Tuesday, 22 April 2014

Non-pharmacological pain interventions

Roger Watson, Editor-in-Chief

A systematic review by Hökka et al. (2014) published in JAN considers non-pharmacological treatment of pain in advanced cancer. The search for such treatments is doubtless spurred by the desire for treatments that will not lead to dependence and will have few, or no, adverse side-effects. However, it is hard to imagine any treatment that has an effect not having a side-effect. That is how treatments work; they disrupt some function of the body to produce a desired effect and this, inevitably, has an unwanted effect. The search continues for treatments with good therapeutic indices: the appropriate balance between desired effect and unwanted side-effect. From this perspective, the search for – so-called – non-pharmacological treatments may be fruitless as, if they work, they are either having an effect, with the risk of side-effects, or the person receiving them thinks they work; i.e. they have a placebo effect. 

Non-pharmacological treatments fall under the umbrella of complementary and alternative medicine (CAM) and this covers a very broad range of purported treatments that are united by a single concept: they have not been shown to work. Numerous reviews over the years have, largely, demonstrated this. Some would say that the ‘jury remains out’ on the issue; others would say that judgement has been delivered. 

Nevertheless, the use of CAM continues and the reasons they are used range from mild to severe symptoms and – while it could be argued that resources should not be invested in their development and testing – the fact that they are widely used, despite the lack of evidence, merits their study. Certainly, the evidence for efficacy needs to be evaluated and reported.

Hökka et al. (2014) report very little evidence that the treatments they reviewed work for people with advanced cancer. Moreover, in the words of the authors: ‘There are several research gaps: we found no studies about music, spiritual care, hypnosis, active coping training, cold or ultrasonic stimulation.’ This means that, for a remarkably wide range of non-pharmacological treatments being used to treat pain in advanced cancer, there seems to be no effort to study them. If people are asking to use these treatments or if nurses are proposing them, then they need to be honest about the state of evidence in this field.


Hökka M, Kaakinen P, Pölkki T (2014) A systematicreview: non-pharmacological interventions in treating pain in patients withadvanced cancer Journal of Advanced Nursing doi:10.1111/jan.12424

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