Alternative Strategies for Pain Management
Madison – When she was an oncology nurse, Kristine Kwekkeboom saw too many patients whose pain was not well-managed by medications.
Sometimes the pain would flare up, or the meds would wear off too soon and patients would have to wait until a physician approved more medication.
That experience led her to look for another way to help cancer patients fight pain and related symptoms.
Kwekkeboom, now an assistant professor at the University of Wisconsin–Madison School of Nursing, is conducting a study of alternative, non-drug strategies for pain and other symptoms resulting from cancer. Funded by a grant from the National Institute of Nursing Research, her study will run through early 2011.
Trying to Find Ways to Control Pain
Kwekkeboom's observations about undertreating pain have been borne out. A recent study by the Harvard School of Public Health found that, in a survey of 40 metropolitan hospitals, one-third of patients did not feel their pain was well controlled.
Several non-drug strategies fall within the scope of nursing practice. Kwekkeboom is focusing on cognitive and behavioral (mind-body) strategies, including mental imagery, relaxation, and distraction techniques.
These are strategies that nurses learn as part of basic nursing education and when practicing nurses diagnose symptoms like pain, fatigue or anxiety in their patients, they can prescribe these strategies independently, without a doctor's order.
Kwekkeboom did an earlier feasibility study to see if adult cancer patients of all ages would actually participate in a research study using relaxation and guided imagery techniques delivered on an MP3 player and used independently at home.
She focused on pain, fatigue, and sleep disturbance. All but three of the 30 participants completed the two-week study and used the treatment strategies, on average, once a day.
While there was no significant difference between symptom ratings at the beginning of the study and two weeks later, Kwekkeboom was encouraged that when patients used one of the non-drug strategies, their symptoms improved in the period immediately after. The alternative strategies helped, but temporarily.
Non-Drug Therapies to Manage Pain Symptoms
She is particularly interested in symptom clusters that appear to accompany the toxic chemotherapies or radiation given to advanced cancer patients. Cancer researchers are finding that certain symptoms tend to "cluster," occurring at the same time. The combination of pain, fatigue and disruptions in normal sleep is one such symptom cluster.
She will be studying the effects of relaxation, guided imagery and distraction strategies, each of which has been shown effective for pain, fatigue, and sleep disturbance alone.
The non-drug strategies have not been tested when all three symptoms occur together. It's possible that this one treatment can help patients control all three symptoms.
Kwekkeboom's new study will involve 104 patients who have advanced lung, colorectal, prostate, or GYN cancer that is either recurring or progressing despite treatment. The patients will be divided into two groups–those who get the treatment right away, and others who record their symptoms for two weeks and then are offered the treatment.
Patients will be educated about how to use the strategies and will then choose guided imagery, relaxation and distraction strategies from 12 options provided on an MP3 player, and use the strategies whenever needed. They will be asked to keep a log of which strategies they use and when. Patients can continue to use any prescribed medications, using the non-drug strategies as additional treatment.
Pain More Than Just Physical
One reason these alternative symptom management strategies are effective, Kwekkeboom says, is that there's more to symptoms like pain than just a physical sensation, they also have mental and emotional components.
"These kinds of strategies do a good job at treating symptoms in ways that medications alone cannot," Kwekkeboom explains.
"Medications target the sensory dimension of symptoms -- for example, analgesics are used to reduce the intensity of the pain sensation. But the non-drug strategies help to give people a sense of personal control over their symptoms and let them know there is something they can do to change their pain, fatigue, or sleep disruption and change the way they think about their symptoms. Patients feel the intensity of the symptom, but also react to it cognitively and emotionally, often with dysfunctional thoughts and fear or anxiety about what the symptom means."
Kwekkeboom says that at the end of the study, she will study patient responses to each type of non-drug strategy to further understand how the strategies work and for whom.
"My ultimate goal is to equip practicing nurses with a theoretical basis to match individual patients with the most appropriate strategies. I want to give nurses a set of questions that they can ask a patient and then use the patient's answers to determine what kind of treatment is going to work best for their patient."
Date Published: 08/17/2009
News tag(s): integrative