Cognitive behavioral therapy helps patients restructure thought behaviors that focus on how they respond to pain. The clinician identifies the patient’s immediate thought response to pain and helps change the behavior pattern. By helping the patient move away from unhelpful, distorted thoughts to something more calming and rational, the patient can change how they experience the pain.

Guided imagery uses words and/or music to help patients enter into a deeply relaxed state where they can use all of their senses to envision peaceful images with great detail, creating a relaxing scene. This calms the body and mind, offering a mental escape from pain while enhancing coping skills. This technique is easy for most patients to learn, and today there are many smart phone applications that take users through the process step-by-step.

Mindfulness is a psychological process that directs the patient’s attention and thoughts to experiences occurring in the present moment, with no judgment attached. It is a very effective technique for cancer patients, who often focus on what may happen in the future rather than what is happening in the moment. Mindfulness stops the extra noise, helping patients to stop thinking about how they should be feeling or what they should be doing, redirecting their thoughts to how they are actually feeling in the moment. There are many different ways to practice mindfulness, such as deep breathing, thinking pleasant thoughts, or simply going for a walk and focusing on the surrounding sounds.

Deep breathing is often used in conjunction with other relaxing techniques, as well as by itself. By truly focusing on breathing, the patient’s thoughts can be distracted away from pain. Deep breathing tries to get the patient to breathe more intentionally, concentrating on inhaling through the nose into the lungs, holding the breath, and then exhaling through the mouth. Studies have shown it can be helpful in activating the parasympathetic nervous system, calming the body from stress reactions.


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Acceptance commitment therapy is often used for chronic pain but has some elements that work for cancer as well. The modality helps patients acknowledge and accept that while pain is unpleasant and probably cannot be completely eliminated, it may be reduced to a tolerable level. The therapy gives patients a sense of control, helping them reframe acceptance of their pain while changing the way they think about it and respond to it.

Spiritual-based interventions can be effective for some patients in helping to manage pain. Research suggests they may improve spiritual well-being and quality of life, while reducing depression, anxiety, and hopelessness in cancer patients.2

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Lack of Clinician Awareness

In spite of the many safe, nonpharmacologic interventions MSWs can bring to the table for cancer pain management, they are seldom utilized in this role. Unfortunately, the majority of clinicians simply are not aware of the deep expertise MSWs have in pain management. This lack of knowledge among providers is a critical barrier that inhibits MSW participation in pain management.

Obviously, there is much work to be done before the contributions of social workers become more widely accepted in the area of cancer pain management. Clinicians’ inaccurate perceptions and lack of knowledge about MSWs’ expertise in cancer pain management inhibit their role on the multidisciplinary care team. More education is needed to help clinicians understand the wide scope of proven, evidence-based interventions that MSWs can offer.

MSWs must be proactive in educating providers and colleagues by participating in team huddles and multidisciplinary meetings, contributing to patient treatment plans, and calling attention to industry articles and research that demonstrate the effectiveness of psychosocial/emotional interventions.

An Approach Whose Time Has Come

MSWs approach pain management much differently than most clinicians, taking a holistic approach that taps into what is happening mentally, emotionally, and spiritually with the patient. In an era where the overuse of opioids has become a concern — even for cancer patients in severe pain — the insight and expertise offered by MSWs could provide patients  with convenient access to nonpharmacologic interventions that greatly improve quality of life while doing no harm.

References

1. American Cancer Society. Managing cancer pain at home. American Cancer Society. Last medical review/revised January 3, 2019. Accessed May 11, 2020. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/pain/pain.html

2. Xing L, Gua X, Bai L, Qian J, Chen J. Are spiritual interventions beneficial to patients with cancer? A meta-analysis of randomized controlled trials following PRISMA. Medicine (Baltimore). 2018;97(35):e11948.