Page 71 Guide to Pain Management in Low-Resource Settings

Chapter 9

Complementary Th erapies for Pain Management

Barrie Cassileth and Jyothirmai Gubili

Is conventional pharmacotherapy have an important role to play everywhere, and espe-
always the best option cially in the low-resource setting.
for pain control?
How often are complementary
Both acute and chronic pain may be treated with pre- therapies used by the patient?
scription pharmaceuticals, but they also may be con-
trolled by complementary therapies such as acupunc- Complementary therapies are increasingly used to al-
ture, massage therapy, and other modalities discussed leviate pain and other symptoms, such as nausea and
in this chapter at less cost and typically with fewer fatigue. Internationally, 7% to more than 60% of can-
side effects. cer patients use complementary therapies, depend-
Each year about nine million cancer patients ing on definitions used in numerous surveys. These
worldwide experience moderate to severe pain most of therapies also are frequently used for pain that is not
the time. Th irty percent of newly diagnosed cancer pa- cancer-related.
tients and 70–90% of patients with advanced disease
suff er signifi cant pain. Pain experienced by cancer pa- How do complementary
tients can be chronic, caused directly by tumor inva- therapies work?
sion or by cancer treatment itself, or acute pain, such as
following surgery. Pain in terminal stages of disease has Complementary therapies may work by direct analgesic
its own characteristics and special issues. Th e World eff ects (e.g., acupuncture), by anti-infl ammatory action
Health Organization (WHO) recommends use of anal- (e.g., herbs), or by distraction (e.g., music therapy), to
gesics for pain, starting with nonopioid drugs followed aff ect pain perception, assist relaxation, improve sleep,
by opioids for uncontrolled and persistent pain. But, or reduce symptoms such as nausea, neuropathy, vomit-
pharmacological interventions, although eff ective, do ing, anxiety, or depressed mood, as well as pain. Th ese
not always meet patients’ needs, and they may produce therapies often work when used alone, but they are also
diffi cult side eff ects. Th ey are also costly and may be dif- used with pharmaceuticals, often reducing the dos-
fi cult to obtain. Th ese issues pose a great challenge for ages required, and thus decreasing side eff ects and cost.
patients requiring long-term pain management, often When complementary therapies work synergistically
forcing them to choose between living in pain or living with a pharmaceutical pain regimen, eff ectiveness may
with undesirable side eff ects. Complementary therapies be improved and costs reduced.
Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 59
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
verifi cation of diagnoses and drug dosages. Th e mention of specifi c pharmaceutical products and any medical procedure does not imply endorsement or
recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.