Cancer pain is significantly affected by psychological factors and an individual’s cognitive style. Cognitive-behavioral therapy (CBT) approaches to management of cancer pain can effectively improve coping, self-efficacy, and a sense of control over the pain. A number of well-conducted randomized trials support the utility of CBT interventions for cancer-related pain. The majority of these interventions were initially developed for patients with chronic, non-malignant pain and subsequently applied to the treatment of patients with cancer. Thus, CBT is generally considered a potentially effective adjunct for the treatment of chronic cancer-related pain.
Additionally, cognitive-behavioral techniques are focused on reducing the impact of pain on the performance of normal daily activities by addressing patients’ and caregivers’ interpretation of and emotional reactions to pain and illness.
The process includes patient education, behavioral skill training, and cognitive skill training:
- Patient education is typically provided in the first session. Patients receive a detailed explanation of the rationale for the treatment approach, and they are taught to recognize the relationship between how they think, how they feel, and how they behave.
- Behavioral skill training focuses on teaching patients practical skills that aid coping and adaptation to the illness. For example, patients are taught simple relaxation techniques that they can utilize in stressful or anxiety-provoking situations. They may be taught to pace their activities to reduce fatigue or frustration, which may also help related mood disturbances. They may learn to incorporate pleasurable activities and experiences in their daily lives (pleasant activity scheduling).
- Cognitive skill training focuses on teaching patients how to identify and modify patterns of maladaptive thinking, and how to replace them with more adaptive ones (cognitive restructuring). As part of cognitive skill training, patients are encouraged to examine whether, in the process of trying to make sense of the cancer or the pain, there may be errors in their thinking or mistaken beliefs.
INTEGRATIVE THERAPIES
Mind-body therapies
- Relaxation therapy
- Imagery
- Hypnotic analgesia
- Biofeedback
- Meditation
- Creative arts therapy
Biofield therapies: Reiki, therapeutic touch, and healing touch
Manual interventions
- Massage therapy
- Acupuncture, acupoint stimulation, and electroacupuncture
- Homeopathy