Psychological and Behavioral Approaches to Cancer Pain Management
Publication: Journal of Clinical Oncology
Abstract
This review examines evidence for psychological factors that affect pain across the cancer continuum from diagnosis through treatment and long-term survivorship or end of life. Evidence is convincing that emotional distress, depression, anxiety, uncertainty, and hopelessness interact with pain. Unrelieved pain can increase a desire for hastened death. Patients with cancer use many strategies to manage pain, with catastrophizing associated with increased pain and self-efficacy associated with lower pain reports. A variety of psychological and cognitive behavioral treatments can reduce pain severity and interference with function, as indicated in multiple meta-analyses and high-quality randomized controlled trials. Effective methods include education (with coping skills training), hypnosis, cognitive behavioral approaches, and relaxation with imagery. Exercise has been tested extensively in patients with cancer and long-term survivors, but few exercise studies have evaluated pain outcomes. In survivors post-treatment, yoga and hypnosis as well as exercise show promise for controlling pain. Although some of these treatments effectively reduce pain for patients with advanced disease, few have been tested in patients at the end of life. Given the clear indicators that psychological factors affect cancer pain and that psychological and behavioral treatments are effective in reducing varying types of pain for patients with active disease, these methods need further testing in cancer survivors post-treatment and in patients with end-stage disease. Multidisciplinary teams are essential in oncology settings to integrate analgesic care and expertise in psychological and behavioral interventions in standard care for symptom management, including pain.
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Authors' Disclosures of Potential Conflicts of Interest
Although all authors completed the disclosure declaration, the following author(s) and/or an author's immediate family member(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a “U” are those for which no compensation was received; those relationships marked with a “C” were compensated. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.
Employment or Leadership Position: None Consultant or Advisory Role: None Stock Ownership: None Honoraria: None Research Funding: None Expert Testimony: None Patents, Royalties, and Licenses: Mark P. Jensen, two books: Hypnosis for Chronic Pain Management, Therapist Guide and Hypnosis for Chronic Pain Management: Workbook Other Remuneration: None
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© 2014 by American Society of Clinical Oncology.
History
Published online: May 05, 2014
Published in print: June 01, 2014
Authors
Author Contributions
Conception and design: Karen L. Syrjala, Mark P. Jensen, Francis J. Keefe
Financial support: Karen L. Syrjala
Administrative support: Karen L. Syrjala
Collection and assembly of data: Karen L. Syrjala, M. Elena Mendoza, Jean C. Yi, Hannah M. Fisher, Francis J. Keefe
Data analysis and interpretation: Karen L. Syrjala, Mark P. Jensen, Francis J. Keefe
Manuscript writing: All authors
Final approval of manuscript: All authors
Funding Information
Supported by Grants No. CA160684 and CA131148 from the National Cancer Institute, Grant No. NR014021 from the National Institute of Nursing Research, and Grant No. PEP 12 180 01 PCSM from the American Cancer Society; by a private donation from Robert E. Frey; and by a Livestrong Foundation grant to the Fred Hutchinson Cancer Research Center as a member of the Survivorship Center of Excellence Network.
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Article Citation
Psychological and Behavioral Approaches to Cancer Pain Management. JCO 32, 1703-1711(2014).
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Journal of Clinical Oncology 2014 32:16, 1703-1711
Journal of Clinical Oncology 2014 32:16, 1703-1711
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