Addressing Cancer Pain with Integrative Therapies
Cancer and pain don’t always go together, but they frequently do, adding significantly to the distress of a cancer diagnosis. According to the American Cancer Society, 30-50% of cancer patients report having some pain, a number that rises to 75-90% for advanced cancers.
The causes of cancer pain vary widely, says Kim Dittus, MD, an oncologist at the UVM Cancer Center, some related to the tumor itself as it presses on nerves, some caused by surgery, and some by radiation and chemotherapy treatments.
Fortunately, cancer pain can be managed. Many medications are available and are often effective. And a family of nonpharmacological interventions has entered the medical mainstream, often as a complement to medication, as study after study proves their efficacy in reducing pain.
Acupuncture
What is it?
Acupuncture is a form of traditional Chinese medicine that involves the insertion of thin needles into specific points on the body. These points are believed to be connected by channels, or meridians, which carry energy or "qi" throughout the body.
How it works to address pain
Acupuncture is effective in reducing pain, but exactly how isn’t clear to western medicine, says UVM Medical Center acupuncturist Julie Suarez Cormier, shown treating a patient in the image above. It appears to prompt the release of endorphins, which are natural pain-relieving chemicals produced by the body; stimulate the nervous system, which can help to reduce pain signals and promote healing; and have anti-inflammatory effects, which can help to reduce swelling and pain.
Studies show…
A meta-study published in JAMA Oncology found that acupuncture and acupressure were “significantly associated with reduced cancer pain and decreased use of analgesics.”
Where it’s available and how to access it
Acupuncture is available at no cost on Tuesdays and Thursdays to all patients admitted to the UVM Medical Center on the Hematology/Oncology unit. Interested patients should tell their nurse or doctor they would like the treatment. In addition, a number of acupuncturists in the community specialize in cancer. To find them, patients should search the Vermont Acupuncture Association website, inputting their location and specifying “oncology” in the specialty box. For additional resources, check the Osher Center for Integrative Health’s practitioner network.
Insurance/costs
In-patient acupuncture in the Hem/Onc unit is free. Most of Vermont’s major insurance companies will cover some acupuncture treatment outside of the hospital, and employer-based Blue Cross Blue Shield usually covers all treatment. Out-of-pocket costs range from $50 to $95 per visit, with a minimum of six visits recommended.
Mindfulness
What is it?
Mindfulness is a way of paying attention to the present moment, non-judgmentally and with self-compassion. Meditation is the vehicle through which mindfulness is developed, like going to the gym for your mind, says Donna Smith, a physical therapist and qualified Mindfulness-Based Stress Reduction (MBSR) teacher.
How it works to address pain
Mindfulness allows patients to explore their perceptions of pain and examine the thoughts and feelings they overlay on those perceptions. The practice often reduces the intensity of the pain, decreases the emotional distress associated with it, and can improve overall quality of life.
Studies show…
A study published in the Journal of Pain and Symptom Management found that a mindfulness-based stress reduction program led to significant reductions in pain intensity and emotional distress among cancer patients.
Where it’s available and how to access it
A variety of free online weekly and monthly mindfulness programs for cancer patients are available through the UVM Cancer Center. For more information, contact Donna Smith at donna.smith [at] med.uvm.edu or (828) 450-4250. For additional resources, check the Osher Center for Integrative Health’s practitioner network.
Insurance/costs
The weekly mindfulness courses offered through the UVM Cancer Center are free.
Counseling
What is it?
Counseling is a process that helps individuals, couples, or groups address emotional challenges, personal or interpersonal problems, and mental health concerns. Its goal is to promote well-being, improve overall functioning, and enhance relationships.
How it works to address pain
Counseling addresses cancer pain first by giving patients permission to talk about it, enabling them to get the services they need. Counselors also help patients develop relaxation strategies, like mindfulness or listening to music, that put the body in self-healing mode. Counselors also help patients address the emotional pain of cancer to “bridge that feeling of helplessness and hopelessness and find strategies that will work,” says UVM Cancer Center psychologist Kathy McBeth.
Studies show…
A study published in Critical Reviews in Oncology/Hematology found that counseling was effective in reducing pain and improving psychological well-being among cancer patients.
Where it’s available and how to access it
The UVM Cancer Center offers individual and couples counseling focusing on the needs of cancer patients and their loved ones. There is currently a waiting list for these services, and McBeth suggests contacting Cancer Center Support Services to be placed on the list or for referrals to recommended therapists in the community. The Cancer Center also offers a wide variety of support groups. For a listing of reputable online and phone support groups, networks, and communities, including one-on-one peer support for oncology patients and their families, contact the Frymoyer Community Health Resource Center at 802-847-8821 or ResourceCenter [at] UVMHealth.org. For additional resources, check the Osher Center for Integrative Health’s practitioner network.
