Effect of complementary and alternative medicine interventions on cancer related pain among breast cancer patients: A systematic review

Journal Pre-proof Effect of complementary and alternative medicine interventions on cancer related pain among breast cancer patients: A systematic review Razieh Behzadmehr, Neda Dastyar, Mahdieh Poodineh Moghadam, Mahnaz Abavisani, Mandana Moradi

PII:

S0965-2299(19)31908-9

DOI:

https://doi.org/10.1016/j.ctim.2020.102318

Reference:

YCTIM 102318

To appear in:

Complementary Therapies in Medicine

Received Date:

7 December 2019

Revised Date:

13 January 2020

Accepted Date:

14 January 2020

Please cite this article as: Behzadmehr R, Dastyar N, Moghadam MP, Abavisani M, Moradi M, Effect of complementary and alternative medicine interventions on cancer related pain among breast cancer patients: A systematic review, Complementary Therapies in Medicine (2020), doi: https://doi.org/10.1016/j.ctim.2020.102318

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Effect of complementary and alternative medicine interventions on cancer related pain among breast cancer patients: A systematic review

Razieh Behzadmehr1, Neda Dastyar2, Mahdieh Poodineh Moghadam3, Mahnaz Abavisani4, Mandana Moradi5

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Associate Professor of Radiology, Department of Radiology, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran. Department of Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran. Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, Iran. Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran. Clinical Pharmacy Department, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran.

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Corresponding Author: Mandana Moradi Behdasht St, Zabol University of Medical Sciences, Zabol, Iran

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Email: [email protected] , Fax: +98-543228321, tell: +98-5435223102

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A systematic review of 46 studies on 3685 participants. Acupuncture, Tai chi/qi gong, yoga, music therapy, massage, meditation, reflexology, and Reiki reduced the pain. Aromatherapy have no effect on cancer related pain among breast cancer patients.

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Highlights

Abstract

Objective: This systematic review aimed to evaluate the efficacy of CAM interventions for cancer-related pain in breast cancer patients.

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Methods: Databases (PubMed, Scopus, Web of Science, and EMBASE) were searched from January 1, 2000, up to April 31, 2019, using the keywords: Complementary and alternative medicine therapies and cancer related pain. Standard tools were used to evaluate the quality of the studies included. Results: Of the 3742 articles found, 46 articles comprising 3685 participants entered the final phase. Our results indicate that interventions including acupuncture/acupressure, tai chi/qi gong, hypnosis, meditation, music therapy, yoga, massage, reflexology, and Reiki improve cancer-related pain in breast cancer patients. However, aromatherapy had no effect on the same. Conclusions: Despite the positive effect of various CAM interventions in reducing cancer-related pain, necessary

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precautions should be adopted to use them alongside other treatments to control cancer pain in the clinical setting. Keywords: Complementary and Alternative Medicine; Cancer Related Pain, Breast Neoplasm; Systematic

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Review

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1. Background

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Breast cancer is one of the leading public health challenges in the world. According to the latest statistics, breast cancer is the most common cancer among women and the second common type of cancer in the world with

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the 2,088,849 new cases in 2018 (1, 2). Breast cancer accounts for 11.6% of all type of cancers worldwide (2). Cancer-related pain is recognized as one of the most common complications in patients with breast cancer (3). The overall pain prevalence rate in cancer patients ranges from 33% to 66%, indicating that more than two-

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thirds of the patients suffer from it (4, 5) and the incidence of cancer-related pain in patients with breast cancer ranges from 29.8% to 65% (6). Cancer-related pain in patients with breast cancer causes disrupted daily activities,

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psychological distress, decreased social activity, decreased social support, and ultimately a reduction in the quality of life (7-12). Moreover, cancer-related pain is not often controlled satisfactorily and remains untreated (13, 14). The existing treatments for cancer-related pain management are the drugs and opioids which despite of positive effect on decreasing the pain associated with side effects such as vomiting, constipation, tolerance, physical dependence, dizziness, sedation, hyperalgesia, nausea, immunologic and hormonal dysfunction, and respiratory depression (15). Therefore, pain control is a top priority in the routine care of patients with breast cancer (16).

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The use of complementary and alternative medicine (CAM) has gained popularity in recent times with a positive effect on pain control (17, 18). Despite of side effects of some CAM therapies, most of them are wide availability and affordability, are more than other treatments easy to practice (19-22). Although there have been several individual studies in this regard, no comprehensive study exists on the effect of different CAM interventions on cancer-related pain in patients with breast cancer. Our systematic review is aimed to serve as a guide for the appropriate use of CAM interventions by healthcare providers, patients, and nurses, while taking into account the discrepancies found in these individual studies. The purpose of this study was to determine the effect of complementary and alternative interventions on cancer-

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related pain among patients with breast cancer.

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2. Methods

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2.1. Design and inclusion criteria

This systematic review was conducted and reported in compliance with the Cochrane book and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (23). Here, we investigated

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the effect of different CAM interventions on cancer-related pain in patients with breast cancer. The inclusion and exclusion criteria described in Table 1. Types of CAM therapies in five specialized categories were included:

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natural products, mind-body therapies, alternative medical systems, manipulative and body-based methods, and energy therapies. The cam therapies categories and them definitions described in supplementary Table 1 and

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supplementary Table 3. 2.2. Search strategy

Four international electronic databases (PubMed, Scopus, Web of Science, and EMBASE) were searched from

January 1, 2000 up to April 31, 2019. The PubMed search strategy was adapted for searching other databases. Additionally, we searched the database PROSPERO for ongoing or recently completed systematic reviews. The search was conducted by two researchers independently (A.A.N, A.M). The search strategy (Supplementary Table

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2) included MESH terms, Emtree terms and free words from related articles. The main keywords used included: complementary and alternative medicine, cancer related pain. 2.3. Selection of studies and data extraction and quality assessment The two researchers who conducted the search also performed the screening, quality assessment, and extraction of data. The main extracted data included the study ID, publication details, participant information (country, age, the current status of the disease, type of pain) and information about the main categories and subcategories of CAM (Instruments, intervention duration per session, procedure, total duration).

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To evaluate the quality of clinical trial studies and quasi-experimental studies, JADAD and JBI, standard and well-known tools, were used respectively. The JADAD Scale and JBI tool used for assess the quality of RCT and quasi-experimental studies.

