Sellick S M, Zaza C
Northwestern Ontario Regional Cancer Centre, Thunder Bay.
Cancer Prev Control. 1998 Feb;2(1):7-14.
Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacologic strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback.
The databases MEDLINE (1966 to June 1997), CINAHL (1982 to June 1997) and PsychoINFO Lit (1980 to June 1997) were searched systematically for randomized controlled trials (RCTs) of the 5 nonpharmacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria.
The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined.
Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed.
对安大略省两家癌症中心的医护人员进行调查，以确定他们对癌症疼痛非药物管理策略的熟悉程度、看法以及进一步了解这些策略的兴趣。随后针对参与者最感兴趣的5种策略开展了循证教育课程。本文介绍了关于这5种策略有效性的批判性文献综述结果：针灸、按摩疗法、催眠、治疗性触摸和生物反馈。
系统检索数据库MEDLINE（1966年至1997年6月）、CINAHL（1982年至1997年6月）和PsychoINFO Lit（1980年至1997年6月），查找这5种非药物策略的随机对照试验（RCT）。还检索了作者的个人文件以及相关论文和主要文献的参考文献列表。根据既定标准对试验质量进行了评估。
检索到1项针灸随机对照试验、1项按摩疗法随机对照试验和6项催眠随机对照试验。催眠研究表明，其在癌症疼痛管理中的应用得到了很多支持。对于所研究的其他疗法，证据要么缺乏，要么不太明确。
由于患者无论其有效性如何都会使用多种非药物策略，临床医生需要熟悉现有的研究，并能够讨论那些证据充分、证据不足或不存在证据的策略。需要对疼痛管理的非药物策略的有效性进行更多研究。
