The Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) released a joint guideline regarding integrative medicine for pain management in oncology, which was recently published as a report in the Journal of Clinical Oncology.

“Pain is one of the most common, disabling, and feared symptoms experienced by patients diagnosed with cancer,” the authors of the guideline explained in their report. Pain arising from the cancer itself, as well as from a variety of cancer treatments, may result in acute or chronic pain, and with modern treatments patients are more likely to live longer with illness and perhaps receive ongoing treatment.

The purpose of the guideline was to provide evidence-based recommendations to health care providers on the use of integrative pain management approaches for patients with cancer. The guideline was developed with an expert panel that included professionals representing integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy. Evidence for recommendations was based on a literature search including reports of randomized controlled trials or systematic reviews that were published during the years 1990 through 2021.


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The panel identified 227 relevant reports for their analysis. The most common primary outcomes that were examined across studies were related to pain severity, pain reduction, and change in pain symptoms.

Based on the evaluated evidence, the panel made several recommendations including acupuncture should be offered to adults who have joint pain related to aromatase inhibitor use, acupuncture and reflexology or acupressure may be offered to patients with general cancer pain or musculoskeletal pain, and hypnosis may be offered to patients with procedural pain. The panel also recommended massage as part of palliative or hospice care.

The aforementioned recommendations were of moderate strength and based on benefits seeming to outweigh risks, and with intermediate evidence in support of these recommendations. The panel also presented some recommendations that they regarded as weak recommendations and/or based on low-quality evidence. Overall, other mind-body interventions and the use of natural products for pain were interventions for which the panel considered the supporting evidence to be of low quality or to be inconclusive.

For pediatric patients, the panel considered potential interventions to be generally based on insufficient or inconclusive evidence. They indicated they could make no recommendations on the use of integrative medicine interventions for pain in this patient population due to limited data.

The guideline authors noted there is a need for effective communication between health care providers and patients for shared decision making regarding pain management. Additionally, health care providers need to know how to answer patients’ questions about integrative medicine.

“This guideline provides the evidence base for integrating selected integrative medicine approaches into a comprehensive pain management strategy to improve symptom control and quality of life for patients with cancer and survivors,” the authors concluded in their report.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Mao JJ, Ismaila N, Bao T, et al. Integrative medicine for pain management in oncology: Society for Integrative Oncology–ASCO Guideline. J Clin Oncol. Published September 19, 2022. doi:10.1200/JCO.22.01357