The quality assessment of the RCT included studies were assessed using the Jadad scale whose rating criteria take

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into account randomization, double blinding, and withdrawals or dropouts (24). The scoring range in the Jadad scale goes from 0 to 5 in which a higher score represents higher quality of the study. The quality of quasistudies

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assessed

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quasi-experimental

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tool

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(25).

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experimental

3.1. Study selection

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3.Results

Of the 3742 articles that were identified through database searches, only 2427 non-duplicate articles were selected.

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We excluded 2350 articles after reviewing the title and abstract based on our inclusion criteria. Of the 77 articles whose full-text versions were reviewed, 46 met the inclusion criteria and entered the final phase. Of the 32 articles

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excluded, most were published in non-English languages (n=8) (Figure 1).

3.2. Study characteristics A total of 46 studies conducted on 3685 breast cancer patients in 14 countries between 2005 and 2019 entered the final stage. The sample size ranged from 8 to 300 individuals. In terms of the classification of CAM interventions, most studies were conducted in mind-body therapies (n = 24), alternative medical systems (n = 14), and manipulative and body-based methods fields (n = 8). The fewest studies were carried out in the field of energy

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therapy (n = 1). Among the mind-body therapy interventions, most of the interventions were yoga (n = 9), meditation (n = 5), alternative medical systems, and acupuncture interventions (n = 12). Patients underwent surgery in most studies (n = 19) and the exact stage of breast cancer was not determined (n = 25). Regarding the type of pain studied, the most common pain types included: chronic cancer-related pain (n = 18), and postoperative cancer-related pain (n = 17). The most common pain measurement tools included VAS (n = 17) and BPI (n = 8).

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Most of the included studies were clinical trials (n = 35) (Table 2).

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3.3. Complementary and alternative medicine interventions on cancer related pain

3.3.1.1. Acupuncture/Acupressure

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3.3.1. Alternative Medical Systems

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Of the forty-seven studies included, twelve were clinical trials that assessed the effect of acupuncture on cancerrelated pain in 904 patients from 2007 to 2019, mostly carried out in the United States (n = 9)(26-37). Based on their disease condition, the patients were frequently treated with aromatase inhibitors (AIs) (n = 7) (27, 28, 30,

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33-35, 38). Stage 1–3 patients comprised the largest sample size in most studies (n = 6) (27, 28, 30, 33-35) . The BPI-SF instrument was most commonly used to measure pain (n = 8) (27, 28, 30, 33-35, 37). The type of pain

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studied included: aromatase inhibitor-related pain (n =7) (27, 28, 30, 33-35, 37) , postoperative pain (n = 3) (29, 32, 36), and chronic cancer-related pain (n = 2) (31, 37). In most studies (n = 11) (26-36), acupuncture was performed by an expert. Disinfected disposable needles (25*4 mm) were used often (n = 5) (26-28, 31, 33). The Acupuncture points were only mentioned in seven articles and mostly included between 15 and 21 points. The common points included the bilateral, shoulder, and lumbar regions. Acupuncture was performed in all studies in a way that the needle was inserted at a depth ranging from 24mm to 40 mm based on the desired point. Each acupuncture session lasted for 20 minutes in one half and 30 minutes in the other half of the studies. The

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intervention was carried out once (n = 2) (26, 29) or twice a week (n = 7) (27, 28, 30, 31, 33-35) in most studies. The total acupuncture period lasted from 1 day to 12 weeks. Of the twelve studies included, three of them had no control group. Of the remaining 9 studies, 5 used acupuncture also on the control group (Sham), in 3 patents received usual care, and 1 used Kinesiotherapy. In regard of studies quality, of 10 RCTs, 3 had high quality (score=4), 6 had moderate quality (score=3), and one study had low quality (score= 2). The results indicate that, in the majority of the studies (n = 10) (27-36), acupuncture reduced different types of cancer-related pain (aromatase inhibitor-related pain [n = 6] (27, 28, 30, 33-35), postoperative pain [n = 3](29, 32, 36) and chronic cancer related pain (31) ). In one study, acupressure was performed on 6 points for 20 minutes a

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day for 6 weeks by the patients themselves with no significant effect in reducing breast cancer-related pain. 3.3.1.3. Tai chi/qi gong

Two studies investigated the effect of Tai chi/qi gong on cancer-related pain in 79 participants aged between 44

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and 59 years who had undergone chemotherapy and aromatase inhibitor therapy (AIT) (38, 39). The type of pain studied was chronic pain and AIT-induced pain, which were assessed using BPI and SDS tools. Tai chi/qi gong

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intervention consisted of relaxation, meditation, and attaining a state of ecstasy for 15 minutes to one hour. The control group did not receive any intervention. One was mixed-method and one was quasi-experimental study.

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The quasi-experimental study had a high quality. The results of both studies showed a significant effect of Tai chi/qi gong intervention on reducing cancer-related pain.

3.3.2.1. Aromatherapy

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3.3.2. Mind-Body Therapies

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Two studies conducted in the United States, investigated the effect of aromatherapy on cancer-related pain in 74 participants aged between 42 and 55 years who had undergone radiotherapy and surgery (40, 41). Radiotherapy

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and surgery-induced pain were evaluated using the VAS tool. Aromatherapy massage was used in one study and inhalation aromatherapy was used in the other one, with lavender being used more frequently than others. Aromatherapy massage was performed 2-3 times daily and inhalation aromatherapy was performed using two drops, 5 to 60 minutes after the surgery. All studies were RCTs, one study moderate quality (score=3) and one had low quality (score=2). Our results indicated that inhalation aromatherapy and aromatherapy massage did not reduce the pain in these subjects. 3.3.2.2. Hypnosis

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Five studies mostly carried out in the United States (n=3)(42-44) investigated the effect of hypnosis on cancerrelated pain in 1,034 participants aged between 48 and 59 years . The patients underwent surgery in most studies (n = 3) (44-46)and were at different stages of the disease, but the stage of the disease was not specifically identified in the reports. The most common type of pain was postoperative pain, which was assessed by various standard tools. In most studies, 15-minute hypnosis was performed on the cancer patients, while the control group only received routine care. The intervention was carried out weekly in two studies. Of five studies, 3 was RCTs, one was quasi-experimental and one was pilot study. All RCTs had moderate quality (score=3). The quasi-

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experimental study had a high quality. The results showed that hypnosis significantly reduced pain in most studies.

