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Psychological, rehabilitative, and integrative therapies for cancer pain

E Alessandra Strada, PhD, MSCP, FT
Russell K Portenoy, MD
Section Editor
Janet Abrahm, MD
Deputy Editor
Diane MF Savarese, MD


Pain is one of the most feared consequences of cancer and cancer treatment. Among hospitalized patients with cancer, the prevalence of pain is from 62 to 86 percent [1]. Although it has been suggested that adequate pain relief can be achieved in 70 to 90 percent of patients when well-accepted treatment guidelines for cancer pain are followed, the availability of effective therapy has not eliminated the problem of undertreatment. A systematic review concluded that among patients with advanced cancer, pain levels are reported as moderate to severe in about 40 to 50 percent, and very severe or excruciating in 25 to 30 percent [2]. (See "Cancer pain management: General principles and risk management for patients receiving opioids", section on 'The problem of undertreatment'.)

Pain affects the psychological, cognitive, social, and spiritual domains of patients' lives; in turn, the experience of pain can be influenced by emotional, cognitive, social, and spiritual factors. The burden of pain is manifested not only through suffering, but also through impaired function, decreased activity, and alterations in one’s sense of identity and social role [3]. Uncontrolled or poorly relieved cancer pain has a profoundly negative impact on quality of life, and it increases suffering for caregivers as well.

Thus, the adverse effects of cancer pain are complex and highly individual. In some cases, patients suffer from mood effects (anxiety or depression), or from inability to do their jobs, hobbies, or other functions because of uncontrolled pain. In other cases, it is the meaning attributed to pain which drives suffering. The common assumption that pain is an indicator of progressive illness can cause increased fear and emotional distress for patients and caregivers alike.  

Pain and its associated outcomes may be ameliorated by a diverse array of interventions. Opioid-based pharmacotherapy is a mainstay of treatment for moderate to severe pain in patients with active cancer. In appropriate patients, nonpharmacologic strategies may provide satisfactory pain relief with fewer drug side effects, and/or better outcomes with regard to physical and psychosocial functioning, and some patients prefer to try nonpharmacologic approaches first. (See "Cancer pain management: General principles and risk management for patients receiving opioids", section on 'General principles of pain management' and "Cancer pain management with opioids: Optimizing analgesia".)

Nonpharmacologic therapies for cancer pain include primary treatments for the etiology of the pain (eg, radiotherapy), invasive symptomatic therapies (eg, nerve blocks), and noninvasive symptomatic therapies. (See "Cancer pain management: Interventional therapies".)


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