Non-Pharmacological Cancer Pain Management: Web Resources

Patient Scenario and Learning Need

The chosen topic for this internet information assessment is pain management. The patient scenario is as follows: a patient's caregiver has expressed the desire to learn about non-pharmacological treatments for her mother's cancer pain in a palliative care setting. The daughter would like to be prepared if breakthrough pain occurs during the use of pharmacological means, and to help her mother learn skills she could use to combat intractable pain before such pain occurs.

The patient, though interested, is reluctant to believe that alternative treatments might work as well as, or in supplement to, pain medication, but is willing to review evidence provided by the nurse in connection with her daughter's request. On more than one occasion, the patient has expressed the desire to spend quality time with her children and other family members while she is ill, rather than feeling as though she is "out of her mind" on medication or in severe pain. This tells me, as the nurse, that the patient would likely be interested in and compliant with a non-pharmacological or supplemental program to avoid taking additional pain medication if she does not have to.

The patient and her daughter would like to know whether massage, acupressure, acupuncture (if available in the home), limited movement techniques, and guided imagery or other psychological means would be effective components of a pain management plan (Smeltzer & Bare, 2008, pp. 105–108).

The patient and her caregiver would then possibly apply any techniques the nurse offered as viable through web-based learning, if such resources provided truthful options. The techniques most likely to be included in an alternative pain management plan would include massage, acupressure, acupuncture, and guided imagery. Some of these techniques are supported by nursing intervention materials, specifically psychological techniques such as guided imagery and the relaxation response (Smeltzer & Bare, 2008, pp. 105–108). The patient's learning preference is one of trial and error through application and practice. She is not currently bed-bound but would like to be prepared for when she reaches that state. Both the patient and her daughter have high levels of reading skill and both have access to and regularly use the internet.

The learning objective for the patient is exposure to non-pharmacological pain management techniques that will be possible to apply when she is bed-bound or has limited mobility, but that can be tried now in order to develop an alternative pain management plan to supplement medication. The desired outcome is to have an alternative pain management plan in place prior to the patient's condition declining to a bed-bound state and prior to any additional decrease in mobility.

The three websites chosen for this exploration are:

Learning Objective

Website 1: Alternative Medicine Foundation — Pain Management: An Alternative and Complementary Medicine Resource Guide (http://www.amfoundation.org/pain.htm)

Website 2: Cancer Treatment Centers of America — Pain Management (http://www.cancercenter.com/complementary-alternative-medicine/pain-management.cfm)

Website Evaluation: Accuracy and Credentials

Website 3: Journal of the American Osteopathic Association — Nonpharmacologic and Complementary Approaches to Cancer Pain Management by Lynette A. Menefee, PhD, and Daniel A. Monti, MD (http://www.jaoa.org/cgi/content/full/105/suppl5/S15)

Website 1 has limited credentials, as it is non-authored and associated with the foundation itself. It does, however, offer an extensive resources list for alternative and medical pain management.

Website 2 is also non-authored but offers the advice and testimony of a certified pain management RN and the director of the Cancer Treatment Centers of America's pain management program.

Website 3 is authored by two experts in pain management and integrative pain therapies: Lynette A. Menefee, PhD, from the Jefferson Pain Center, Department of Anesthesiology, and Daniel A. Monti, MD, from the Department of Psychiatry and Human Behavior — both at Jefferson Medical College in Philadelphia, Pennsylvania. Dr. Monti is director of the Jefferson Myrna Brind Center of Integrative Medicine.