3.3.2.3. Meditation

Five studies investigated the effect of meditation on cancer-related pain in 555 participants aged between 46.5

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and 56.8 years. Most studies (n = 3)(47-49) were performed in the United States and were clinical trials (n = 4)(4750). The patients underwent different treatments in most studies. The most common type of pain studied was

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chronic cancer-related pain assessed using the BPI tool (48, 51). The most commonly used meditation program was mindfulness-based stress reduction (MBSR) (n = 2) (48, 51). Meditation lasted from 20 minutes to 2 hours

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in various studies. The control group only received routine care in most of the included studies (n = 4) (48-51). The overall duration of the intervention was from 3 days to 8 weeks carried out weekly. Of all, four studies were RCTs, and one was quasi-experimental. All RCTs had a moderate quality(score=3). The quality of quasi-

3.3.2.4. Music therapy

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experimental study was high. All studies show that meditation significantly reduced pain in these patients.

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Two studies investigated the effect of music on cancer-related pain in 150 participants aged between 45.01 and

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56.63 years (52, 53). Both studies were performed on patients undergoing breast surgery and postoperative pain was evaluated using the SF-MPQ and VAS tools. In both studies, patients listened to at least one of the four musical genres including classical, traditional, relaxation, and new age music for 5 to 30 minutes. Patients in the control group received no intervention. Of two, one was RCT, and one was quasi-experimental study. The RCT had moderate quality (score=3) and quasi-experimental study had high quality. The results of both studies showed that music significantly reduces cancer-related pain after surgery. 3.3.2.5. Yoga

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Nine studies, most of which (n = 4)(54-57) were conducted in the United States, investigated the effect of yoga on cancer-related pain in 499 participants aged between 51.5 and 68.88 years (54-62). Patients underwent different treatments for breast cancer. The most common type of pain studied was chronic cancer-related pain measured using the VAS tool. Yoga intervention was performed on patients for 20, 60, or 120 minutes, with control groups receiving only routine care. Of nine studies, 8 were RCTs, and one was prospective cohort. Of 8 RCTs, 3 had high quality (score=4), 2 had moderate quality(score=3), and 3 had low quality (score=2). All studies showed that yoga had a significant effect in reducing cancer-related pain in patients with breast cancer. 3.3.3. Manipulative and Body-Based Methods

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3.3.3.1. Massage therapy

Five studies investigated the effect of massage therapy on cancer-related pain in 298 participants (47, 63-66). Most studies (n = 3)(47, 63, 64) were conducted in the United States. The age of participants ranged from 31 to

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57.6 years. Patients underwent breast cancer surgery in most studies (n = 4) (47, 63, 64, 66). The type of pain studied was postoperative pain in most studies (n = 4)(47, 63, 64, 66). VAS and SF-MPQ tools were used to

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measure pain. Most studies (n = 4)(47, 63-65) were clinical trials. The massage therapy intervention was performed by a massage specialist. Each massage therapy session lasted for 20 to 30 minutes and the intervention

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was performed on different parts of the body including neck, back, hands, and legs. There was no intervention in the control group. Of five studies, 4 were RCTs, and one was quasi-experimental study. Of 4 RCTs, 3 had moderate quality(score=3), one had low quality(score=1). The quasi-experimental Study had a moderate quality.

3.3.3.2. Reflexology

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The results of all the included studies showed that massage therapy reduces cancer-related pain.

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Three studies investigated the effect of reflexology on cancer-related pain in 364 participants (67-69). Studies

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have been performed on patients with different medical conditions. Patients were in the first to fourth stages of the disease. The type of pain studied was chronic cancer-related pain in most studies (n = 2)(67, 69). The duration of the intervention was 0 to 30 minutes. The overall course of interventions was between one and 10 weeks. Of three studies, two were RCTs, and one was quasi-experimental. One RCT had moderate quality (score=3), and one had low quality (score=2). The quasi-experimental had moderate quality. Results of all included studies showed a significant effect of reflexology on relieving cancer-related pain. 3.3.4. Energy Therapies

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3.3.4.1. Reiki/therapeutic touch One study investigated the effect of therapeutic touch on cancer-related pain in 51 participants (70). Patients underwent different treatments. Patients were in the first to fourth stages of the disease. The type of pain studied was chronic cancer-related pain. The duration of interventions was 30 minutes. The study was quasi-experimental which had a moderate quality. The results of the above showed that therapeutic touch had significant effect on in

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reliving the cancer-related pain.

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4. Discussion Pain is the most important acute complication affecting the quality of life of cancer patients. The use of CAM for the treatment of chronic diseases is particularly popular today. We aimed to investigate the effect of CAM interventions on cancer-related pain in patients with breast cancer. A total of 46 studies conducted on 3939 patients with breast cancer in 14 countries between 2004 and 2019 were included in this systematic review. The study results showed that most CAM therapies have a significant effect on reducing the cancer-related pain in patients with breast cancer. Interventions such as acupuncture, Tai chi/qi gong, yoga, music therapy, massage, meditation,

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reflexology, and Reiki reduce such pain, but interventions such as aromatherapy have no effect on the same. In regard of quality of included studies, of 33 RCTs, only 3 studies had a high quality, 21 had moderate quality and 7 had low quality. Of 7 quasi-experimental studies, 4 had high quality and 3 had moderate quality. According to the researcher's best knowledge, no previous study with this purpose was found. Most interventions involved

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the use of acupuncture therapy. In most studies of control group sham technique was used. Our results indicate that acupuncture reduced the pain in most of the studies, which is consistent with the results from previous studies

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on pain in different types of cancer (71-75). Moreover, it contradicts Pan, Y.’s study, which showed that acupuncture had no significant effect on pain (76). This difference could be attributed to the variations in the

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databases searched and the studies that entered the final phase. Various studies have shown that acupuncture can relieve a variety of chronic pain, mainly musculoskeletal (77) and back pain (78). We demonstrate that Tai chi/qi

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gong intervention significantly reduced cancer-related pain, which contradicts some previous studies (79). Such differences may be due to the variations between the databases studied and the duration and type of studies included. Consistent with the present study, the results of other studies have also shown that Tai chi/qi gong can

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improve fibromyalgia pain (80) and chronic pain in adults (81). Our findings indicate that aromatherapy did not reduce cancer-related pain in breast cancer patients. Conflicting with our data, other individual studies have shown

