Cancer Pain : Nondrug Treatments for Pain

by National Cancer Institute

(Page 6 of 8)

Nondrug treatments are now widely used to help manage cancer pain. There are many techniques that are used alone or along with medicine. Some people find they can take a lower dose of medicine with such techniques. These methods include: relaxation, biofeedback, imagery, distraction, hypnosis, skin stimulation, transcutaneous electric nerve stimulation (TENS), acupuncture, exercise or physical therapy, and emotional support and counseling.

You may need the help of health professionals - social workers, physical therapists, psychologists, nurses, or others - to learn these techniques. Family and friends can also help. To find names and numbers of practitioners who specialize in and organizations knowledgeable about these techniques:

• Talk with your doctor or nurse.
• Contact a local hospice, cancer treatment center, or pain clinic.
• Visit your local bookstores or library.
• Contact the National Center for Complementary and Alternative Medicine Clearinghouse toll-free at 1-888-644-6226 or via e-mail at [e-mail].

Because pain may be a sign that the cancer has spread, an infection is present, or there are problems caused by the cancer treatment, report any new pain problems to the doctor or nurse before trying to have the pain relieved by any of the following methods.

Some general guidelines for relieving pain with nondrug methods include:

• Learn which methods work for you. Try using a non- medicine method along with your medicine. For instance, you might use a relaxation technique (to lessen tension, reduce anxiety, and manage pain) at the same time you take medicine.

• Know yourself and what you can do. Often when people are rested and alert, they can use a method that demands more attention and energy. When tired, people may need to use a method that requires less effort. For example, try distraction when you are rested and alert; use hot or cold packs when you are tired.

• Be open-minded and keep trying. Keep a record of what makes you feel better and what doesn't help.

• Try each method more than once. If it doesn't work the first time, try it a few more times before you decide it is not helping you.

Relaxation

Relaxation relieves pain or keeps it from getting worse by reducing tension in the muscles. It can help you fall asleep, give you more energy, make you less tired, reduce your anxiety, and help other pain relief methods work better. Some people, for instance, find that taking pain medicine or using a cold or hot pack works faster and better when they relax at the same time.

How to Use Relaxation

Relaxation may be done sitting up or lying down. Choose a quiet place whenever possible.

Close your eyes. Do not cross your arms and legs because that may cut off circulation and cause numbness or tingling. If you are lying down, be sure you are comfortable. Put a small pillow under your neck and under your knees or use a low stool to support your lower legs.

There are many methods. Here are some for you to try:

Visual concentration and rhythmic massage:

• Open your eyes and stare at an object, or close your eyes and think of a peaceful, calm scene.

• With the palm of your hand, massage near the area of pain in a circular, firm manner. Avoid red, raw, or swollen areas. You may wish to ask a family member or friend to do this for you.

Inhale/tense, exhale/relax:

• Breathe in deeply. At the same time, tense your muscles or a group of muscles. For example, you can squeeze your eyes shut, frown, clench your teeth, make a fist, stiffen your arms and legs, or draw up your arms and legs as tightly as you can.

• Hold your breath and keep your muscles tense for a second or two.

• Let go! Breathe out and let your body go limp.

Slow rhythmic breathing:

• Stare at an object or close your eyes and concentrate on your breathing or on a peaceful scene.

• Take a slow, deep breath and, as you breathe in, tense your muscles (such as your arms).

• As you breathe out, relax your muscles and feel the tension draining.

• Now remain relaxed and begin breathing slowly and comfortably, concentrating on your breathing, taking about 9 to 12 breaths a minute. Do not breathe too deeply.

• To maintain a slow, even rhythm as you breathe out, you can say silently to yourself, "In, one, two; out, one, two." It may be helpful at first if someone counts out loud for you. If you ever feel out of breath, take a deep breath and then continue the slow breathing. Each time you breathe out, feel yourself relaxing and going limp. If some muscles, such as your shoulder muscles, are not relaxed, tense them as you breathe in and relax them as you breathe out. Do this only once or twice for each specific muscle group.

• Continue slow, rhythmic breathing for a few seconds up to 10 minutes, depending on your need.

