome of study, it has realized that REBT can be used in hospitals and other psychological clinics to reduce the pain of cancer patients.

Oncologists’ perceptions of cancer pain management in Spain: The real and the ideal

AIM

Studies in some countries suggest that cancer pain is often not adequately controlled, but little is known about the situation in Spain. The objective of this study was to identify medical oncologists' perceptions about pain management in their patients.

METHODS

Two-round Delphi survey of 24 medical oncologists from 22 large, geographically diverse hospitals in Spain. Physicians rated each of 150 statements on a Likert scale (1=strongly disagree; 5=strongly agree). The mean, standard deviation and frequency of replies in three agreement categories were calculated for each item. Statements allowing comparison of oncologists' perceptions of how pain is managed in routine clinical practice with how it should be managed were grouped together and analyzed.

RESULTS

The most notable discrepancies between the real and the ideal occurred in the failure to provide written information or to confirm that patients understand what they are told, the lack of comprehensive and systematic evaluation of pain, and the lack of use of non-pharmacological treatments (NPTs) for cancer pain.

CONCLUSIONS

Medical oncologists need to improve their communication skills, providing patients with both written and verbal information about their disease and the plan for pain management. Pain should be evaluated at each patient visit using validated scales, and greater attention should be paid to the possible use of NPTs.

Managing acute and chronic pain in a substance abuse treatment program for the addicted individual early in recovery: a current controversy

Patients early in recovery from addictive disorders are in a tenuous position and when these individuals are stressed from acute or chronic pain they face even more challenges. Physicians are often conflicted by the desire to help the patient achieve pain control and maintain sobriety. While there have been a handful of studies examining patients in either active addiction with pain or with a more remote history of addiction with pain, there have been very few, if any, that look at treating patients during their addiction recovery process who suffer from pain. This article will examine the issue of whether it is ever appropriate to use opioid pain medications on such patients and, if so, what guidelines can be used to maximize the chances of a good outcome while minimizing the chances of causing a recurrence or exacerbation of addiction.

Preliminary results of an individually tailored psychosocial intervention for patients with advanced hepatobiliary carcinoma

BACKGROUND

A plethora of research now exists documenting the benefits of psychosocial interventions for cancer patients; however, no studies have been conducted with people diagnosed with hepatobiliary carcinoma.

METHODS

A total of 28 patients agreed to participate in the study in which 14 patients were randomized to the intervention arm of the study and 14 patients to an attention-standard of care arm. Evaluation of the benefits of the intervention was performed using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep), the Center for Epidemiological Studies-Depression, the State Trait Anxiety Index (STAI) to assess anxiety, peripheral blood leukocytes to measure immune system modulation, and survival.

RESULTS

Results indicate that patients who were randomly assigned to the intervention arm of the study reported clinically, but not statistically, significant improvements on symptoms of depression and anxiety, disease-related symptoms and treatment side effects, health-related quality of life (HRQL), and modest improvements in peripheral blood leukocytes and survival when compared with the standard of care group.

CONCLUSIONS

The findings of this study suggest that the individually tailored intervention was feasible and preliminary data suggested that the intervention may improve patients' HRQL, mood, and had modest improvements in immune system functioning and survival. Further research is needed with a larger sample size to test the statistical significance and generalizability of the individually tailored intervention.

A randomized trial of a representational intervention to decrease cancer pain (RIDcancerPain)

OBJECTIVE

Based on theories regarding cognitive representations of illness and processes of conceptual change, a representational intervention to decrease cancer pain (RIDcancerPain) was developed and its efficacy tested.

DESIGN

A two-group RCT (RIDcancerPain versus control) with outcome and mediating variables assessed at baseline (T1) and 1 and 2 months later (T2 and T3). Subjects were 176 adults with pain related to metastatic cancer.

MAIN OUTCOME MEASURES

Outcome variables were two pain severity measures (BPI and TPQM), pain interference with life, and overall quality of life. Mediating variables were attitudinal barriers to pain management and coping (medication use).

RESULTS

One hundred and fifty subjects completed the study. Subjects in RIDcancerPain (T1-T2 and T1-T3) showed greater decreases in Barrier scores than those in control. Subjects in RIDcancerPain (T1-T3) showed greater decreases in pain severity than those in control. Change in Barriers scores mediated the effect of RIDcancerPain on pain severity.

CONCLUSION

RIDcancerPain was efficacious with respect to some outcomes. Further work is needed to strengthen it.

Establishing mild, moderate, and severe scores for cancer-related symptoms: how consistent and clinically meaningful are interference-based severity cut-points?

Methods are presented to separate 16 frequently occurring cancer symptoms measured on 10-point symptom severity rating scales into mild, moderate, and severe categories that are clinically interpretable and significant for use in oncology practice settings. At their initial intervention contact, 588 solid tumor cancer patients undergoing chemotherapy reported severity on a standard 11-point rating scale for 16 symptoms. All reporting a one or higher were asked to rate on an 11-point scale how much the symptom interfered with enjoyment of life, relationship with others, general daily activities, and emotions. Factor analysis revealed that these items tapped into the same dimension, and the items were summed to form an interference scale. Cut-points for mild, moderate, and severe categories of symptom severity were defined by comparing the differences in interference scores corresponding to each successive increases in severity for each symptom. The cut-points differed among symptoms. Pain, fatigue, weakness, cough, difficulty remembering, and depression had lower cut-points for each category compared to other symptoms. Cut-points for each symptom were not related to site or stage of cancer, age, or gender but were associated with a global depression measure. Cut-points were related to limitations in physical function, suggesting differences in the quality of patients' lives. The resulting cut-points summarize severity ratings into clinically significant and useful categories that clinicians can use to assess symptoms in their practices.