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that aromatherapy reduces pain in some types of cancers (72, 82). This difference may be due to the type of studies that entered the final phase of analysis and their sample size. Regarding hypnosis, most studies showed that it had a significant effect in reducing cancer-related pain, which is consistent with previous studies on postoperative pain (83, 84) and labor pain (85). Meditation was also shown to significantly reduce cancer-related pain in patients with breast cancer, which is supported by studies showing its effect on headache (86) and chronic pain in adults (87, 88). Music therapy was also found to significantly decrease cancer-related pain similar to another study on chronic adult pain (89). In

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accordance with previous studies, which showed that yoga decreased lower back pain (90, 91) and disabilityrelated pain, here, we found that yoga also reduces cancer-related pain, (92). Massage therapy also showed a significant effect on cancer-related pain, which is consistent with previous studies on other types of cancers (93) including chronic lower back pain (94), back pain during pregnancy (95), and postoperative pain (96). Interventions such as reflexology and Reiki, also had a positive effect on reducing cancer-related pain, which is in line with previous studies on other populations of women during childbirth (97, 98) and in chronic diseases (99). Despite the positive results of various types of CAM therapies on cancer-related pain, most studies had a moderate

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quality that it seems to require to conduct more studies with better methodological quality. Also there is a little number of studies in some fields of CAM therapies which require further studies in these areas to better evaluate their effectiveness. Limitations

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Although most of the interventions studied had a positive effect on cancer-related pain, the researchers faced some limitations while investigating the precise effectiveness of these interventions: 1. Most studies have not mentioned

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any information on the side effects of these interventions; hence, the safe use of such interventions necessitates further detailed studies on their complications. 2. Most of the included studies had a small sample size and the

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effectiveness of the interventions were evaluated for a limited time period that limits the generalization of results for long-term use in cancer care centers. 3. One of the limitations of this study was that most of the included studies had moderate and low methodologic quality. 4. One of the limitations was the variety of interventions to

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reduce cancer pain that reduced the generalizability of the results, and 5. Lastly, due to the variety of type, duration, number of interventions, as well as differences in the tools used to evaluate the effectiveness of interventions on

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Strengths

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cancer-related pain, it was not possible to do the meta-analysis.

To the best of our knowledge, this is the first systematic review that specifically investigates the effect of various CAM interventions on cancer-related pain in patients with breast cancer. Here, we used the systematic review approach to analyze the effectiveness of the different CAM interventions.

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It seems CAM therapies have different effects on the physical and psychological dimensions of patients with breast cancer, depending on the type of CAM therapy they perform (100). Studies suggest that cancer interventions, both in the early and advanced stages of cancer, should be used more to reduce cancer-related symptoms with the advice of an oncologists in addition to the main treatments including chemotherapy (101, 102). But opioid treatments are also used to treat symptoms at more severe stages, such as cancer-related pain (103). 5.Conclusion Despite our results that showed that some CAM therapies could significantly improve cancer-related pain in patients with breast cancer. Considering the moderate and low methodology quality of most of included studies,

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small sample size and high heterogeneity between studies, CAM therapies should be used cautiously along with other medical treatments by health care professional's consultations to ease cancer-related pain. Further studies with larger sample size, longer duration, and improved methodology quality are necessary to making better

Conflicts of interest

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All authors declare that they have no competing of interest.

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decision about effect of different CAM interventions on cancer-related pain in patients with breast cancer.

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Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent

As this study was a systematic review and did not involve contact with patients or patient information, it was not

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applicable for informed consent to be obtained.

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37. Zick SM, Sen A, Hassett AL, Schrepf A, Wyatt GK, Murphy SL, et al. Impact of SelfAcupressure on Co-Occurring Symptoms in Cancer Survivors. JNCI cancer spectrum. 2018;2(4):pky064. 38. Lee TI, Chen HH, Yeh ML. Effects of chan-chuang qigong on improving symptom and psychological distress in chemotherapy patients. The American journal of Chinese medicine. 2006;34(1):37-46. 39. Galantino ML, Callens ML, Cardena GJ, Piela NL, Mao JJ. Tai chi for well-being of breast cancer survivors with aromatase inhibitor-associated arthralgias: a feasibility study. Alternative therapies in health and medicine. 2013;19(6):38-44. 40. Halm MA, Baker C, Harshe V. Effect of an essential oil mixture on skin reactions in women undergoing radiotherapy for breast cancer: a pilot study. Journal of Holistic Nursing. 2014;32(4):290303. 41. Kim JT, Wajda M, Cuff G, Serota D, Schlame M, Axelrod DM, et al. Evaluation of aromatherapy in treating postoperative pain: pilot study. Pain Pract. 2006;6(4):273-7. 42. Butler LD, Koopman C, Neri E, Giese-Davis J, Palesh O, Thorne-Yocam KA, et al. Effects of supportive-expressive group therapy on pain in women with metastatic breast cancer. Health Psychology. 2009;28(5):579. 43. Jensen MP, Gralow JR, Braden A, Gertz KJ, Fann JR, Syrjala KL. Hypnosis for symptom management in women with breast cancer: a pilot study. The International journal of clinical and experimental hypnosis. 2012;60(2):135-59. 44. Montgomery GH, Bovbjerg DH, Schnur JB, David D, Goldfarb A, Weltz CR, et al. A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. Journal of the National Cancer Institute. 2007;99(17):1304-12. 45. Amraoui J, Pouliquen C, Fraisse J, Dubourdieu J, Guzer SRD, Leclerc G, et al. Effects of a Hypnosis Session Before General Anesthesia on Postoperative Outcomes in Patients Who Underwent Minor Breast Cancer Surgery The HYPNOSEIN Randomized Clinical Trial. Jama Network Open. 2018;1(4). 46. Berliere M, Roelants F, Watremez C, Docquier MA, Piette N, Lamerant S, et al. The advantages of hypnosis intervention on breast cancer surgery and adjuvant therapy. Breast. 2018;37:114-8. 47. Dion L, Engen D, Lemaine V, Lawson D, Brock C, Cha S, et al. Effect of guided meditation and massage therapy for breast cancer patients undergoing autologous tissue reconstruction-a pilot study. Integrative Medicine Research. 2015;4(1):78. 48. Lengacher CA, Reich RR, Paterson CL, Ramesar S, Park JY, Alinat C, et al. Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2016;34(24):2827-34. 49. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. 50. Johannsen M, O’Connor M, O’Toole MS, Jensen AB, Højris I, Zachariae R. Efficacy of mindfulness-based cognitive therapy on late post-treatment pain in women treated for primary breast cancer: a randomized controlled trial. Journal of clinical oncology. 2016;34(28):3390-9. 51. Lee CE, Kim S, Kim S, Joo HM, Lee S. Effects of a Mindfulness-Based Stress Reduction Program on the Physical and Psychological Status and Quality of Life in Patients With Metastatic Breast Cancer. Holistic nursing practice. 2017;31(4):260-9. 52. Binns-Turner PG, Wilson LL, Pryor ER, Boyd GL, Prickett CA. Perioperative music and its effects on anxiety, hemodynamics, and pain in women undergoing mastectomy. AANA journal. 2011;79(4 Suppl):S21-7. 53. Li XM, Yan H, Zhou KN, Dang SN, Wang DL, Zhang YP. Effects of music therapy on pain among female breast cancer patients after radical mastectomy: results from a randomized controlled trial. Breast cancer research and treatment. 2011;128(2):411-9. 54. Carson JW, Carson KM, Porter LS, Keefe FJ, Shaw H, Miller JM. Yoga for women with metastatic breast cancer: results from a pilot study. Journal of pain and symptom management. 2007;33(3):331-41. 16

