Pain (Patient) (cont.)
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Physical, Integrative, Behavioral, and Psychosocial Interventions
Noninvasive physical, integrative, thinking and behavioral, and psychological methods can be used along with drugs and other treatments to manage pain during all phases of cancer treatment. These interventions may help with pain control both directly and indirectly, by making patients feel they have more control over events. The effectiveness of the pain interventions depends on the patient's participation in treatment and his or her ability to tell the health care provider which methods work best to relieve pain.
Weakness, muscle wasting, and muscle/bone pain may be treated with heat (a hot pack or heating pad); cold (flexible ice packs); exercise (to strengthen weak muscles, loosen stiff joints, help restore coordination and balance, and strengthen the heart); changing the position of the patient; restricting the movement of painful areas or broken bones; or controlled low-voltage electrical stimulation.
Integrative interventions include massage therapy, acupuncture, and music.
Massage therapy has been studied as part of supportive care in managing cancer-related pain. Massage may help improve relaxation and benefit mood. Preclinical and clinical trials show that massage therapy may:
Physical methods to help relieve pain have direct effects on tissues of the body and should be used with caution in patients with cancer. Studies suggest that massage therapy may be safe in patients with cancer with the following precautions:
(For more information on massage, see Exercise 2 in the following section.)
Acupuncture is an integrative intervention that applies needles, heat, pressure, and other treatments to one or more places on the skin called acupuncture points. Acupuncture may be used to manage pain, including cancer-related pain. See the PDQ summary on Acupuncture for more information.
Music interventions may help relieve pain and decrease anxiety in some patients. Music has been used to relieve pain caused by the cancer and by procedures and treatments. Studies have reported that music may work on areas of the brain that increase pleasant feelings and decrease unpleasant responses. Favorite music from the patient's own collection has been shown to help the most. Music that begins before a procedure is more effective than music that begins during or after a procedure. Music may be used along with pain medicine.
There are two main types of music intervention, music therapy and music medicine:
The use of music for pain related to cancer is still being studied.
Music is also used in relaxation exercises. See the next section, on Thinking, Behavioral, and Psychosocial Interventions.
Thinking, Behavioral, and Psychosocial Interventions
Thinking, behavioral, and psychosocial interventions are also important in treating pain. These interventions help give patients a sense of control and help them develop coping skills to deal with the disease and its symptoms. Beginning these interventions early in the course of the disease is useful so that patients can learn and practice the skills while they have enough strength and energy. Several methods should be tried, and one or more should be used regularly.
The following relaxation exercises may be helpful in relieving pain.
Exercise 1. Slow rhythmic breathing for relaxation *
Exercise 2. Simple touch, massage, or warmth for relaxation *
Especially for the elderly person, a back rub that effectively produces relaxation may consist of no more than 3 minutes of slow, rhythmic stroking (about 60 strokes per minute) on both sides of the spine, from the crown of the head to the lower back. Continuous hand contact is maintained by starting one hand down the back as the other hand stops at the lower back and is raised. Set aside a regular time for the massage. This gives the patient something pleasant to anticipate.
Exercise 3. Peaceful past experiences *
Additional points: Some of the things that may comfort you, such as your favorite music or a prayer, can probably be recorded for you. Then you can listen to the tape whenever you wish. Or, if your memory is strong, you may simply close your eyes and recall the events or words.
Exercise 4. Active listening to recorded music *
Additional points: Many patients have found this technique to be helpful. It tends to be very popular, probably because the equipment is usually readily available and is a part of daily life. Other advantages are that it is easy to learn and not physically or mentally demanding. If you are very tired, you may simply listen to the music and omit marking time or focusing on a spot.
*Adapted and reprinted with permission from McCaffery M, Beebe A: Pain: Clinical Manual for Nursing Practice. St. Louis, Mo: CV Mosby: 1989.
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