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Assessing the Impact of Acupuncture on Pain, Nausea, Anxiety, and Coping in Women Undergoing a Mastectomy.
Oncology Pain and Complementary Therapy
Here are the journal articles for this month. Happy reading!Great articles! Thank you.
I love complementary therapies and alternative medicines and am happy to always learn more about them. I loved that these articles not only spoke of the benefits but also the risks. As beneficial as massage therapy is, I was surprised at the adverse events listed – fractures and dislocations, internal hemorrhage, hepatic hematoma, dislodging of DVT w/ resultant embolism of the renal artery, and displacement of a ureteral stent.”
I think that in spite of adverse events, if the patient is known well that some of these therapeutic techniques could be done specifically for the patient’s needs with reduced risk.
Acupuncture is also being used to treat dry mouth in Head/Neck radiation patients but that is pretty new so not mentioned in the articles.
The Article – Oncology Pain and Complementary Therapy discusses Massage, acupuncture, therapeutic touch for bone pain, visceral pain, neuropathic pain which I liked that they discussed each therapy for specific types of pain.
When I was an inpatient nurse, I would massage my patients if I were bathing or applying lotion. Now as I am outpatient, I do not have those opportunities but I will recommend patients seek out these therapies on their own.
There will be an issue of paying for it and if insurance covers it or not. I feel that we should be very selective with providers and choose those that are familiar with cancer pain and the cancer patient. Some massage facilities are only cash pay and will not bill insurance. Although the patient can submit to insurance on their own, that is more work for their already busy schedule of fighting cancer.
As with most alternative therapies – much more research is needed.
Do any of your clinic recommend any of these types of therapies? If so, specific providers or generic referrals?
The James Survivorship clinic provides free massage to their patients.
Head/Neck refers to acupuncture for dry mouth. Gyn refers patients to massage.
“Post op acupuncture in addition to usual care, resulted in decreased pain, nausea, and anxiety as well as an increased ability to cope.” Any idea if JCBC incorporates acupuncture in their post –op care?
TherapyMindy-
Thanks for starting the discussion! I introduced the topic of complimentary and alternative medicine (CAM) because it is finally becoming more widely accepted within the medical community and shows lots of potential for effectiveness. Unfortunately insurance companies are a bit slower to accept so sometimes we will refer a patient for massage, acupuncture, etc but their insurance will not pay. When I floated to the James Survivorsip Clinic I found out that their acupuncture provider only bills for a clinic visit (and not for acupuncture treatment) for that reason- he wants everyone to be able to get treatment regardless of insurance. I am not familiar with any of the surgical oncology clinics at the Breast Center referring patients to the Survivorship clinic for acupuncture. I think many of the providers are not fully aware of the availability and/or effectiveness of these treatments. I have been mentioning it to patients based on assessment, especially with pain that is not fully responding to other treatments, but I would like to see it become part of common treatment plans.We need to answer 3 of the 4 questions and reply to 2 peers for credit.
1.What was the knowledge gained from the article?
2.Will the research/information in this article change or influence your practice? If so how?
3.What other questions does the article raise about current practice?
4.Do you agree/disagree with the conclusions of the author, why?1.What was the knowledge gained from the article?
2.Will the research/information in this article change or influence your practice? If so how?
After reading the article (Oncology Pain and Complementary Therapy: A Review of the Literature) I feel more knowledgeable about CTs. I feel that when I am working in the different clinics I will be more mindful of informing providers and patient’s to utilize the survivorship clinic to help manage patient symptoms.
3.What other questions does the article raise about current practice?
After reading the article (Oncology Pain and Complementary Therapy: A Review of the Literature) I really got to thinking, why aren’t CTs used more? With the development of tolerance to narcotics and the opioid crisis, you would think clinicians would be seeking out alternative methods to treat and manage pain. These methods can also help to calm patient’s anxiety. These methods have been around and used for 1000s of years, in many cultures, and should be more sought after here in the U.S.
4.Do you agree/disagree with the conclusions of the author, why?
I do agree with the conclusions of the author (Oncology Pain and Complementary Therapy: A Review of the Literature)that the use of CTs and Western medicine as an integrative approach to cancer pain and symptom management may prove to be more beneficial than pharmacologic treatment alone. I have seen this proven when working in the survivorship clinic and when talking to my oncology patients about pain control. While doing patient assessments and intake patients who use CTs, they often articulate how much they benefit from massage therapy and acupuncture in addition to pain medication. We are lucky to have the survivorship clinic that offers many CTs to our oncology patient’s.Mindy and Greg- I do think it is a shame that many insurance providers do not cover massage and acupuncture. A lot of patient’s would benefit from these services but can not afford to pay out of pocket for them. In my opinion these services should be provided to all of the oncology patient’s seen at the James, done by providers who are knowledgeable on the specialty of caring for cancer patients. This is done in the survivorship clinic, but unfortunately not all providers here at the James are utilizing it.
Greg- that’s cool to hear that the acupuncture MD at the survivorship clinic is so passionate about his patient care and has learned how to work around the billing. More doctors need to have this mentality!
Thank you for participating Kasey!
In addition to the providers not utilizing those services more, many patients are resistant and only want narcotics. I think it is an entire culture that needs to change their way of thinking and be more accepting of other alternatives than what they are used to prescribing and what patients are used to being given.1.What was the knowledge gained from the article?
There are more alternatives to managing pain besides drugs which The James does offer on a very small scale vs the need.2.Will the research/information in this article change or influence your practice?
