Physical, Integrative, Behavioral, and Psychosocial Interventions
Key Points for this Section
Noninvasive physical, integrative, thinking and behavioral, and psychological methods can be used along with drugs and
other treatments to manage pain during all phases of cancer treatment. These interventions may help with pain control both directly and indirectly, by making patients feel they have more control over events. The
effectiveness of the pain interventions depends on the patient's participation
in treatment and his or her ability to tell the health care provider which
methods work best to relieve pain.
Weakness, muscle wasting, and muscle/bone pain may be treated with heat (a hot
pack or heating pad); cold (flexible ice packs); exercise (to strengthen weak muscles, loosen
stiff joints, help restore coordination and balance, and strengthen the heart);
changing the position of the patient; restricting the movement of painful areas
or broken bones; or controlled low-voltage electrical stimulation.
Integrative interventions include massage therapy and acupuncture.
Massage therapy has been studied as part of supportive care in managing cancer-related pain. Massage may help improve relaxation and benefit mood. Preclinical and clinical trials show that massage therapy may:
Physical methods to help relieve pain have direct effects on tissues of the body and should be used with caution in patients with cancer. Studies suggest that massage therapy may be safe in patients with cancer with the following precautions:
(For more information on massage, see Exercise 2 in the following section.)
Acupuncture is an integrative intervention that applies needles, heat, pressure, and other treatments to one or more places on the skin called acupuncture points. Acupuncture may be used to manage pain, including cancer-related pain. See the PDQ summary on Acupuncture for more information.
Thinking, Behavioral, and Psychosocial Interventions
Thinking, behavioral, and psychosocial interventions are also important in treating pain. These
interventions help give patients a sense of control and help them develop
coping skills to deal with the disease and its symptoms. Beginning these
interventions early in the course of the disease is useful so that patients can
learn and practice the skills while they have enough strength and energy.
Several methods should be tried, and one or more should be used regularly.
- Relaxation and imagery: Simple relaxation techniques may be used for
episodes of brief pain (for example, during cancer treatment procedures).
Brief, simple techniques are suitable for periods when the patient's
ability to concentrate is limited by severe pain, high anxiety, or
fatigue. (See Relaxation exercises below.)
- Hypnosis: Hypnotic techniques may be used to encourage relaxation and may
be combined with other thinking/behavior methods. Hypnosis is effective
in relieving pain in people who are able to concentrate and use imagery
and who are willing to practice the technique.
- Redirecting thinking: Focusing attention on triggers other than pain or
negative emotions that come with pain may involve distractions that are
internal (for example, counting, praying, or saying things like "I can
cope") or external (for example, music, television, talking, listening to
someone read, or looking at something specific). Patients can also learn
to monitor and evaluate negative thoughts and replace them with more
positive thoughts and images.
- Patient education: Health care providers can give patients and their families information and
instructions about pain and pain management and assure them that most pain
can be controlled effectively. Health care providers should also discuss
the major barriers that interfere with effective pain management.
- Psychological support: Short-term psychological therapy helps some
patients. Patients who develop clinical depression or adjustment disorder
may see a psychiatrist for diagnosis.
- Support groups and religious counseling: Support groups help many
patients. Religious counseling may also help by providing spiritual care
and social support.
The following relaxation exercises may be helpful in relieving pain.
Exercise 2. Simple touch, massage, or warmth for relaxation *
Touch and massage are traditional methods of helping others relax. Some
- Brief touch or massage, such as hand holding or briefly touching or
rubbing a person's shoulders.
- Soaking feet in a basin of warm water or wrapping the feet in a warm, wet
- Massage (3 to 10 minutes) of the whole body or just the back, feet, or
hands. If the patient is modest or cannot move or turn easily in bed,
consider massage of the hands and feet.
- Use a warm lubricant. A small bowl of hand lotion may be warmed in the
microwave oven or a bottle of lotion may be warmed in a sink of hot water
for about 10 minutes.
- Massage for relaxation is usually done with smooth, long, slow strokes.
Try several degrees of pressure along with different types of
massage, such as kneading and stroking, to determine which is preferred.
Especially for the elderly person, a back rub that effectively produces
relaxation may consist of no more than 3 minutes of slow, rhythmic stroking
(about 60 strokes per minute) on both sides of the spine, from the crown of the
head to the lower back. Continuous hand contact is maintained by starting one
hand down the back as the other hand stops at the lower back and is raised.
Set aside a regular time for the massage. This gives the patient something
pleasant to anticipate.
Exercise 3. Peaceful past experiences *
Something may have happened to you a while ago that brought you peace or
comfort. You may be able to draw on that experience to bring you peace or
comfort now. Think about these questions:
- Can you remember any situation, even when you were a child, when you felt
calm, peaceful, secure, hopeful, or comfortable?
- Have you ever daydreamed about something peaceful? What were you
- Do you get a dreamy feeling when you listen to music? Do you have any favorite music?
- Do you have any favorite poetry that you find uplifting or reassuring?
- Have you ever been active religiously? Do you have favorite readings,
hymns, or prayers? Even if you haven't heard or thought of them for many
years, childhood religious experiences may still be very soothing.
Additional points: Some of the things that may comfort you, such as your
favorite music or a prayer, can probably be recorded for you. Then you can
listen to the tape whenever you wish. Or, if your memory is strong, you may
simply close your eyes and recall the events or words.
Additional points: Many patients have found this technique to be helpful. It
tends to be very popular, probably because the equipment is usually readily
available and is a part of daily life. Other advantages are that it is easy to
learn and not physically or mentally demanding. If you are very tired, you may
simply listen to the music and omit marking time or focusing on a spot.
*Adapted and reprinted with permission from McCaffery M, Beebe A: Pain:
Clinical Manual for Nursing Practice. St. Louis, Mo: CV Mosby: 1989.