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Tables Table 1. Studies inclusion and exclusion criteria:

Target population

Included Clinical trials, quasiexperiment, pilot study, cohort, feasibility studies English January 1, 2000 up to April 31, 2019 Breast cancer

Outcome

Cancer related pain

Language

Qualitative, Commentaries, Editorials, Reviews, Cross-sectional, case

report. None-English Before January 2000 and after April 2019 None breast cancer patients Other outcomes

Jo

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na

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re

-p

Search duration

Excluded

ro of

Criteria Type of study

21

USA

Results

Positive Effect

e-

1.Aromatase inhibitorrelated pain 2.BPI-SF 3.ND

na l

1.288, 2. 60.5, 3. Women undergoing breast cancer surgery, 4. 0-III, 5. RCT

Jo ur

Zick, S M (2018) (37)

1.12, 2. 59, 3. Breast cancer patients under Aromatase inhibitors therapy, 4. I-III, 5. Feasibility Study

f

1. Cancer related pain after surgery. 2.VAS 3.ND

oo

1.20, 2. 49.5, 3.Women undergoing breast cancer surgery, 4. ND, 5. Feasibility Study

Intervention 1.Instructor 2.Needles 3.Points 4.Duration per session and total time 5.Control group 1. Acupuncturists 2.Stainless steel Seirin Number 1 (0.16 * 15) and Number 3 (0.20 * 3) 3. Course the liver qi, Zusanli (ST36), Taichong (LV3) and Qiuxu (GB40) 4. The needles were inserted to a depth where a “de qi” sensation was elicited. 5. No control group. 1. Acupuncturists 2.25 mm or 40 mm and 0.25 gauge. 3. Four local points around the joint with most pain. 4. The needles were inserted to the depth for 20 min treatment. Intervention was delivered twice a week for two weeks, then weekly for six more weeks for a total maximum of ten treatments over eight weeks. 5. No control group. 1. Self-Acupressure, 2.Sterile disposable acupuncture 30 mm in length and either 0.16 mm, 0.18 mm, or 0.2 mm in diameter. 3. Stimulating acupressure points comprised Du 20, Conception Vessel 6, Large Intestine 4, Stomach 36, Spleen 6, and Kidney 3 4. The needles were inserted with bilateral rotation until "de qi" sensation was elicited for 3 min. Acupressure was self-administered daily for 6 weeks followed by a 4-week washout period. 5.Usual care

pr

Outcome measurement 1.Type of pain 2.Instrument 3. Quality score

USA Mao, J J (2009) (33)

USA

Acupuncture

Study characteristics 1.Participants, 2.Age (mean or range), 3.Treatment, 4.Stage, 5.Study design

Pr

Country

Subcategory

Author(year)

Mallory, M J (2015) (32)

Acupuncture

Alternative Medical Systems

Alternative Medical Systems

Main CAM category

Table 2. Description of the study characteristics, outcome, measurement, interventions and results

1.Chronic cancer related pain 2.BPI-SF 3.3

Positive Effect

No Effect

22

1.226, 2. 60.7, 3. Breast cancer patients under Aromatase inhibitors therapy, 4. I-III, 5. RCT

USA

Hershman, DL (2018) (30)

Positive Effect

Positive Effect

e-

1.Aromatase inhibitorrelated pain 2. BPI-SF 3.3

na l

USA

1.21, 2. 59, 3. Breast cancer patients under Aromatase inhibitors therapy, 4. I-III, 5. RCT

Jo ur

Acupuncture

Alternative Medical Systems

Crew, K (2007) (27)

f

1.Aromatase inhibitorrelated pain 2. BPI-SF 3.4

oo

1.38, 2. 58, 3. Breast cancer patients under Aromataseinhibitors therapy, 4. I-III, 5. RCT

1. Acupuncturists 2.30 mm or 40 mm and 0.25 gauge. 3. Four local points around the joint with the most pain. 4. The needles were inserted to the depth for 30 min treatment. Intervention was delivered twice weekly for 2 weeks, then weekly for 6 more weeks, for a total of 10 treatments over 8 weeks. 5.Sham 1. Acupuncturists 2.25 mm or 40 mm and 34 gauge and auricular needles were 15 mm and 38 gauge. 3. Patient’s most painful joint areas. 4. The needles were inserted 0.5 inch into the skin for 20-25 min twice weekly for six weeks. 5.Sham 1. Acupuncturists 2.25 mm × 40 mm and 34 gauge and auricular needles were 15 mm and 38 gauge. 3. The joint specific point protocols for the shoulder, wrist, fingers, lumbar area, hip and knee are as follows: shoulder (LI-15, SJ-14, SI-10); wrist (SJ-4, LI-5); fingers (SI-5, SI3, ba xie, LI-3); lumbar (Du-3, Du-8, UB-23); hip (GB-30, GB-39); and knee (SP-9, SP-10, ST-34). 4. The needles were inserted 0.5 inch into the skin for 30 min twice weekly for six weeks. 5.Usall care 1. Acupuncturists 2.ND 3. 18 Needles were used manually once during each session in 3 of the patient’s most painful joint areas. 4. The needles were inserted contralateral limb for 30-45 min twice per week treatment during 6 weeks, followed by 1 session per week for 6 weeks. 5.Sham

pr

1.Aromatase inhibitorrelated pain 2. BPI-SF 3. 4

USA

Crew, K (2010) (28)

