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Complementary therapy at the end of life

 

Clinical bottom line

There is no solid evidence that complementary and alternative therapies have any value for treating pain, dyspnoea or nausea and vomiting at the end of life.


Systematic review

CX Pan et al. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review. Journal of Pain and Symptom Management 2000 20: 374-387.

Searching

Six electronic databases were searched for papers about pain, dyspnoea, and nausea and vomiting at the end of life. The intention was to find papers that clearly studies interventions for these conditions, rather than surveys.

The authors found 21 studies, 11 of which were randomised trials, two non-randomised controlled studies, and eight case series. Most of the studies investigated highly individual treatments in highly individual situations, so the likelihood of data pooling was low.

Pain

Fourteen studies addressed pain. Six different therapies were studied:

TENS was evaluated in one RCT with 15 patients, one non-randomised controlled stydy with 60, and two case-series with 38.

Acupuncture was evaluated in one RCT with 239 patients and two case series with 275 patients. There was no difference between real and sham acupuncture in the RCT.

Massage was evaluated in one RCT with 28 patients and one case series with 9, and with additional aromatherapy in one case series with 103 patients.

Psychological therapies were evaluated in one RCT with 94 patients. This showed highly significant improvements for oral mucositis pain (p < 0.01) compared with usual treatment.

Music therapy was evaluated in one RCT with nine patients.

Hypnosis was evaluated in one RCT with 58 patients.

Dyspnoea

Acupuncture was evaluated in one RCT with 24 patients and one case series with 20.

Acupressure was evaluated in one RCT with 31 patients.

PMR/breathing retraining was evaluated in one RCT with 20 patients.

Psychoanalysis was evaluated in one RCT with 65 patients.

Coping and counseling was evaluated in one RCT with 20 patients.

Nausea/vomiting

Acupressure was evaluated in one non-randomised controlled study with nine patients.

Comment

Most of these studies could show some benefit of treatment with some outcome. The problems, though, are manifest. Firstly, most were far too small to tell anything, even if their conducte was immaculate. Secondly, their conduct was not immaculate. Few were blinded, and most had what would normally be considered major structural flaws.

There really is no solid evidence that complementary and alternative therapies have any value for treating pain, dyspnoea or nausea and vomiting at the end of life.