Other Treatments for Pain
Key Points for This Section
- When radiation therapy does not relieve pain, other treatments may be used.
- Nerve blocks
- Neurological treatments
- Physical treatments, such as heat, cold, and exercise, can help relieve pain.
- Integrative treatments include massage therapy, acupuncture, and music.
- Some methods help relieve pain by changing how you think about pain and teaching you ways to relax.
When radiation therapy does not relieve pain, other treatments may be used.
A nerve block is the injection of either a local anesthetic or a drug into or around a nerve to block pain. Nerve blocks help control pain that can't be controlled in other ways. Nerve blocks may also be used to find where the pain is coming from, to predict how the pain will respond to long-term treatments, and to prevent pain after certain procedures.
Surgery can be done to implant a device that delivers drugs or stimulates the nerves with mild electric current. In rare cases, surgery may be done to destroy a nerve or nerves that are part of the pain pathway.
Physical treatments, such as heat, cold, and exercise, can help relieve pain.
Physical methods to treat weakness, muscle wasting, and muscle and bone pain include the following:
- Applying heat (a hot pack or heating pad).
- Applying cold (ice packs).
- Exercise to strengthen weak muscles, loosen stiff joints, help coordination and balance, and strengthen the heart.
- Changing position (for patients who are not able to move on their own).
- Limiting the movement of painful areas or broken bones.
- Transcutaneous electrical nerve stimulation (TENS), a procedure in which mild electric currents are applied to some areas of the skin to control pain.
Integrative treatments include massage therapy, acupuncture, and music.
Integrative therapy combines conventional (standard) medical treatment with complementary and alternative (CAM) therapies that have been shown to be safe and to work. CAM therapies treat the mind, body, and spirit.
Massage has a direct effect on body tissues and should be used with care in patients with cancer. Studies show that massage therapy may be safe in patients with cancer. However, when massage is used in cancer patients, the following precautions should be taken:
- Avoid massaging any open wounds, bruises, or areas where the skin has broken down.
- Avoid massaging directly over the area where the tumor is.
- Avoid massaging areas with deep vein thrombosis (blood clot in a vein). Symptoms may include pain, swelling, warmth, and redness in the affected area.
- Avoid massaging soft tissue when the skin is sensitive following radiation therapy.
(For more information on massage, see Exercise 2 in the following section.)
Acupuncture is an integrative therapy that applies needles, heat, pressure, and other treatments to one or more places on the skin called acupuncture points. Acupuncture may be used to manage pain, including pain related to cancer. See the PDQ summary on Acupuncture for more information.
Music has been used to relieve pain and anxiety caused by cancer and cancer treatments. Studies have reported that music may work on areas of the brain that increase pleasant feelings and decrease unpleasant responses. Your favorite music may help you the most. Music is more helpful if you begin listening before a procedure than it is during or after a procedure. Music may be used along with pain medicine.
There are two main types of music treatments— music therapy and music medicine:
- Music therapy is given by a trained specialist called a music therapist. The music used may be live or recorded. Therapy may include music improvisation (making up music), song writing and singing, and relaxing to music. The music therapist bases treatment on your needs, such as controlling pain, decreasing anxiety, or learning new coping skills.
- Music medicine is listening to music (usually recorded music) to take attention away from the pain. Music medicine is guided by a medical professional who does not have special training in music therapy.
The use of music for pain related to cancer is still being studied.
Music is also used in relaxation exercises.
Some methods help relieve pain by changing how you think about pain and teaching you ways to relax.
Treatments that change how you think about pain and respond to it are also helpful in treating pain. These are called psychological interventions. Psychological interventions give you a sense of control and teach you coping skills to deal with the disease and its symptoms. Staying calm when you feel pain may keep you more comfortable. You may try several methods and choose one or more to use regularly.
- Hypnosis: Hypnosis may help you relax and may be combined with other thinking and behavior methods. Hypnosis to relieve pain works best in people who are able to concentrate and use imagery and who are willing to practice the technique.
- Redirecting thinking: In redirecting thinking, you focus your attention away from pain by thinking about other things. Methods may be internal (for example, counting, praying, or saying things like "I can cope") or external (for example, music, television, talking, listening to someone read, or looking at something specific). You can also learn to replace negative thoughts with positive thoughts and images.
- Talk therapy: Talk therapy may help you focus your attention away from the pain.
- Support groups and religious counseling: Support groups help many patients. Religious counseling may also help by offering spiritual care and social support.
- Imagery: Imagery is imagining positive, calming images. This can help you relax, reduce stress, and give you a sense of well-being.
