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When used in an appropriate manner these methods are believed to be effective on secondary pathologies such as inflammation, edema, progressive tissue damage, muscle spasm and function loss which takes part in acute pain. This is an important component of Traditional Chinese Medicine TCM which has become a largely complementary in the West together with the conventional medicine. Acupuncture is accepted as a scientific treatment method that provides the body to restore its balance by means of stimulating some special points on the body with needles.

It can be explained by Gate control theory, which states that sensory stimulant lumbago , can be suppressed by another stimulant pricking a needle within the neural system. It appears to be more effective in preventing vomiting than in reducing. A randomized study found that true acupuncture was much more effective in relieving joint pain and stiffness than sham inactive acupuncture in patients taking aromatase inhibitors.

Acupuncture has also shown to be effective in treating hot flashes occurring in women with breast cancer and men with prostate cancer caused by hormone therapy. It looked at whether acupuncture can help women with severe tiredness fatigue after chemotherapy treatment for breast cancer. The women in the trial had acupuncture carried out by a therapist for 20 minutes, once a week, for 6 weeks.

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The results showed that it helped to reduce fatigue and improve the women's QoL. It is not clear from the study whether this benefit continues in the longer term because the women were only followed up for 18 weeks. A review of acupuncture trials in also found that there is not enough evidence that it can reduce tiredness and hence more research is needed.


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There is also evidence to show that acupuncture has the potential to produce rapid and effective analgesia when needles are inserted deeply enough and manipulated sufficiently. This involves manipulation of the body's soft tissue using various manual techniques and the application of pressure and traction.

Traditional African medicine

The peripheral receptors are stimulated which reaches the brain through spinal cord. Massage seems to increase well-being through the reduction of stress and anxiety levels, and thus may contribute to pain control. A growing number of health care professionals recognize massage as a useful addition to conventional medical treatment. Some evidence from research studies with cancer patients supports the use of massage for short-term symptom relief; additional research is needed to find out if there are measurable, long-term physical or psychological benefits.

A systematic review has shown that out of 27 clinical trials testing massage interventions in cancer pain, 26 showed significant improvements in anxiety, emotional distress, comfort, nausea and pain. A randomized control trial RCT involving cancer patients and 12 licensed massage therapist evaluating changes in symptoms scores for pain, fatigue, stress, nausea and depression was conducted.

Three variation of massage were used- Swedish, light touch and foot massage. The main outcome measures were data from symptom cards collected from independent observers that were recorded before and after the first session of massage. Another Cochrane review has concluded that massage therapy confer short-term benefits on psychological benefits, with effects on anxiety supported by limited evidence. A special type of massage called manual lymph drainage MLD is done as part of Complex Decongestive Therapy CDT , which is used to treat lymphedema after certain cancer surgeries.

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CDT also includes external compression garments, special exercises, and skin care. This treatment is usually done by lymphedema specialists rather than general-practice massage therapists. There is sufficient evidence to show that therapeutic massage is useful discipline in relieving various symptoms of cancer. However, there is a dearth of randomised controlled trials on massage therapy in cancer patients. It was difficult to interpret the results of reported trials due to conflicting results, variation in methodology and use of non-validated symptom scores. Further clinical trials of better designs and mechanistic studies on psychopyhsiologic effects of massage are required to determine its significance in clinical practice.

The use of manual pressure applied to specific areas, or zones, of the feet and sometimes the hands or ears that are believed to correspond to other body areas or organs. Pressure is applied to these reflex points by special hand and finger techniques which relives stress and bring about physiological changes and thereby reduction in pain perception.

It is stated in the literature that reflexology is used especially for reducing end stage cancer pain and side effects of chemotherapy and to increase living quality. I had reflexology on my feet when I was being treated in the hospital and it benefitted me in many ways. It gave me a feeling of instant relaxation and was a welcome relief to get off the ward and be in a different environment. The room that is used has a real feeling of sacred space with music and oils.

I would definitely recommend it to other patients. It can be argued that reflexology can be evaluated as holistic approaches that treat the whole person rather than the symptoms. None of the studies reported any adverse event associated with reflexology. Due to the lack of medical assessment data before or during implementation of reflexology, it is difficult to determine the safety of reflexology.

Moreover, physicians must bear in mind that most patients use CAM to empower themselves in the management of their illness and thus may not be seeking evidence of safety. Yoga is an ancient healing system, inclusive of various asanas or poses with breathing techniques and meditation to assist in the movement and balancing of life force energy or prana. Though a lot of evidence supports use of yoga as an adjunct treatment for cancer patients and survivors yet studies on Yoga contributing in improvement of pain scores are scant.

Individual experiences of patients suffering from cancer have reported that Yoga helped them survive cancer better with strength, hope and vitality. As chemotherapy and radiation therapy pose tremendous stress and emotional burden on the patient complementary therapies like yoga can generate a feeling of well-being for the patient and promote the fighting capabilities. Eshe et al. The deep, relaxing breathing often emphasized in yoga in cancer therapy also increases the current of oxygen-rich blood to the cells, delivering vital nutrients to tired cells and further clearing out toxins.