A pain management program for chronic cancer-treatment-related pain: a preliminary study

A large proportion of patients may develop chronic pain following cancer treatments such as surgery, radiotherapy, or chemotherapy. These patients can experience significant levels of physical and psychological morbidity. Our aim was to investigate a cognitive-behavioral pain management program (PMP) for cancer patients with chronic treatment-related pain. Thirteen patients (1 man, 12 women; mean age 52 yrs) completed the study, 9 of whom had a history of breast cancer and had received extensive medical treatment, including surgery. A combination of physical and psychological techniques were adapted from previous work in chronic benign pain and implemented by two therapists. Interventions included education, relaxation, exercise training, and goal setting. A variety of outcomes were examined to assess general fitness, psychological distress, coping success, activities of daily living, and pain report. The median number of interventions by each therapist was 10 (4 to 15). Postintervention, there was a significant trend toward improvement in many variables, including anxiety and depression (P < .01), fitness (walking: P < .05), and coping with pain (P < .01). This was a feasibility study and has several limitations. It appears, however, that all patients had a positive outcome. Further research is now required to assess the effectiveness of this approach.

PERSPECTIVE

Results of this preliminary study are clinically relevant, as they suggest that a pain management program that uses cognitive-behavioral principles is worthy of further investigation for patients with chronic cancer-treatment-related pain.

Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy

PURPOSE

To describe a randomized trial of a cognitive behavioral intervention on reducing symptom severity among patients diagnosed with solid tumors and undergoing a first course of chemotherapy and to determine whether the intervention had an additive or interactive effect on symptom severity in the presence of supportive care medications.

PATIENTS AND METHODS

Patients (N = 237) were accrued from comprehensive and community cancer centers, interviewed, and randomly assigned to either the experimental intervention (n = 118) or conventional care (n = 119). A symptom severity index, based on summed severity scores across 15 symptoms, was the primary outcome. Each patient's site of cancer, stage at diagnosis, chemotherapy protocols, and use of supportive medications were learned from medical records.

RESULTS

Groups were equivalent at baseline, and attrition by characteristics by group was not different. The proportion of patients not receiving chemotherapy at 10 and 20 weeks did not differ by group. At the 10- and 20-week observations, there was a significant interaction between the experimental group and baseline symptom severity. Patients in the experimental group who entered the trial with higher symptom severity reported significantly lower severity at 10 and 20 weeks. Controlling for chemotherapy treatment status at follow-up and supportive care medications did not alter the effect of the experimental intervention.

CONCLUSION

Compared with conventional care alone, the experimental intervention was effective among patients who entered the trial with higher levels of symptom severity. Age, sex, site or stage of cancer, and supportive medications did not modify the effect of this cognitive behavioral intervention on symptom severity.

Meta-analysis of the effect of psychoeducational interventions on pain in adults with cancer

PURPOSE/OBJECTIVES

To determine the effect of psychoeducational interventions on pain in adults with cancer.

DATA SOURCES

25 intervention studies published from 1978-2001.

DATA SYNTHESIS

When analyzed across all studies, a statistically significant, beneficial effect on pain was found. However, threats to validity were present in some studies. The most serious of these involved a lack of random assignment to treatment condition and a floor effect on pain. When limited to the studies with the best methodologic quality, the effect on pain continued to be statistically significant. Effect on pain by type of treatment was examined and found to be somewhat variable and limited by the small number of studies testing each type of treatment.

CONCLUSIONS

Methodologic quality was variable. Reasonably strong evidence exists for relaxation-based cognitive-behavioral interventions, education about analgesic usage, and supportive counseling. Minimal data were available about the relative effectiveness of different types of psychoeducational interventions because few studies included within-study contrasts of different experimental interventions and usual care was not well documented.

IMPLICATIONS FOR NURSING

Psychoeducational interventions are not a substitute for analgesics, but they may serve as adjuvant therapy. Assessment and clinical judgment are critical. The intervention must be acceptable to patients and not too burdensome for patients in pain to use.

Increasing the efficacy of a celiac plexus block in patients with severe pancreatic cancer pain

The purpose of this study was to evaluate the technical possibilities of placing a catheter near the celiac plexus for performance of a celiac plexus block, and to study the efficacy of repeated neurolytic celiac plexus blocks with alcohol in patients with advanced pancreatic cancer pain resistant to opioid treatment. In 12 patients, a neurolytic celiac plexus block with alcohol, administered via an indwelling celiac catheter, was performed. To evaluate the efficacy, visual analog scale scores were recorded every day. Quality of life scores were registered before and 4 weeks following the procedure. Alterations in opioid consumption, and the time between the diagnosis of pancreatic cancer and the performance of the block, were registered. All patients were followed until they died. Two patients remained without pain after the first neurolytic celiac plexus block. In all other patients a second block was administered which provided only temporary relief. Additional intermittent administration of bupivacaine through the catheter was necessary to provide adequate pain relief in these patients. Quality of life increased significantly during the treatment. Opioid consumption decreased significantly in all patients. Our study indicates that a neurolytic celiac plexus blockade with alcohol results in a significant but short-lasting analgesic effect. The use of a celiac catheter improves the long-term management of pancreatic cancer pain.