- Relaxation exercises: Simple relaxation exercises may be used for short periods of pain (for example, during cancer treatment procedures). Short, simple techniques are helpful when it's hard to concentrate because of severe pain, high anxiety, or fatigue.
The following relaxation exercises may help relieve pain:
Exercise 1. Slow rhythmic breathing for relaxation
- Step 1. Breathe in slowly and deeply, keeping your stomach and shoulders relaxed.
- Step 2. As you breathe out slowly, feel yourself begin to relax; feel the tension leaving your body.
- Step 3. Breathe in and out slowly and regularly at a comfortable rate. Let your breath come all the way down to your stomach, as it completely relaxes.
- Step 4. To help you focus on your breathing and to breathe slowly and rhythmically: Breathe in as you say silently to yourself, "in, two, three." OR Each time you breathe out, say silently to yourself a word such as "peace" or "relax."
- Do Steps 1 through 4 only once or repeat Steps 3 and 4 for up to 20 minutes.
- Step 5. End with a slow deep breath. As you breathe out, say to yourself, "I feel alert and relaxed."
Exercise 2. Receiving touch, massage, or warmth for relaxation
- Touch and massage are traditional methods that caregivers use to help patients relax. Some examples are:
- Brief touch or massage, such as hand holding or briefly touching or rubbing the patient's shoulders.
- Soaking the patient's feet in warm water or wrapping the feet in a warm, wet towel.
- Massage (3 to 10 minutes) of the whole body or just the back, feet, or hands. If the patient is modest or cannot move or turn easily in bed, just the hands and feet can be massaged.
- Use warm lotion. A small bowl of hand lotion may be warmed in a microwave oven or a bottle of lotion may be warmed in a sink of hot water for about 10 minutes.
- Massage for relaxation is usually done with smooth, long, slow strokes. Try different amounts of pressure along with different types of massage, such as kneading and stroking, to find out what the patient likes.
Especially for the elderly person, a relaxing back rub may be no more than 3 minutes of slow, rhythmic stroking (about 60 strokes per minute) on both sides of the spine, from the crown of the head to the lower back. Keep one hand on the body at all times by starting one hand down the back as the other hand stops at the lower back and is raised. Set aside a regular time for the massage. This gives the patient something pleasant to look forward to.
Exercise 3. Peaceful past experiences
- Something may have happened to you a while ago that brought you peace or comfort. You may be able to remember that experience to bring you peace or comfort now. Think about these questions:Some of the things that may comfort you, such as your favorite music or a prayer, can probably be recorded for you. Then you can listen to it whenever you wish. Or, if your memory is strong, you may simply close your eyes and recall the events or words.
- Can you remember any situation, even when you were a child, when you felt calm, peaceful, secure, hopeful, or comfortable?
- Have you ever daydreamed about something peaceful? What were you thinking?
- Do you get a dreamy feeling when you listen to music? Do you have any favorite music?
- Do you have any favorite poetry that you find uplifting or reassuring?
- Have you ever been active religiously? Do you have favorite readings, hymns, or prayers? Even if you haven't heard or thought of them for many years, childhood religious experiences may still be very soothing.
Exercise 4. Active listening to recorded music
- Step 1. You will need the following:
- An MP3 player, CD player, or iPod®.
- Earphones or a headset. (This helps focus the attention better than a speaker does, and avoids disturbing others.)
- A recording of music you like. (Most people like fast, lively music, but some select relaxing music. Others like comedy routines, sporting events, old radio shows, or stories.)
- Step 2. Mark time to the music; for example, tap out the rhythm with your finger or nod your head. This helps you think about the music instead of your discomfort.
- Step 3. Keep your eyes open and focus on a fixed spot or object. If you wish to close your eyes, picture something about the music.
- Step 4. Listen to the music at a comfortable volume. If the discomfort increases, try increasing the volume; decrease the volume when the discomfort decreases.
- Step 5. If the music is not helping enough, try adding or changing one or more of the following:
- Massage your body in rhythm to the music.
- Try other music.
- Mark time to the music in more than one manner, such as tapping your foot and finger at the same time.
Many patients have found listening to music to be helpful. It tends to be very popular, probably because playing music is a part of daily life and easy to do. If you are very tired, you may simply listen to the music without marking time or focusing on a spot.
These exercises were adapted and reprinted with permission from McCaffery M, Beebe A: Pain: Clinical Manual for Nursing Practice. St. Louis, Mo: CV Mosby: 1989.