1.67, 2. 59.7, 3. Breast cancer patients undergoing Aromatase inhibitors therapy, 4. IIII, 5. RCT

Pr

USA

Mao, J J (2014) (34)

1.Aromatase inhibitorrelated pain 2. BPI-SF 3.3

Positive Effect

Positive Effect

23

1.78, 2. 32 – 65, 3. Breast cancer patients undergoing different therapy, 4. ND, 5. RCT

1.Chronic cancer related pain 2. BPI-SF 3.2

USA

pr

e-

1.Cancer related pain after surgery 2.NRS 3.3

na l

Bao, T (2013) (26)

Pr

South Korea

1.30, 2. 53.7, 3. Women undergoing breast cancer surgery, 4. ND, 5. RCT

USA

QuinlanWoodward, J (2016) (36)

1.47, 2. 51, 3. Breast cancer patients undergoing Aromatase inhibitors therapy, 4. 0III, 5. RCT

Jo ur

Acupuncture

Alternative Medical Systems

Kim, T-K (2019) (31)

1. Acupuncturists 2.Sterile disposable acupuncture needles (gauge and size 0.20× 25 mm). 3. LI4, LI11, GB34, ST40, LR3, GV20, GB21, TE5, ST36, SP6, LR3, GV20, LI11, LI4, GB21, TE5, GB34, ST36, ST40, SP6 and LR3. 4. The needles were inserted with bilateral rotation until "de qi" sensation was elicited for 20 min treatment. Intervention was delivered twice weekly for 6 weeks, Electrical stimulation was delivered using pulse width of 0.5–0.7 ms at alternating frequencies of 2–10 Hz. 5.Sham 1. Acupuncturists 2.0.25 mm × 40 mm 3. Unilateral LI4, LR3, GB39, SP6 4. The needles were inserted to a depth of 5 to 30 mm for 20 min treatment 2-3 times weekly (total 8-12 times) during four weeks. 5. No control group. 1. Acupuncturists 2.Sterile disposable acupuncture 30 mm in length and either 0.16 mm, 0.18 mm, or 0.2 mm in diameter. 3. ND 4. The needles were inserted with bilateral rotation until "de qi" sensation was elicited for 36 min treatment. Intervention was delivered two times during post-surgery hospitalization at least 12 h apart. 5.Usual care 1. No mention 2.0.25mm × 40 mm sterilized needles. 3.15 acupuncture points including: CV4, CV6, CV12 and bilateral LI 4, MH 6, GB 34, ST 36, KI 3, BL 65. 4. The needles were inserted 0.5 inch into the skin for 20 min weekly for 8 weeks. 5.Sham

f

1.Aromatase inhibitorrelated pain 2. BPI-SF 3.3

oo

1.32, 2. ≥18, 3. Breast cancer patients undergoing Aromatase inhibitors therapy, 4. IIII, 5. RCT

Australia

Oh, B (2013) (35)

1.Aromatase inhibitorrelated pain 2. VAS 3.4

Positive Effect

Positive Effect

Positive Effect

No Effect

24

f

oo

pr

e-

USA USA

1. Acupuncturists 2.0.25 mm×30-mm size and 34 gauge and auricular needles were 15 mm and 38 gauge. 3. CV 3, SP 9, ST 36, KI 7, LR 3, GB 21, LI 15, HT 14, 5 LU, LI 4, ST 38, and BL 60 4. The needles were inserted contralateral to limb for 30 min weekly treatment during 10 weeks. 5.Kinesiotherapy 1.Aromatase inhibitor1. Intervention related pain 2.Control 2. BPI 1.The procedure included: Relaxation, Standing Meditation, Coiling Silk 3.ND Qigong, and Tibetan White Crane Tai Chi. Participants met twice per week for 8 weeks for 1 h in a group program under the supervision of a tai chi master. 2.No control group 1.Chronic cancer related 1. The subjects practiced Chan Chuang qigong with proper posture, pain including stationary standing, circling the arms, breathing naturally and 2. SDS keeping the whole body in a state of relaxation, but with clear 3.Included consciousness. Patients were asked to practice at least 15 min, but no more than 1 h a time. 2.Usual care 1. Radiation-induced pain. 1. Type of aromatherapy 2. VAS 2.Aromas, dose and time per session 3.3 3.Frequecy and total duration 4.Control group

na l

1. 67, 2. 44-49, 3. Breast cancer patients under undergoing chemotherapy, 4. II, 5. Quasi-experimental design 1.24, 2. 55.92, 3. Women undergoing radiotherapy for breast cancer, 4. ND, 5. RCT

Jo ur

Halm, M A (2014) (40)

Aromatherapy

Mind-Body Therapies

Taiwan

Lee, T I (2006) (38)

1. 12, 2. 59, 3. Breast Cancer patients under Aromatase inhibitors therapy, 4. I-III, 5. Mixed-method

1.Cancer related pain after surgery 2. VAS 3.3

Pr

Brazil

Acupuncture

1.48, 2. 53.7, 3. Women undergoing breast cancer surgery, 4. ND, 5. RCT

Galantino, M L (2013) (39)

Tai Chi Qi Qong

Alternative Medical Systems

Giron, PS (2016) (29)

Positive Effect

Positive Effect

Positive Effect

No Effect

1. Massage aromatherapy 2. Helichrysum, Frankincense; Lavender; and Geranium, Jojoba, Aloe vera, Tamanu, and Evening primrose. 17.5% 3.Three times a day for 1month 4.Placebo

25

1. Instructor 2.Time 3.Control

Positive Effect

1. Cancer related pain after surgery 2.ND 3. Included

pr

oo

f

1.Chronic cancer related pain 2. BPI 3.ND

1. Researcher 2. Four to five sessions of self-hypnosis, weekly. 3.No control group 1.Trained anesthesiologist 2.Different times 3.Usual care

Positive Effect

1. 148, 2. 57, 3. Women undergoing breast cancer surgery, 4. ND, 5. RCT

1.Cancer related pain after 1.Trained anesthesiologist surgery 2.15 min 2.VAS 3.Usual care 3.3

No Effect

France

Amraoui, J (2018) (45)

Pr

1.Cancer related pain after 1. Psychologist. surgery 2. 15 min before surgery 2.VAS 3. Attention control 3.3

