Hökkä, M., Kaakinen, P., & Pölkki, T. (2014). A systematic review: Non-pharmacological interventions in treating pain in patients with advanced cancer. Journal of Advanced Nursing, 70, 1954–1969. 

DOI Link

Purpose

STUDY PURPOSE: To provide information on the benefits and safety on nonpharmacologic interventions in managing pain for patients with advanced cancer 
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: CINAHL, MEDIC, MEDLINE, and PsycINFO
 
KEYWORDS: Palliative care, hospice care, terminally ill, complementary therapies or nonpharmacological, and neoplasms or cancer and pain or pain management
 
INCLUSION CRITERIA: Main focus on nonpharmacologic interventions for treating pain; palliative, hospice, or end-of-life patients with cancer; adults; English, Swedish, or Finnish language
 
EXCLUSION CRITERIA: Those not meeting inclusion criteria

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 444
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Collaboration risk of bias assessment tool

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 11 (nine randomized, controlled trials and two quasiexperimental designs)
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,033
  • SAMPLE RANGE ACROSS STUDIES: 9–385 patients
  • KEY SAMPLE CHARACTERISTICS: All had advanced cancer

Phase of Care and Clinical Applications

PHASE OF CARE: End of life care
 
APPLICATIONS: Palliative care

Results

Interventions included massage or aromatherapy massage (five studies), physical therapy and massage (one study), transcutaneous electrical nerve stimulation (TENS, one study), acupuncture (one study), reflexology (one study), warm water footbath (one study), biofeedback-assisted relaxation (one study), and varied strategies of relaxation and imagery with nature sounds (one study). The effectiveness of massage was mixed, TENS had the potential to reduce pain on movement, acupuncture reduced pain immediately after the intervention but the benefit was transient, reflexology showed no effect, relaxation with biofeedback was beneficial, and psychoeducational and behavior strategies had only a short-term effect. Most studies were found to have a relatively high risk of bias.

Conclusions

There was insufficient evidence to draw firm conclusions about the effectiveness of nonpharmacologic interventions to reduce pain among patients with advanced cancer.

Limitations

  • Very few studies included for most of the specific interventions
  • High risk of bias of studies were included

Nursing Implications

Treating pain is a high priority among patients with advanced cancer receiving palliative care. The effectiveness of many nonpharmacologic interventions is unclear and warrants additional well-designed research. Most of the evidence involved studies in inpatient settings. Additional research among outpatients and those receiving palliative care in the home is needed. Nonpharmacologic interventions are generally low-risk. The identification of approaches than can facilitate reductions in pain would be beneficial for patients with cancer-related pain.

Legacy ID

5560