FROM:   Semin Oncol Nurs 2005 (Aug);   21 (3):   184–189

Ronald C. Evans, DC, FACO, FICC and Anthony L. Rosner, PhD, LLD (Hon)

Foundation for Chiropractic Education and Research,
Norwalk, IA

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OBJECTIVES:   To review written resources disclosing reliable facts and knowledge in chiropractic services in cancer pain management.

DATA SOURCES:   Conventional and biomedical and complementary and alternative medicine journals, electronic media, full text databases, electronic resources, books in print, and newsletters.

CONCLUSION:   The judicial use of chiropractic services in cancer patients appears to offer many economical and effective strategies for reducing the pain and suffering of cancer patients, as well as providing the potential to improve patient health overall.

IMPLICATIONS FOR NURSING PRACTICE:   Clinicians should assess and support the use of chiropractic services in cancer patients. Chiropractic is one of the leading alternatives to standard medical treatment in cancer pain management.

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From the FULL TEXT Article:

Background

Almost 1.37 million people (710,000 men, 662,870 women) will be diagnosed with cancer in 2005. [1] In the United States, nearly 46% of men and 38% of women will be diagnosed with cancer in their lifetime, with 80% of all cancers diagnosed at ages 55 and older. [1] The direct medical costs of treating cancer are estimated to be about $60 billion per year.

Table 1

Statistics show that one out of three cancer patients suffers from pain, either from the primary lesion or secondary to its treatment; if the cancer has advanced or metastasized, the chances of a patient experiencing pain are even higher. [2] The gamut of pain expression (dull, aching, sharp, constant, intermittent, mild, moderate, or severe sensations) may be the result of cell infiltration or necrosis of tissue near the primary lesion. In terms of medical treatment, there are other potential sources of pain such those as shown in Table 1.

Partly because of the prospect of side effects and additional pain encountered during therapy, cancer pain is often undertreated. Interrelating factors that might contribute to the undertreatment of pain include: (1) physician knowledge, (2) patient reluctance, (3) fear of addiction, and (4) fear of side effects.

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CANCER SURVIVORS

Despite the aforementioned widespread prevalence of cancer in the United States, the number of cancer survivors is actually growing such that there are currently 8.9 million individuals in the United States living with cancer. Mortality rates for most major cancers are declining such that today more people survive cancer than ever before. Among the growing ranks of cancer survivors are the following groups [1, 3, 4]:

(1)   2 million women are breast cancer survivors;

(2)   1 million men are prostate cancer survivors;

(3)   5–year survival rates of children with cancer increased from 56% in the early 1970s to 79% for those diagnosed in 1995– 2003; and

(4)   the 5–year survival rate for all cancers increased from 51% in the early 1970s to nearly 66% from 1995–2000.

As a result of this increased survival in cancer, the focus of treatment has now been able to shift toward the management of pain issues, acute and chronic, both during and after medical therapies. Given the prospect of pain accompanying standard treatment options alluded to above and given the multifactoral nature of pain, [5] the patient may harbor attitudinal barriers to effective pain management that could be overcome with novel interventions.

Nearly all patients with cancer-related pain experience have used medications at one time or another to treat their pain, but pharmacologic treatments are neither suitable for all patients nor universally effective. Drug treatments may also produce undesired side effects. Largely for these reasons, significant interest has developed among both patients and health care providers in alternative treatments for cancer pain.

Physical treatments for pain most frequently studied are chiropractic, (largely but not exclusively dominated by spinal manipulation), physiotherapy, and acupuncture. [6] If effective and available, these nonpharmacologic treatments may be the first choice for patients and may also be best suited for those patients who:

(1)   have poor responses to medical treatment or medical contraindications for further pharmacologic treatment;

(2)   wish to become pregnant or are nursing;

(3)   have a history of long-term, frequent, or excessive use of analgesic or pain-abortive medications that can aggravate other problems; or

(4)   simply prefer to avoid the use of medications. [7]

Based on the strength of research findings, its accreditation, its safety, and its widespread recognition, chiropractic management of pain such as that experienced in cancer patients would appear to be one of the leading alternatives to standard medical treatment for one to consider seriously. For reasons that will become apparent, the remainder of this article will address this very issue.

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DEFINITIONS AND THEORETICAL BASIS OF CHIROPRACTIC

In its 109–year history, chiropractic has achieved distinction in addressing disorders of the musculoskeletal system and how these aberrations may impinge upon the nervous system, subsequently affecting our general health. This branch of health care is concerned with the diagnosis, treatment, and prevention of these disorders primarily (but not exclusively) through the application of manual treatments, which include spinal manipulation. [8]

The cardinal clinical feature of musculoskeletal disorders is pain. To no great surprise, both the rationale and outcomes of chiropractic management have always revolved around the relief of pain. Indeed, this conjecture is supported in both theory and fact. If such documentation can be found to be convincing, and if the risks of chiropractic interventions are found to be minimal compared with its benefits, a strong case can be made for considering chiropractic as a treatment option for controlling pain associated with cancer.

Table 2

The theoretical basis of chiropractic in alleviating pain can best be demonstrated by a variety of mechanisms that have been buttressed with evidence in the literature (Table 2). It can be seen that the effects of spinal manipulation have been proposed to be multifaceted, ranging from the reduction of nerve root encroachments to the release of trapped meniscoid fluids to the suppression of inflammatory mediators to possibly the release of analgesic opioids. The net effect of all of these is to reduce pain generation, [9–13, 18, 19–23] its sensation, [14–18] or its aggravation caused by anxiety. [24]

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EMPIRICAL BASIS FOR CHIROPRACTIC

In just the past 20 years, at least 73 randomized clinical trials involving spinal manipulation have made their appearance in the English literature. Even more remarkable is the fact that the majority of these have been published in general medical and orthopedic journals. These trials address not only back pain, but also headache and neck pain, the extremities, and a surprising variety of nonmusculoskeletal conditions.

When spinal manipulation is used, the majority of these trials have shown positive outcomes with the remainder yielding equivocal results. There are 43 trials addressing acute, subacute, and chronic low back pain, with 30 trials showing that manipulation is more effective than control or comparison treatments and the remaining 13 reporting no significant differences between treatment groups. None of these studies appears to have produced a negative outcome and none indicate that manipulation is any less effective than any comparison intervention. [25, 26]

Source:  chiro.org