1.Chronic cancer related pain 2. PRS 3.4

na l

Belgium

1. 200, 2. 48, 3. Women undergoing breast cancer surgery, 4. ND, 5. RCT

Jo ur

Hypnosis

Mind-Body Therapies

1. 8, 2. 58.5, 3. Breast cancer patients undergoing different therapy, 4. ND, 5. Pilot Study

1. 300, 2. 59, 3. Women undergoing breast cancer surgery, 4. ND, 5. quasi-experimental design 1. 124, 2. 52.8, 3. Breast cancer patients undergoing different therapy, 4. ND, 5. RCT

Butler, L D (2009) (42)

Montgomery, G H (2007) (44)

No Effect

USA

Berliere, M (2018) (46)

1. Inhalation aromatherapy 2. Lavender, two drops, 5, 30, and 60 min, after surgery 3.ND 4.No control group

USA

Hypnosis

USA

Jensen, M P (2012) (43)

1.50, 2. 42.8 and 47.8, 3. 1.Cancer related pain Women undergoing after surgery breast cancer surgery, 4. 2.ND ND, 5. RCT 3.2

e-

USA

Kim, Jung T. (2006) (41)

1.Psychotherapist 2.Weekly for 90 min sessions for one year, 3.Usual care

Positive Effect

Positive Effect

26

Dion, L J (2015) (47)

USA

Positive Effect

1.Chronic cancer related pain 2. BCPT 3.3

1.Time,duration, 2.Control

Positive Effect

1. 38, 2. 47.7, 3. Women undergoing breast cancer surgery, 4. ND, 5. RCT

pr

oo

f

1. The 8-week MBSR (mindfulness-based stress reduction) program, The subjects attended the MBSR program that was offered once a week for 2 h each and continued for 8 weeks. 2.Usual care

1.Mindful Awareness Practices (MAPs) program, 6 weekly, 2h group sessions that included presentations of theoretical materials on mindfulness, relaxation, and the mind-body connection; experiential practice of meditation and gentle movement exercises (e.g., mindful walking); and a psych educational component for cancer survivors. 2.Usual care 1. Participants randomly assigned to MBSR (BC) (Mindfulness-Based Stress Reduction for Breast Cancer) attended 2h sessions once per week for 6 weeks conducted by a clinical psychologist trained in MBSR. 2.Usual care 1. Included slightly shorter 2h sessions, shorter meditation exercises (≤30 min), more gentle yoga exercises, and omission of the whole-day session. MBCT was delivered in groups of 13 to 17 participants in weekly sessions over 8 consecutive weeks. 2.Usual care

e1.Chronic cancer related pain 2. BPI 3.3 1.Chronic cancer related pain 2. SF-MPQ 3.3

na l

Denmark

Johannsen, M (2016) (50)

1. 299, 2. 56.6, 3. Breast cancer patients undergoing different therapy, 4. 0-III, 5. RCT 1. 129, 2. 56.8, 3. Breast cancer patients undergoing different therapy, 4. ND, 5. RCT

Jo ur

Meditation

Mind-Body Therapies

Lengacher, C A (2016) (48)

USA

USA

Meditation

Bower, J E (2014) (49)

1.Chronic cancer related pain 2. BPI 3.Included

Pr

1. 18, 2. 53.8, 3. Breast cancer patients undergoing different therapy, 4. ND, 5.Quasiexperimental study 1. 71, 2. 46.5, 3. Breast cancer patients undergoing different therapy , 4. 0-III, 5. RCT

South Korea

Lee, Ch E (2017) (51)

1.Cancer related pain after surgery 2. VAS 3.3

1. 15-min viewing of a DVD about paced breathing, gratitude meditation, by a 20-min, After completion of the session on day 3. 2.Only massage

Positive Effect

Positive Effect

Positive Effect

27

1. 120, 2. 45.01, 3. Women undergoing breast cancer surgery, 4. ND, 5. RCT

1.Cancer related pain after surgery 2. SF-MPQ 3.3

USA USA

Peppone, L J (2015) (56)

pr

1. Women listened to 1 of 4 types of music; listening for 5 min to a selection of each genre (classical, easy listening, inspirational, and new age) throughout the perioperative period (during the preoperative, intraoperative, and postoperative periods). 2.Usual care

1.Aromatase inhibitorrelated pain 2. BPI 3.2

1. Participants met twice per week for 8 weeks, The yoga program had between 5 and 10 participants, lasted 90 min. 2. No control group.

Positive Effect

1. 63, 2. 57.3, 3. Women with metastatic breast cancer, 4. ND, 5. RCT

1.Chronic cancer related pain 2. BPI-SF 3.4

Positive Effect

1. 167, 2. I: 55.1, C: 53.2, 3. Breast cancer patients undergoing different therapy , 4. IIII, 5. RCT

1.Chronic cancer related pain 2. URCC SI 3.3

1. Consisted of eight 120-min weekly group sessions (gentle postures (approx. 40 min), breathing techniques (10 min), meditation (25 min), presentations on the application of yogic principles to optimal coping (20 min), and group discussions (25 min). 2.Support group 1. Each session consisted of physical alignment postures, breathing, and mindfulness exercises. Twice a week for 75 min each time over 4 weeks for a total of eight sessions of yoga. 2.Usual care

Pr

1. 14, 2. 45.5, 3. Women undergoing breast cancer surgery, 4. I-III, 5. Prospective cohort study 1. 10, 2. 57, 3. Breast cancer patients under Aromatase inhibitors therapy, 4. I-III, 5. RCT

e-

Positive Effect

Jo ur

Porter, L S (2019) (57)

USA

Yoga

Mind-Body Therapies

Galantino, M L (2012) (55)

Positive Effect

1. Women listened to 4 types of music twice a day (30 min per session), once in the early morning (6 a.m.–8 a.m.) and once in the evening (9 p.m.–11 p.m.). (Classical Chinese folk music, popular world music, the music recommended by the American Association of Music Therapy (AAMT), and Chinese relaxation music). 2.Usual care 1.The yoga intervention consisting of 12 sessions weekly. 2.No control group

1.Cancer related pain after surgery 2. DPQ 3.ND

na l

China Sudarshan, M (2013) (61)

Canada

Music Yoga

Li, X-M (2011) (53)

1. Intervention 2.Control

f

1.Cancer related pain after surgery 2. VAS 3.Included

oo

1. 30, 2. 56.63, 3. Women undergoing breast cancer surgery, 4. ND, 5. Quasiexperimental design

