New Evidence on Yoga, Massage and Acupuncture for Cancer Pain

A new guideline highlights the potential role of integrative or complementary pain management techniques, such as massage, acupuncture and music therapy, in relieving cancer pain in adults.

In September 2022, Journal of Clinical Oncology published recommendations guiding doctors on offering various non-pharmacological pain management strategies.

Cancer pain is a clinical challenge for many patients and doctors, and evidence that complementary approaches can help manage it is growing.

However, guidance on when these approaches are appropriate has been lacking, and many cancer centres do not address the issue adequately.

Existing guidelines for chronic cancer-related pain have largely focused on diagnosis and drug-based interventions.

In this new complementary pain management guideline, experts address two key questions:

1. Which mind–body therapies are recommended for managing pain in adults and children diagnosed with cancer?
2. Which natural products are recommended for managing pain in adults and children diagnosed with cancer?

The expert panel reviewed the literature and identified 277 relevant studies. These included systematic reviews and randomised controlled trials published between 1990 and 2021, assessing pain intensity, reductions in pain-related symptoms and adverse effects.

The experts based their recommendations on the strength of available evidence. For approaches with stronger evidence, the panel made various recommendations about acupuncture, reflexology, massage and hypnosis. The panel:

• Found that acupuncture could be offered for joint pain associated with aromatase inhibitors, such as arimidex and femara, in breast cancer, and for general or musculoskeletal cancer-related pain.
• Recommended reflexology or acupressure for pain during systemic cancer treatment.
• Identified hypnosis as an option for procedure-related pain during cancer treatment or diagnostic investigations, and massage as an option during palliative or end-of-life care or after breast cancer treatment.

These recommendations were considered moderately strong, based on moderate-quality evidence that benefits outweighed risks.

The panel also offered several weak recommendations based on low-quality evidence: Hatha yoga for pain after treatment for breast or head and neck cancer, and music therapy for pain after cancer surgery.

The experts found no evidence to support recommending natural products, including omega-3 fatty acids and glutamine.

Advanced treatments such as immunotherapy and targeted therapy mean that patients live longer after a cancer diagnosis, making pain and adverse-effect management essential to quality of life. The guideline gives doctors recommendations for incorporating non-drug approaches, such as acupuncture and massage, at appropriate points to improve pain management.

Putting these therapies into clinical practice is not always easy. Healthcare systems currently appear reluctant to fund doctors providing complementary approaches. As quality of life is recognised as being as important as life itself, however, we hope insurance systems will begin covering these treatments, since growing evidence supports their effectiveness in cancer pain management.