Alternative Strategies for Pain Management
That experience led her to look for another way to help cancer patients fight pain and related symptoms.
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.
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.
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.
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.
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.
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.
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