I will discuss these alternatives with patients and also physicians/staff so that they are more aware. They can choose to research it more and/or utilize these alternatives in patient care.
I will try to find those specific providers that we currently use and trust which I will then recommend for patients to pursue.3.What other questions does the article raise about current practice? The big question is, Why not?” Why aren’t more utilizing these alternatives, why isn’t insurance being more supportive of these alternatives to opoids? The media is constantly reporting on the opoid crisis so why aren’t they reporting on these alternatives? How are we going to change the culture and way of thinking of the information is not provided on a large scale
Thank you for initiating a journal club that all of the James Nursing staff can participate in.
Great articles it appears that this is a growing interest of our patients.
1.What was the knowledge gained from the article? After reading Oncology Pain and Complementary Therapy (CT): A Review of the Literature, I was provided a great description of the different complementary therapy modalities. I struggle at times defining these therapies I feel after reading this article I am better equipped to educate my patients. This article also reminded of how many patient experience pain especially the metastatic patient.
I specifically liked the Reiki definition for this is a therapy that is available to the breast cancer patients here at SSCBC and my patients are always inquiring about it. We also have Dr Borja one of the Complementary Therapy providers running a clinic out of the SSCBC so I’m aware of the increase interest in CT by my patients.
The other article Assessing the impact of Acupuncture on Pain, Nausea, Anxiety, and Coping in Women Undergoing a Mastectomy provided data on a study of 30 women with half of those women receiving acupuncture postoperatively. The finding were reduction in pain, nausea, and anxiety as well as an increase in ability to cope. This was a small study but the results are hopeful that in combination with western medicine acupuncture could be helpful in decreasing the side effects our patients are experiencing for the treatment modalities that they receive for their cancer.2.Will the research/information in this article change or influence your practice? If so how? I will use the information gained by these articles to support the use of CT to reduce pain, nausea and anxiety ect. I will provide this information to my patients as well as request5 referrals from the providers.
3.What other questions does the article raise about current practice? Will Western Medicine get on board with the possibility of promoting CT. Insurance coverage definitely is an obstacle. The Reiki is provided to patients at SSCBC at no cost because I think it’s funded by a grant. There is also a grant for massage for our survivorship clinic at SSCBC which I’ve heard from patients how much they look forward to those visits.
4.Do you agree/disagree with the conclusions of the author, why? I agree with the authors of these articles that CT can help with many side effects from cancer treatments. CT can reduce the side effects of cancer treatments. I think the emphasis is reduce these side effects. I find a lot of my patients welcome the idea of eliminating the side effects of cancer and cancer treatments especially pain but the reality is that our goal is to make it tolerable.1.What was the knowledge gained from the article?
I liked how the different modalities were explained, since I have a very limited knowledge of CT. I also like how it seems to support that the complimentary therapies can help reduce the need for opioid medications, which we all know have issues of their own. High anxiety levels contribute to increased pain levels, so it makes perfect sense to give a patient alternative ways to reduce the anxiety, and thus the pain. I also believe if patients participate in the methods used to manage their pain, it gives them some control over a situation I am sure feels out of control. This will also decrease anxiety and pain. Win Win.
2.Will the research/information in this article change or influence your practice? If so how?
I plan to look into it further and will mention it to patients when I have a better handle on what I am talking about. Many are looking at alternative treatments for pain/anxiety. This is the time in their lives that they want and need to focus on themselves. I don’t see how it couldn’t be beneficial in one way or another.
3.What other questions does the article raise about current practice?
It made me wonder if doing one or some of these therapies prior to surgery would also be beneficial.
Greg and Patricia are spot on about insurance. It is an obstacle and needs to be addressed. Even our own health insurance has minimized our benefits with regard to massage and chiropractic care.
Mindy,
I wonder if there would be a way to teach family members how to do some types of massage or therapeutic touch.
I also agree with you about being selective with regard to providers. Not all massage therapists are gentle or versed in cancer pain. There is a lot more to research and consider for sure.Today, I was able to witness a patient receiving Reiki and I felt like one of the benefits from this therapy was the therapist actively listens for 30-60 minutes and the therapist quickly develops a therapeutic relationship with the patient.
I feel like the patients just greatly benefit from someone spending so much time listening to all their cancer journey.After reading both of the articles, I still feel as though in my practice I am always trying to offer other modalities for the relief of pain that does not involve medications if possible. Our bodies are not to have too much acetaminophen or too much ibuprofen on top of the fact that narcotic medications don’t always offer the relief to some of the pain that patients are experiencing. The alterative therapies offered in these articles can allow patients to undergo some of these without always coming to a physicians office that can maybe lessen their anxiety too. I firmly believe that a persons feeling of pain can be influenced by other stressors, like anxiety. Going to a spa for instance for some of the modalities may just have an overall positive experience for the patient.
Again, I am not certain that I will change my offering of pain relief in practice because I believe I already suggest maybe undergoing a massage or other types of stress relief activities that they choose. A warm bath, a walk in fresh air, etc.
Mindy,
I too remember giving my patients a massage while they were inpatient because I felt as though that could relax them a bit more. I also know that I seem to use therapeutic touch quite frequently to which I feel like it helps to soothe the patient. I know that it is not necessarily what these articles were overall about, but I think that we as nurses forget that we are trying to offer alternative modalities to calm and relieve tension in our patients everyday. Reducing all of this can also help reduce their pain in a sense as well.
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