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Complementary and alternative therapies for cancer pain

Clinical bottom line

There is no evidence from methodologically robust clinical trials to support any complementary therapy as being of use in the treatment of cancer pain


Reference

A Bardia et al. Complementary and alternative medicine therapies in relieving cancer pain: a systematic review. Journal of Clinical Oncology 2006 24: 5457-5464.

Background

Pain is a major symptom in patients with cancer. Many of them will try complementary therapies as well as conventional therapies for pain relief. The evidence-base for their efficacy is limited.

Systematic review

The systematic review used a wide searching strategy to August 2005. Any type of complementary therapy was looked for, according to National Center for Complementary and Alternative Medicine criteria. These included homeopathy, acupuncture, hypnosis, dietary, manipulative or energy therapies.

Inclusion criteria included randomised trials with a complementary intervention for cancer-related pain in humans. This did not include procedural pain or pain after cancer-related surgery.

Results

Of the 16 trials, quality scores (on a 0-5 rating) were 3 or greater (indicating minimal bias) in 10. Trials were small, with a median of 53 patients (range 9 to 460 patients). Over half the patients were in two trials, and the other 14 trials had fewer than 100 patients.

Only one of the two larger trials had a quality score suggesting minimal chance of bias. Even so, this, the largest, trial was not blind, and had a high attrition rate. It suggested some immediate benefit of healing therapy, but by one month there was no difference between massage, healing therapy, and rest.

Comment

The simple fact is that there is no evidence from methodologically robust clinical trials to support any complementary therapy as being of use in the treatment of cancer pain.