Is There Any Role for Complementary and Alternative Medicine in the Treatment of Cancer-Related Pain—A Systematic Review of Randomized Control Trials (RCTs) (319-A)

Abstract

1.Discuss current evidence on the use of complementary and alternative therapies for cancer-related pain.2.Discuss the striking paucity of well-designed, multi-institutional trials evaluating complementary and alternative interventions for cancer-related pain. Background. Although wider dissemination of evidence-based applications for CAM interventions has been recommended, a thorough evidence base about their usefulness for cancer-related pain is missing. Aim. The aim of this article was to provide a systematic review of randomized control trials (RCTs) evaluating the efficacy of various CAM therapies for cancer-related pain. Methods/Session descriptions. Two independent reviewers conducted a systematic literature search using databases (ie, MEDLINE, EMBASE, and the Cochrane Library), all from time of initiation up until June 2010 with the search term “cancer pain” and the limits of “clinical trials” and “complementary medicine.” All RCTs that had a CAM intervention for cancer-related pain in adults were included. A total of 155 references were identified through database searches; 31 trials with a total of 2,481 patients met criteria for inclusion. Median sample size was 57 (range, 9-380); median duration of intervention was 28 days (range, 15 minutes to 365 days). All studies, but one, were from single institutions; only six studies had sample size justification. Thirteen trials reported significant benefit for the following CAM therapies: acupuncture (n = 2), support groups (n = 2), hypnosis (n = 2), relaxation/imagery (n = 3), massage therapy (n = 3) and herbal supplement/HESA-A (n = 1). 11 studies reported immediate post-intervention or short-term benefit of the following CAM interventions: acupuncture (n = 2), music (n = 1), hypnosis (n = 1), relaxation (n = 1), herbal supplement/Ai-Tong-Ping (n = 1), massage (n = 3), and healing touch (n = 2). No trial reported any significant adverse effect of CAM therapy. Conclusion. Although the outcomes seem promising, the relevance of these results is limited by the lack of adequate power, duration, and sham control. Future RCTs should strive to improve the methodological deficiencies of the studies outlined in our systematic analysis. Physical Aspects of Care