Insurance/costs
Most insurance plans cover therapy with a co-pay.
Yoga
What is it?
Yoga is a mind-body practice that originated in India over 5,000 years ago. It involves physical postures, breathing exercises, and meditation to promote overall health and well-being.
How it works to address pain
Yoga reduces pain by helping patients relax, reduce their stress and anxiety, sleep better, and boost endorphin levels. Yoga postures help stretch and strengthen muscles, improve posture, and reduce muscle tension, which can also contribute to pain relief.
Studies show…
A systematic review published in the Journal of Clinical Oncology found that yoga was effective in reducing cancer-related fatigue, pain, and anxiety and was a safe and effective intervention for reducing cancer-related symptoms and improving quality of life in breast cancer patients.
Where it’s available and how to access it
The UVM Cancer Center offers free regular yoga sessions for cancer patients via Zoom, led by Geri Ann Higgins, a registered yoga teacher certified to work with cancer patients. The class offers modified poses and accommodations for recovering patients with special needs. Interested patients should email Higgins at Geriann.Higgins [at] UVMHealth.org for weekly email links to the Zoom sessions. For additional resources, check the Osher Center for Integrative Health’s practitioner network.
Insurance/costs
Zoom yoga sessions for cancer patients are free.
Massage and Acupressure
What is it?
Massage is a form of therapy that involves manipulation of the soft tissues in the body to enhance health and well-being. Acupressure, a form of massage therapy that originated as an art in ancient China, is a non-invasive therapy where pressure is applied to strategic points on the body.
How it works to address pain
Pressing on specific points on the body increases circulation and helps turn off pain signals. Acupressure also reduces cancer pain by stimulating the body's natural pain-relieving mechanisms, such as the release of endorphins and enkephalins.
Studies show…
A meta-study published in JAMA Oncology found that acupressure and acupuncture were “significantly associated with reduced cancer pain and decreased use of analgesics.”
Where it’s available and how to access it
Massage and acupressure are available at no cost to patients in the Infusion Center in UVM Medical Center’s Hematology/Oncology unit during chemotherapy sessions. Kirsten Wiley, a massage and acupressure therapist who specializes in working with cancer patients, administers the treatment on varying days of the week. Interested patients should inform their doctor, nurse, or medical assistant. For additional resources, check the Osher Center for Integrative Health’s practitioner network.
Insurance/costs
Massage/acupressure for cancer patients is free when administered in UVM Medical Center’s Infusion Center. The average cost for a 30-minute session outside the hospital is about $40.
Diet and Nutrition
What is it?
A systematic approach to cooking and eating that can help relieve some types of cancer pain.
How it works to address pain
Diet can be a supportive element in reducing cancer pain. The key, says Emily Stone, a culinary medicine dietitian at the UVM Medical Center, is lowering the circulating level of inflammatory compounds in the body. She recommends a Mediterranean diet of vegetables, fruits, seeds, lean protein like fish, unprocessed natural and whole food omega-3 fats, and whole grains. Things to avoid, Stone says: processed food, trans fat, refined grains, added sugar, and red and processed meat.
Studies show…
A study published in Pain and Therapy found that the Mediterranean diet has shown promise for reducing pain and inflammation.
Where it’s available and how to access it
Free recipes that incorporate these nutritional principals are available from UVM Medical Center’s Culinary Medicine Team at this website. Stone also refers patients to Eating Well magazine’s Mediterranean Diet Center. The UVM Cancer Center also offers health and wellness coaching that includes guidance for those who want to move toward a plant-based, whole foods diet. Interested patients should contact health and wellness coach Emily Calman at emily.calman [at] uvmhealth.org. See this link for a sumptuous salad recipe that follows these nutritional guidelines. For additional resources, check the Osher Center for Integrative Health’s practitioner network.
Insurance/costs
Eating healthy food can be expensive but doesn’t have to be, Stone says. She recommends following the advice on the Environmental Working Group’s website, Good Food on a Tight Budget, and in the book Good and Cheap: Eating Well on $4/Day, which can be downloaded free here. Farm Shares for Health — a program offered by the UVM Cancer Center — offers eligible cancer patients free locally grown vegetables. Take this survey to see if you qualify: https://redcap.link/fc3nevn4.
The Victoria Buffum Endowment funds initiatives to improve the care of cancer patients at The University of Vermont Cancer Center. The Victoria Buffum Fund supports many services, including health coaching, mindfulness, and acupuncture.
