7.13 (9.12) Complementary therapies in pain management Flashcards
What are three complementary therapies that can be considered part of a multimodal care plan for patients with advanced illness?
How is each thought to work?
Mind-body therapies
affect psychological factors like anxiety or depressed mood that can increase pain intensity or worsen the impact of pain on QOL.
Acupuncture
modulation of endogenous opioid and other neurotransmitter pathways, activities in the limbic system of the brain, and the processing of pain signals in the central nervous system.
Massage therapy
positive local effects on soft tissue
impact subconscious mechanisms that control emotions and the experience of pain
FS: MAM
List four types of mind-body therapies
Yoga
Qi gong
Tai chi
Hypnosis
Meditation
Music therapy
List 3 benefits of meditation. What is the effect on pain?
Mindfulness-based stress reduction (MBSR) is beneficial for mood, anxiety, depression, and QOL in general, although not so much for pain specifically
List three benefits of yoga. What is the effect on pain?
improve anxiety, depression, distress, and stress
RCTs evaluating pain as the primary end point in a palliative care setting are lacking.
List two effects of music therapy
Reduces pain and anxiety
What is the relationship and relative efficacy of acupuncture and drug therapy according to RCTs?
Other than pain, what other symptom has acupuncture been found to be effective for in cancer patients?
acupuncture did not generate a better effect than drug therapy alone, but acupuncture plus drug therapy demonstrated a significant improvement when compared with drug therapy alone
The strongest support from clinical trials supports the efficacy of acupuncture for nausea and vomiting.
List four symptoms that can be improved from massage therapy in cancer patients. What is the effect on pain?
pain, nausea, anxiety, depression, anger, stress, and fatigue
can reduce anxiety, depression, and pain, with stronger evidence for its effect on anxiety than depression or pain.
Your patient with a prominent chest wall mass wishes to receive massage therapy to reduce distress and pain. What advice do you give them?
Strong pressure should not to be applied over areas of disease involvement. In these cases, gentle light touch massage or reflexology (hand or foot massage) can still be used.
Your patient expresses that her cancer pain is worsening her pre-existing depression and she wishes to avoid taking more medications. What kind of complementary therapy do you recommend?
massage, acupuncture
Your patient expresses that her cancer pain is being made worse by underlying anxiety and distress. She wishes to avoid taking more medications. What kind of complementary therapy do you recommend?
Massage, mind body techniques
Your patient tells you that they have not received complete analgesia from opioids and don’t wish to increase the dose due to nausea. They wish to consider other approaches to pain management. What kind of complementary therapy do you recommend?
acupuncture
What is CIM
Complementary and integrative medicine
What does accupuncture entail
Insertion of ultra thin needles at selected points along theoretical lines on the skin (“meridians”)
Can be augmented with electric stimulation
Name 2 peripheral and 2 central mechanisms of accupuncture
Peripheral:
1. Local activation of A-delta and C afferent fibers
2. Increase release of dopamine, opioid petitde
Central:
1. Central activation with B endorphins and Serotonin (enhancing descending pain inhibitory signals in the spinal cord)
2. Decreased pain cortex activity
If considering accupuncture, extra precaution should be taken when treating patients with what 2 conditions?
Immunocompromised
Coagulopathy