For those recovering from surgery, such as that for breast cancer, yoga can help restore motion and flexibility in a gentle, balanced manner. Buffart et al. Out of the records screened, 16 full text research papers on RCTs were included in the review and only four such RCTs evaluated pain as one of the physical outcomes and only one RCT reported a decrease in cancer pain after yoga. The other three studies reported no significant difference between yoga and control group. However two out of the four studies discussed in this extensive review of Buffart et al.

However, several reviews and meta-analysis suggest that yoga contribute to improvement in sleep, mood and QoL, depression, emotional function and anxiety. Recent studies of women cancer survivors of breast cancer, suggest that yoga may help improve several aspects of QoL. However ACS does not comment about effects of yoga on cancer pain. Another meta-analysis conducted by Lin et al.

However interpretation of results on effects of yoga on physical health demonstrates that there was no significant difference between cancer patients in control group or yoga treated group. The author also agrees that because of limited number of studies, effects of yoga on physical health remains unclear. Therefore, at present a lot of studies are providing preliminary support for the feasibility and efficacy of yoga interventions and mindfulness based stress reduction for cancer patients but evidence for contribution of yoga in relieving cancer pain remains scant.

Further studies, systematic reviews and meta-analysis are required to comment on effects of yoga in cancer pain. Tai chi also helps to balance the yin and yang principles, the feminine and masculine life force energies.

Eshe reports that regular practice of tai chi promotes wellness of the mind, body and spirit, and can assist in decreasing the severity of side effects of cancer and chemotherapy. Results demonstrated that Tai chi significantly improved the functional capacity including the aerobic capacity, muscle strength and flexibility as well as QoL as compared to psychological support therapy which could only improve flexibility.

Lee et al. A systematic review by Lee et al. Another systematic review evaluating role of Tai chi on breast cancer patients reports that evidence does not support tai chi to be more effective CAM therapy than walking exercise, psychological support therapy or spiritual growth therapy standard control procedures. Three RCTs in this review compared tai chi with the standard control procedures in QoL and psychological health but failed to demonstrate any significant difference between the various procedures adopted. In contrast to the RCTs the four non-randomized controlled trials included in the extensive review did show some beneficial effects of Tai chi for breast cancer patients but all the studies had high risk of bias as assessed by the Cochrane criteria.

Yet another systematic review by Lee et al. On search of various databases we could not find individual studies, systematic reviews or meta-analysis evaluating effects of tai chi specifically on cancer pain, hence at present it is difficult to assess the role of Tai chi on cancer pain though evidence supports its positive role in improving QoL and psychological health of cancer patients.

It is the induction of a trance-like state to facilitate relaxation and enhance suggestibility for treating conditions and introduce behavioural changes.

The Journal of Alternative and Complementary Medicine | Vol 20, No 5

It is not uncommon to see patients fearing a sense of helplessness and a loss of control over his or her own life due to cancer. Hypnosis helps patient cope more effectively with cancer. Liossi et al. Research supports that hypnosis can reduce anticipatory nausea and vomiting.

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Anticipatory nausea and vomiting occur prior to chemotherapy when previous exposure to chemotherapy has already caused nausea and vomiting but hypnosis had less effects on nausea and vomiting that happened after the chemotherapy dose is given. A prospective, randomized study of 39 advanced-stage Stage III or IV cancer patients with malignant bone disease who received weekly sessions of supportive attention or a hypnosis intervention. Nash et al. A systematic review of 27 papers comprising of RCTs, observational studies, retrospective questionnaires and 24 case studies for use of hypnotherapy to treat symptoms of terminally ill adult cancer patients concludes that quality of research done is not adequate and further research is required to understand the role of hypnotherapy in terminal cancer patients.

A review concluded that four of five RCTs found hypnosis plus cognitive behavioural techniques reduced pain intensity and severity compared with the control in patients with acute procedure related pain and oral mucositis pain related to bone marrow transplant. Various studies and reviews have reported that hypnotherapy may be helpful to reduce procedure related pain viz.

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The review also cautions use of hypnosis by an expert only as this form of CAM may be associate with short term fatigue, anxiety, confusion, fainting or rarely serious reactions also stupor, chronic psychological problems, seizures and therefore screening of vulnerable individuals is recommended for this therapy. A systematic review for effectiveness of hypnosis and procedure related pain and distress in pediatric cancer patients reveals that though hypnosis has potential as a clinically valuable intervention in such patients yet further research is required as various studies had lot of methodological limitations.


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Therefore at present evidence supports use of hypnotherapy for various procedure related pain in pediatric and adult cancer patients but evidence for use of hypnotherapy for chronic cancer pain is inconclusive. This is the controlled use of plant essences, applied either to the skin through massage, added to baths or inhaled with steaming water. It has been shown that the aromatic oils reached the lymph system by means of blood circulation and provided recovery by means of intercellular fluids.

A Cochrane systematic review concluded that aromatherapy have beneficial short-term effects on well-being in cancer patients. Many people fear that massage may spread the tumour to various other areas as it shall increase the blood supply to which Horrigan opines that surface massage will not make the cancer grow due an increased blood supply,[ 48 ] nor make the cancer spread, nor interfere with chemotherapy or radiotherapy, nor cure cancer by natural means.

However aroma therapists advise not to use unresearched oils or unfamiliar oils. There is no evidence that either essential oils or aromatherapy has caused cancer in humans. Lavender and citrus oils of a good quality are also useful for relieving stress.