Page 74 Guide to Pain Management in Low-Resource Settings

62 Barrie Cassileth and Jyothirmai Gubili

become receptive to suggestion. A CD developed at Me- Does physical activity or exercise
morial Sloan-Kettering teaches patients self-hypnosis for reduce cancer pain?
use prior to surgery or at any time to control pain.
Hypnosis has been studied extensively and Exercise has shown to provide multiple benefi ts, and
found eff ective for a wide range of symptoms, including the advantages of exercise for patients is well document-
acute and chronic pain, panic, surgery, burns, post-trau- ed for both noncancer pain and cancer pain. In addition
matic stress disorder (PTSD), irritable bowel syndrome to pain reduction, there are positive eff ects on mood,
(IBS), allergies, and certain skin conditions, and for con- as well as on muscular, pulmonary, and cardiovascular
trolling unwanted habits. In 1996, the U.S. National In- functioning. Studies have shown that cancer patients
stitutes of Health judged hypnosis an eff ective interven- may even reduce fatigue symptoms with exercise.
tion for alleviating pain from cancer and other chronic
conditions. Research suggests that hypnotic sensory an- Herbs and other dietary
algesia is at least in part mediated by reduction in spinal
supplements: what should
cord antinociceptive mechanisms in response to hyp-
notic suggestion. Hypnotic analgesia also may be relat- be considered?

ed to brain mechanisms that prevent awareness of pain
Herbs are used in medical practices around the world.
once nociception has reached higher centers via brain
Some of today’s most powerful pharmaceuticals are
mechanisms. It also may reduce the aff ective dimension,
plant-derived. Herbs and herbal compounds should be
perhaps as the subject reinterprets meanings associated
viewed as dilute, unrefi ned pharmaceuticals. Th ey may
with the painful sensation.
produce physiological eff ects, and those eff ects can be
positive or negative, depending on a patient’s specifi c
And yoga? clinical situation. Herbal agents also may contain harm-
ful constituents, and in patients on prescription medica-
Yoga is a physical and mental exercise that combines
tion, serious adverse eff ects may result from herb-drug
postures and meditation to calm the mind, body, and
interactions. Numerous herbal agents are said to relieve
spirit. Th e practice promotes relaxation and blood fl ow,
pain. When studied, some are found to be useful and
keeping the spine limber and the muscles fl exible. Ses-
others useless.
sions, usually conducted in small groups, are tailored
to individual capabilities, with gentle, meditative class-
es for cancer patients and others with severe pain. Th e Concerns about topical agents
combined aspects of yoga—its gentle postures, deep
breathing, meditation, and group interaction—reduce Allergic reactions
pain perception and assist coping and recovery. For ex- Some common essential oils, such as tea tree, lavender,
ample, in a small study of women with metastatic breast bergamot, and ylang-ylang, are capable of causing con-
cancer, participants reported signifi cantly lower levels of tact dermatitis.
pain and fatigue the day after yoga practice.
Transdermal absorption of phytoestrogens

And music therapy? Many herbal skin products, like lavender or tea tree oil,
have mild estrogenic eff ects. When applied in large quan-
Music can reach deep emotional levels, and particular tities over prolonged periods of time, signifi cant amounts
types of music may hold special meanings for each indi- can be absorbed through the skin. Patients with estrogen-
vidual. Music therapy is particularly eff ective in the pal- receptor-sensitive cancer should avoid these products.
liative care setting, where it improves quality of life and
enhances comfort and relaxation. Music may involve ac- Direct toxicity on skin
tive patient participation such as singing, song writing, or Some herbs can cause necrosis of skin tissues. Blood-
playing musical instruments, or private listening. Th e use root, which contains sanguinarine, is an example. Topi-
of music to ease pain, anxiety, and depression is increas- cal use of bloodroot can lead to severe adverse eff ects
ingly popular, and its eff ects on pain intensity and distress including disfi gurement. Patients should be advised not
associated with pain have been documented in studies. to use this product.