• Overview
  • Ethnicity and Culture
  • Models of Pain Management
  • Evaluating Literature
  • Professional Training, Licensure & Credentials
• Interventions
  • Common Approaches
  • Theories of Mechanism
  • Safety and Adverse Effects
• Conditions
  • Selected Conditions
  • Text Resources
  • Web Resources

Pain, Palliative and Supportive Care Overview

Pain is the most common presenting complaint in the doctor’s office and chronic pain, the presence of disabling pain that lasts beyond 6 months despite adequate medical evaluation and treatment, is one of the most common, costly and debilitating diagnoses in America today. Recent estimates show that one in six Americans were partially or totally disabled by pain, with the cost of treatment and the lost income from the resultant disability exceeding $120 billion (nearly $100 billion for low back pain alone). The treatment of chronic pain highlights both the shortcomings of allopathic medicine as well as the great opportunities for the use of the expanded vision of health and wellness embraced by complementary and alternative medicine (CAM). Pain management is just one aspect of the more general medical specialty called Palliative Care.

When evaluating the pain literature, consider the general caveats that apply to CAM (and allopathic) literature, as well as specific caveats that apply to the use of CAM in the treatment of pain:

General caveats:

1. Observe the usual concerns regarding adequate sample size, valid statistical techniques, appropriate control groups, etc.
2. It’s preferable to use standardized and previously validated assessment measures, rather than ones that have been designed just for the study in question.
3. Ensure the presence of appropriate (though often difficult to arrange) sham therapies for the control group when testing Therapeutic Touch, acupuncture, hypnosis and other CAM therapies.
4. Take into account non-specific treatment factors (expectation, clinician contact time, etc.).

Specific caveats for Pain:

1. Be wary of studies that focus only on levels of pain, rather than improvement in functional activity levels.
2. Distinguish acute from chronic pain.
3. Distinguish pain by etiologic diagnosis, not by location.
4. Minimize or control for psychiatric co-morbidities (especially major depression and PTSD).
5. Control for concurrent use of pain and psychiatric medications.
6. Consider the demographic background of the research participants, as culture and ethnicity may be a factor in pain perception, tolerance, and treatment (for more information see: Overview of Ethnicity, and Culture.

Resources:

• A Virtual Pocket Dictionary of Pain Terms
  International Association for the Study of Pain. An annotated listing of basic definitions. For official information on pain definitions or taxonomy, see the IASP Press publication "Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms". Eds, Harold Merskey and Nikolai Bogduk. 1994. HSL Circ Desk WL 704 C614 1994

• Palliative Care: What it is  World Health Organization definition of palliative care.

• Bandolier Palliative and Supportive Care
  Pages developed in collaboration with the Cochrane Pain, Palliative and Supportive Care Group (PaPaS). Some information may come from systematic reviews, but this is an area with few RCTs, so reviews will frequently not be available. Includes a section on complementary and other therapies for various conditions.

• Pan CX. Morrison RS. Ness J. Fugh-Berman A. Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review. Journal of Pain & Symptom Management. 20(5):374-87, 2000 Nov.  (http://www.library.tufts.edu/ezproxy/ezproxy.asp?LOCATION=http://dx.doi.org/10.1016/S0885-3924(00)00190-1)

• The IAHPC Manual of Palliative Care. Derek Doyle and Roger Woodruff, 2nd ed. 2004, International Association for Hospice and Palliative Care