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2014 ; 32
(16
): 1703-11
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Psychological and behavioral approaches to cancer pain management
#MMPMID24799497
Syrjala KL
; Jensen MP
; Mendoza ME
; Yi JC
; Fisher HM
; Keefe FJ
J Clin Oncol
2014[Jun]; 32
(16
): 1703-11
PMID24799497
show ga
This review examines evidence for psychological factors that affect pain across
the cancer continuum from diagnosis through treatment and long-term survivorship
or end of life. Evidence is convincing that emotional distress, depression,
anxiety, uncertainty, and hopelessness interact with pain. Unrelieved pain can
increase a desire for hastened death. Patients with cancer use many strategies to
manage pain, with catastrophizing associated with increased pain and
self-efficacy associated with lower pain reports. A variety of psychological and
cognitive behavioral treatments can reduce pain severity and interference with
function, as indicated in multiple meta-analyses and high-quality randomized
controlled trials. Effective methods include education (with coping skills
training), hypnosis, cognitive behavioral approaches, and relaxation with
imagery. Exercise has been tested extensively in patients with cancer and
long-term survivors, but few exercise studies have evaluated pain outcomes. In
survivors post-treatment, yoga and hypnosis as well as exercise show promise for
controlling pain. Although some of these treatments effectively reduce pain for
patients with advanced disease, few have been tested in patients at the end of
life. Given the clear indicators that psychological factors affect cancer pain
and that psychological and behavioral treatments are effective in reducing
varying types of pain for patients with active disease, these methods need
further testing in cancer survivors post-treatment and in patients with end-stage
disease. Multidisciplinary teams are essential in oncology settings to integrate
analgesic care and expertise in psychological and behavioral interventions in
standard care for symptom management, including pain.