USA

Music

Binns-Turner, P G (2011) (52)

Positive Effect

Positive Effect

28

Positive Effect

Positive Effect

1.Chronic cancer related pain 2. VAS 3.4

1. Intervention 2.Control 1.The intervention consisted of eight weekly group sessions (four to five patients per group). On average, participants attended seven of the eight sessions (range, five to eight). Each 120-min session included gentle physical stretching posture complemented by breathing exercises, meditation techniques. 2.No control group 1. Weekly 90-min yoga class, The yoga session included documented breathing practices, physical postures, meditation and relaxation techniques. 2.Usual care

1.Chronic cancer related pain 2. VAS 3.2

1. Each session lasted 1 h per week for eight weeks and included warmup and breathing exercises (15 min), asanas (15 min), relaxation and meditation in supine position (30 min). 2.Exercise

Positive Effect

1.Cancer related pain after surgery 2. VAS 3.4

1. 2 days a week, each lasting 1 h, for a period of 10 weeks. 2.Usual care

Positive Effect

1.Cancer related pain after surgery 2. NRS 3.Included

1. Intervention 2.Control

Positive Effect

Turkey India

Lukose, N.(2016) (68)

na l

Pr

e-

USA Australia Turkey Eyigora, S (2018) (58)

1. 20, 2. I: 68.58 C: 68.88, 3. Breast cancer patients who underwent chemotherapy, 4. ND, 5. RCT 1. 42, 2. C: 51.5 , I: 52.3, 3. Women undergoing breast cancer surgery, 4. ND, 5. RCT 1. 40, 2. ND, 3. Women undergoing breast cancer surgery, 4. I-II, 5. Quasi-experimental design

oo

1. 23, 2. 57.6, 3. Breast cancer patients undergoing different therapy, 4. I-III, 5. RCT

f

1.3 monthly visits for two years, daily 20 min. 2.Usual care

pr

1.Chronic cancer related pain 2. VAS 3.3 1.Chronic cancer related pain 2. VAS 3.2

Jo ur

Yoga

Yagli, N V (2015) (62)

Reflexolog y

Mind-Body Therapies

Loudon, A (2014) (60)

Mind-Body Therapies

India

Carson, J W (2007) (54)

1. 147, 2. 35-60, 3. Breast cancer patients undergoing different therapy, 4. II-V, 5. RCT 1. 13, 2. 593. Women with metastatic breast cancer, 4. ND, 5. RCT

Yoga

Mind-Body Therapies

Kumar, N (2013) (59)

Positive Effect

1.One session of reflexology for 20 min. 2.No control group

29

1.Chronic cancer related pain 2. VAS 3.2

1. Once a week by a qualified therapist in 20 min for 10 weeks. 2.Usual care

Positive Effect

1.Cancer related pain after surgery 2. SF-MPQ 3. Included

1. Instructure 2.Time 3.Control 1. Researcher 2. A total of 20 min of foot massage was performed, including 10 min for each foot, on patients in the experimental group. 3.Usual care 1.Massage therapist 2.5-week, 30-min classical massage of the back, neck, and head, twice a week, 3.Usual care

Positive Effect

1. Massage therapist 2. Received 30-min massage sessions (3 massages per week for 5 weeks) 3.Usual care

Positive Effect

pr

oo

f

1. 72, 2. 53.7, 3. Breast cancer Patients undergoing Adjuvant Radiation Therapy, 4. IIII, 5. RCT 1. 70, 2. 31, 3. Women undergoing breast cancer surgery, 4. ND, 5.Quasi-experimental study

1. 58, 2. 53, 3. Women undergoing breast cancer surgery, 4. ND, 5. RCT

1.Cancer related pain after surgery 2. SF-MPQ 3.1

1. 38, 2. 47.7, 3. Women undergoing breast cancer surgery, 4. ND, 5. RCT

1.Cancer related pain after 1. Massage therapist surgery 2.20 min on postoperative days 1, 2 and 3. massage with meditation 2. VAS 3.Massage only 3.3

Dion, L J (2015) (47)

1.Chronic cancer related pain 2. SF-8 3. 3

na l

Germany

1. 86, 2. 59, 3. Breast cancer patients undergoing different therapy, 4. I-III, 5. RCT

USA

HernandezReif, M (2005) (64)

Positive Effect

USA

Listing, M (2009) (65)

1. A minimum of one session of reflexology per week to the patient for four consecutive weeks, The protocol consisted of nine foot reflexes being stimulated by using a thumb-walking motion for 15 min per foot. 2.Usual care

Jo ur

Massage

Manipulative and Body-Based Methods

Turkey

Ucuzal, M (2012) (66)

1.Chronic cancer related pain 2. PROMIS 3.3

e-

Israel

Tarrasch, R (2017) (69)

1. 180, 2. 53-55.5, 3. Women undergoing breast cancer surgery, 4. III-V, 5. RCT

Pr

USA

Frambes, D (2017) (67)

Positive Effect

Positive Effect

30

1. 51, 2. 53, 3. Breast cancer patients undergoing different therapy, 4. IV, 5. Quasiexperimental design

1.Chronic cancer related pain 2. VAS 3.Included

pr

e-

Positive Effect

Pr

USA

Positive Effect

ND: none determined, I: intervention, C: control, BPI: Brief Pain Inventory, VAS: Visual Analogue Scale, SF-MPQ: short-form McGill Pain Questionnaire,

na l

URCC SI: University of Rochester Cancer Center Symptom Inventory, PROMIS: Patient-Reported Outcomes Measurement Information System, sf-8: the Short Form-8 Health Survey, NRS: numeric rating scale.

Jo ur

Reiki

Energy Therapies

Sturgeon, M (2009) (70)

1. Massage therapist 2. A manual massage was administered to the area of the woman’s choice: neck and shoulder massage in sitting position at the bedside with upper extremities supported on one to two pillows, hand massage in sitting or supine position, or foot massage in supine position, with different time duration. 3.ND 1. Intervention 2.Control 1. 30 min massage, using the outcomes measures, occurred one week after the final massage treatment session. 2.No control group

f

1.Cancer related pain after surgery 2. VAS 3.3

oo

1. 46, 2. 57.6, 3. Women undergoing breast cancer surgery, 4. ND, 5. RCT

USA

Drackley, N L (2012) (63)

31

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Jo Figures

32