Samuels Noah, Ben-Arye Eran
Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103102, Israel.
Integrative Oncology Program, The Oncology Service, Lin Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa 3535152, Israel.
Healthcare (Basel). 2024 Feb 4;12(3):403. doi: 10.3390/healthcare12030403.
Cancer-related pain (C-RP) is a prevalent and debilitating concern among patients with cancer, with conventional treatments limited in their ability to provide adequate relief, and by the adverse effects associated with their use. Complementary and integrative medicine (CIM) modalities have been shown to be potentially effective and safe for the treatment of pain and related symptoms, when used in conjunction with conventional medications and under medical supervision. An increasing number of oncology centers provide CIM within their conventional supportive and palliative care service, in an "Integrative Oncology" (IO) setting. A large body of clinical research, including systematic reviews and guidelines such as those published in 2022 by the Society for Integrative Oncology (SIO), in collaboration with the American Society for Clinical Oncology (ASCO), support the use of some CIM modalities for C-RP and related concerns. These include acupuncture for general and peri-operative/procedural pain, as well as aromatase inhibitor-associated arthralgia (AIA); reflexology or acupressure for pain during systemic therapy for cancer; hypnosis for procedural pain or pain due to diagnostic workup; and massage for pain experienced by patients during palliative and hospice care. Further research is needed, within both randomized control trials and pragmatic non-controlled studies which are more reflective of the real-life IO setting. This review summarizes the evidence supporting the use of CIM for C-RP; the analgesic mechanism of the modalities presented; and the challenges facing IO researchers, as well as the implementation of the 2022 SIO-ASCO guideline recommendations.
癌症相关疼痛（C-RP）是癌症患者中普遍存在且使人衰弱的问题，传统治疗在提供充分缓解疼痛的能力方面有限，并且存在与使用相关的不良反应。补充和整合医学（CIM）模式已被证明在与传统药物联合使用并在医学监督下时，对治疗疼痛及相关症状可能有效且安全。越来越多的肿瘤中心在其传统的支持性和姑息性护理服务中，以“整合肿瘤学”（IO）的形式提供CIM。大量临床研究，包括系统评价和指南，如2022年整合肿瘤学会（SIO）与美国临床肿瘤学会（ASCO）合作发表的那些，支持使用一些CIM模式来治疗C-RP及相关问题。这些包括用于一般疼痛和围手术期/操作过程疼痛以及芳香化酶抑制剂相关关节痛（AIA）的针灸；用于癌症全身治疗期间疼痛的反射疗法或指压疗法；用于操作过程疼痛或诊断检查引起的疼痛的催眠疗法；以及用于姑息和临终关怀护理期间患者所经历疼痛的按摩疗法。在随机对照试验和更能反映现实生活中IO环境的实用非对照研究中都需要进一步研究。本综述总结了支持使用CIM治疗C-RP的证据；所介绍模式的镇痛机制；以及IO研究人员面临的挑战，以及2022年SIO-ASCO指南建议的实施情况。
