Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology–ASCO Guideline

Author:

Mao Jun J.1ORCID,Ismaila Nofisat2ORCID,Bao Ting1ORCID,Barton Debra3ORCID,Ben-Arye Eran4ORCID,Garland Eric L.5,Greenlee Heather6ORCID,Leblanc Thomas7ORCID,Lee Richard T.8ORCID,Lopez Ana Maria9ORCID,Loprinzi Charles10ORCID,Lyman Gary H.6ORCID,MacLeod Jodi11ORCID,Master Viraj A.12,Ramchandran Kavitha13,Wagner Lynne I.14ORCID,Walker Eleanor M.15,Bruner Deborah Watkins12ORCID,Witt Claudia M.16ORCID,Bruera Eduardo17ORCID

Affiliation:

1. Memorial Sloan Kettering Cancer Center, New York, NY

2. American Society of Clinical Oncology, Alexandria, VA

3. University of Michigan School of Nursing, Ann Arbor, MI

4. Lin & Carmel Medical Centers, Clalit Health Services; Technion Faculty of Medicine, Haifa, Israel

5. College of Social Work, University of Utah, Salt Lake City, UT

6. Fred Hutchinson Cancer Research Center, Seattle, WA

7. Duke University School of Medicine Durham, NC

8. City of Hope Comprehensive Cancer Center, Duarte, CA

9. Thomas Jefferson. Sidney Kimmel Cancer Center, Philadelphia, PA

10. Mayo Clinic, Rochester, MN

11. Patient Representative, Memorial Sloan Kettering Integrative Medicine Service, New York, NY

12. Winship Cancer Institute of Emory University, Atlanta, GA

13. Stanford University, Palo Alto, CA

14. Wake Forest School of Medicine, Winston-Salem, NC

15. Henry Ford Hospital, Detroit, MI

16. University Hospital Zurich, Zurich, Switzerland

17. MD Anderson Cancer Center, Houston, TX

Abstract

PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 227 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Among adult patients, acupuncture should be recommended for aromatase inhibitor–related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer. Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines .

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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