RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
CANCER
PAIN
July, 2006
Definition
and Scope of the Problem of Cancer Pain
Pain is
among the most common and most feared symptoms of cancer.
According to the Cancer Information Network, between
30%-50% of cancer patients experience pain, and
approximately 70% experience severe pain at some point
during the course of their disease (2006).
National costs of cancer pain management are difficult to
estimate. However, in 1990, a single hospital, City of
Hope, estimated their costs for hospitalizations for
uncontrolled cancer pain at over $5 million. This cost
would have risen to $9 million if their patients receiving
home parenteral infusions of morphine had been in-patients
(Ferrell & Griffith, 1994).
Medical
Treatment of Cancer Pain
Various types of drugs are used to control cancer pain:
non-steroidal anti-inflammatories (NSAIDS), COX-2
inhibitors, and opioids (such as morphine or Demerol).
Non-pain medications can also help: drugs to relieve
cramps, stabilize the heart rhythm, seizure medications,
sleep aids, and drugs to relieve depression and
anxiety. Used correctly, these
medications can completely control pain in over 50% of
cases, according to cancer specialist Daniel Brookoff, MD
(2001a).
For
pain that doesn’t respond to oral medications, opiates can
be given intravenously (I.V.s) or directly into the spinal
canal. In even more severe cases, surgery and radiation are
sometimes used effectively. Use of a TENS (Transcutaneous
Electrical Nerve Stimulation) device sometimes helps.
Pain specialists estimate that pain could be effectively
controlled in nearly all cancers (Brookoff, 2001a). Failure
to adequately treat cancer pain can lower quality of life
and lead to unnecessary hospital stays. The indirect costs
in lost productivity and missed work for patients and
caregivers are unknown but must be substantial, as is the
burden of unrelieved suffering.
Problems
in Cancer Pain Treatment
Some physicians are not adequately informed about the value
of non-narcotic medications, particularly anti-depressants
(Brookoff, 2001a). Likewise, many patients do not
request or use available medications. They may avoid
anti-depressants and take less of their narcotics because
they are afraid of addiction (Brookoff, 2001b). Depression,
insomnia and stress can greatly increase the perception of
pain and suffering (Cicala, 2001).
Non-medical Treatments Including Guided
Imagery
Various complementary therapies have been found successful
to varying degrees in cancer pain. These include
acupuncture (Johnstone, Polston et al, 2002),
hypnosis (Levitan,
1992; Vickers & Vassileth, 2001), and guided imagery
(Syrjala, Cummings & Donaldson, 1992; Syrjala,
Donaldson et al, 1995).
Two
studies at the Fred Hutchinson Cancer Center demonstrated
significant relief of cancer pain with relaxation and
self-hypnosis consisting of relaxation and guided imagery
(Syrjala, Cummings & Donaldson, 1992; Syrjala,
Donaldson et al, 1995).
Researchers at Sloan-Kettering Memorial Cancer Center
reported that “randomized trials support the value of
hypnosis for cancer pain and nausea; relaxation therapy,
music therapy, and massage for anxiety. Such complementary
therapies are increasingly provided at mainstream cancer
centres” (Vickers & Cassileth, 2001). A University of
Minnesota researcher reported significant pain relief from
a hypnosis technique called glove anesthesia (Levitan,
1992).
Self-hypnosis, relaxation, and meditation have been
significantly effective in many types of pain, including
cancer (Sloman, Brown et al, 1994; Sellick & Zaza,
1998). Kabat-Zinn and others reported dramatic improvement
in the chronic pain in a group of 90 patients who
participated in a 10-week meditation program (Kabat-Zinn,
Lipworth & Burney, 1985). These patients had increased
comfort and less psychological distress. In some cases,
they were able to use less medication. Other researchers’
patients achieved profound relief of arthritis pain with
self-hypnosis (guided imagery) (Carni & Gilbert,
1982).
Despite studies that confirm
that mind-body approaches such as guided imagery, hypnosis,
and relaxation have direct physiological effects in stress
levels, the immune system, and pain management (Bakke,
Purtzer & Newton, 2002; Gruzelier, 2002), many times,
doctors aren’t the first ones to suggest alternative pain
approaches. One doctor at the Eastern Virginia School of
Medicine found that many cancer patients come to that
clinic familiar with hypnosis and request it for their pain
(Lynch, 1999).
In a 2003 review of the
literature, the authors reviewed complementary and
alternative medicine (CAM) use in end-of-life issues such
as pain. They found that self-hypnosis was one of the
techniques that may provide relief in cancer pain, and that
relaxation and imagery specifically could help with the
pain of mouth sores (oral musositis) (Pan, Morrison et al,
2000).
Authors of a 2004 review reported evidence of efficacy for
hypnosis in cancer pain (Shukla & Pal, 2004). The
authors of two dissertations on the effects of guided
imagery reported that patients had less anxiety and
depression (Caruso, 1999; Henge, 1999). A 2005 review
confirmed the efficacy of mind-body techniques for in
treating cancer pain, as well as for other anxiety and mood
disturbances that are common in oncology patients (Deng
& Cassileth, 2005)
Conclusion
When used along with prescribed medications, guided imagery
can contribute to controlling pain and anxiety in cancer
patients. In some cases, guided imagery can allow reduction
of medication usage.
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