Nonpharmacological interventions with chronic cancer pain in adults.

BACKGROUND Pain is often poorly controlled in cancer patients. Chronic pain affects adult patients at all stages of cancer management. Optimal pain management may require attention to psychosocial variables and the inclusion of nonpharmacological techniques. METHODS Three nonpharmacological strategies that are effective in reducing pain caused by cancer--patient psycho-education, supportive psychotherapy, and cognitive-behavioral interventions--are reviewed. Recommendations for physicians to facilitate a mental health referral are also discussed. RESULTS Effective treatment of cancer pain begins with assessing the severity, characteristics, and impact of pain. Emotional distress (especially anxiety, depression, and beliefs about pain) has emerged as predictive of patient pain levels. Appropriate pain management may require a multidisciplinary approach. CONCLUSIONS Patient psycho-education has empowered patients to actively participate in pain control strategies. Supportive psychotherapy can assist patients in managing the stressors associated with cancer, and cognitive-behavioral therapy helps patients to recognize and modify the factors that contribute to physical and emotional distress.