Social workers have played a vital role in health care for decades, acting as patient advocates dedicated to supporting and empowering patient rights, high-quality care, and the best possible patient experience. Unfortunately, in many areas of health care, their vast knowledge base and wide range of skills are undervalued and underutilized — particularly in the field of oncologic pain management.
Although not all cancer patients experience pain, those with advanced disease often have pain that can be quite severe. Controlling cancer pain is essential, as suboptimal pain control can be very debilitating, impact quality of life, and inhibit the best possible outcome for the patient. Cancer pain can be controlled in most patients1; however, in cases of intractable pain, the majority of pain specialists and oncologists rely heavily on pharmacologic agents such as opioids, subjecting patients to potentially adverse side effects. Given the current attention to the overuse of opioids and the addictive nature of these drugs, the time is right to recognize the contributions masters-prepared social workers (MSWs) can bring to cancer patients through nonpharmacologic interventions for pain management.
Cancer Pain Has Many Components
Best practices in cancer care delivery are shifting away from care models limited to medical-only solutions to interdisciplinary approaches aimed at treating the whole patient. This approach is especially beneficial when it comes to pain management. The physical manifestation of spiritual/existential pain, as well as emotional and social pain, adds layers of complexity to cancer pain management.
The social work profession has advanced itself by gaining competence in psycho-oncology, which focuses on the psychological, social, behavioral, and ethical aspects of cancer. MSWs can conduct biopsychosocial assessments to identify other factors that may be elevating the patient’s pain level, enabling the care team — especially the MSW — to address these issues. This systematic approach looks at the patient on many different levels, integrating biological, psychological, and sociocultural factors such as anxiety, depression, financial distress, family dynamics, and other issues that are affecting the patient and may be contributing to his or her pain. This holistic view recognizes that problems do not exist in a vacuum and that each problem can influence the patient’s other problems in different ways. Consequently, when it comes to cancer pain management, focusing solely on the patient’s physical pain and pharmacologic agents to reduce it is often not enough.
Complementary Approaches to Pain Management
MSWs have knowledge and training in evidence-based nonpharmacologic interventions that can be highly effective in cancer pain management. Many of these techniques are designed to ultimately change how the patient thinks about and responds to pain by creating calm within the patient. When patients experience pain, they may focus on it, increasing their anxiety. This, in turn, intensifies the pain and produces even more anxiety. Techniques that calm the mind stop this vicious cycle by interrupting that thought pattern, reducing the experience of pain. In addition to working with patients to employ pain-reducing calming techniques, families and caregivers may be included in training sessions so they can help the patient effectively use these strategies at home.
A few nonpharmaceutical interventions MSWs commonly utilize for pain management when working with cancer patients include the following: