Integrating CAM into pain management at the end of life

Dr. Perry Fine — an anesthesiologist from the University of Utah in Salt Lake City — has published an excellent review of this topic. It is essential reading for healthcare professionals as well as family and patient caregivers.

Among other issues, it provides good perspective on the role of CAM approaches to pain management in palliative care, which I have summarized here.

Rehabilitation/physical therapy

• Mobility may be improved
• Carefully assess the home environment and the degree of hands-on physical assistance needed
• Make the decision to use these modalities on a case-by-case basis

Massage

• Family members can be taught simple, safe techniques of massage
• Hospice programs can often provide trained, certified massage therapists

TENS (transcutaneous/percutaneous electrical nerve stimulation)

• Evidence supports its use for persistent low back pain and knee pain

Acupuncture

• Consider for patients with cancer and other end-stage pain
• Evidence that it be an effective antidepressant
• Might have a positive effect on COPD, difficulty breathing during end-stage cancer, and asthma

Cognitive interventions

• Several cognitive interventions are available
• Involving patients in self-care may improve mood and increase coping behaviors

Music therapy

• Reduces anxiety and improves mood
• Low-cost
• May reduce chronic pain
• Improves quality of life by enhancing comfort and relaxation
• Doesn’t interfere with technical aspects of care

Illustration: Association of Children’s Hospices

10/20/06 19:57 JR