• To end your slow rhythmic breathing, count silently and slowly from one to three. Open your eyes. Say silently to yourself, "I feel alert and relaxed." Begin moving about slowly.

Other methods you can add to slow rhythmic breathing:

• Imagery.

• Listening to slow, familiar music through an earphone or headset.

• Progressive relaxation of body parts. Once you are breathing slowly and comfortably, you may relax different body parts, starting with your feet and working up to your head. Think of words such as limp, heavy, light, warm, or floating. Each time you breathe out, you can focus on a particular area of the body and feel it relaxing. Try to imagine that the tension is draining from that area. For example, as you breathe out, feel your feet and ankles relaxing; the next time you breathe out, feel your calves and knees relaxing, and so on up your body.

• Ask your doctor or nurse to recommend commercially available relaxation tapes. These tape recordings provide step-by-step instructions in relaxation techniques.

Precautions:

Some people who have used relaxation for pain relief have reported the following problems and have suggested the following solutions:

• Relaxation may be difficult to use with severe pain. If you have this problem, use quick and easy relaxation methods such as visual concentration with rhythmic massage or breathe in/tense, breathe out/relax.

• Sometimes breathing too deeply for a while can cause shortness of breath. If this happens to you, take shallow breaths and/or breathe more slowly.

• You may fall asleep. This can be especially helpful if you are ready to go to bed. If you do not wish to fall asleep, sit in a hard chair while doing the relaxation exercise or set a timer or alarm.

If you have trouble using these methods, ask your doctor, nurse, social worker, or pain specialist to refer you to someone who is experienced in relaxation techniques. Do not continue any technique that increases your pain, makes you feel uneasy, or causes unpleasant effects.

Biofeedback

Learning this technique requires the help of a licensed biofeedback technician. With the help of special machines, people can learn to control certain body functions such as heart rate, blood pressure, and muscle tension. Biofeedback is sometimes used to help people learn to relax. You can use biofeedback techniques to help you relax and to help you cope with pain. This technique is usually used with other pain relief methods.

Imagery

Imagery is using your imagination to create mental pictures or situations. The way imagery relieves pain is not completely understood. Imagery can be thought of as a deliberate daydream that uses all of your senses - sight, touch, hearing, smell, and taste. Some people believe that imagery is a form of self-hypnosis.

Certain images may reduce your pain both during imagery and for hours afterward. If you must stay in bed or can't leave the house, you may find that imagery helps reduce the closed-in feeling; you can imagine and revisit your favorite spots in your mind. Imagery can help you relax, relieve boredom, decrease anxiety, and help you sleep.

How to Use Imagery

Imagery usually works best with your eyes closed. You may want to use a relaxation technique before using imagery. The image can be something like a ball of healing energy or a picture drawn in your mind of yourself as a person without pain (for example, imagine that you are cutting the wires that send pain signals from each part of your body to your brain). Or think of a pleasant, safe, relaxing place or activity that has made you happy. Exploring this place or activity in your mind in great detail can help you feel calm.

Here is an exercise with the ball of energy.

• Close your eyes. Breathe slowly and feel yourself relax.

• Concentrate on your breathing. Breathe slowly and comfortably from your abdomen. As you breathe in, say silently and slowly to yourself, "In, one, two." As you breathe out, say, "Out, one, two." Breathe in this slow rhythm for a few minutes.

• Imagine a ball of healing energy forming in your lungs or on your chest. It may be like a white light. It can be vague. It does not have to be vivid. Imagine this ball forming, taking shape.

• When you are ready, imagine that the air you breathe in blows this healing ball of energy to the area of your pain. Once there, the ball heals and relaxes you.

• When you breathe out, imagine the air blows the ball away from your body. As it goes, the ball takes your pain with it.

• Repeat the last two steps each time you breathe in and out.

• You may imagine that the ball gets bigger and bigger as it takes more and more discomfort away from your body.

• To end the imagery, count slowly to three, breathe in deeply, open your eyes, and say silently to yourself, "I feel alert and relaxed." Begin by moving about slowly.

About the Author

www.nci.nih.gov
The National Cancer Institute's research programs are extensive and contain many innovative initiatives. I invite you to explore our Web site to find out more about the exciting work being conducted here at NCI and by NCI-supported scientists throughout the country.