Complementary and alternative medicine in the management of pain, dyspnea,and nausea and vomiting near the end of life: A systematic review

To review the evidence for efficacy of complementary and alternative medici ne (CAM) modalities in treating pain, dyspnea, and nausea and vomiting in p atients near the end of life, original articles were evaluated following a search through MEDLINE, CancerLIT, AIDSLINE, PsycLIT, CINAHL, and Social Wo rk Abstracts databases. Search terms included alternative medicine, palliat ive care, pain, dyspnea, and nausea. Two independent reviewers extracted da ta, including study design, subjects, sample size, age, response rate, CAM modality, and outcomes. The efficacy of a CAM modality was evaluated in 21 studies of symptomatic adult patients with incurable conditions. Of these, only 12 were directly accessed via literature searching. Eleven were random ized controlled trials, two were non-randomized controlled trials, and eigh t were case series. Acupunture, transcutaneous electrical nerve stimulation , supportive group therapy, self-hypnosis, and massage therapy may provide pain relief in cancer pain or in dying patients. Relaxation/imagery can imp rove oral mucositis pain. Patients with severe chronic obstructive pulmonar y disease may benefit from the use of acupuncture, acupressure, and muscle relaxation with breathing retraining to relieve dyspnea. Because of publica tion bias, trials on CAM modalities may not be found on routine literature searches. Despite the paucity of controlled trials, there are data to suppo rt the use of some CAM modalities in terminally ill patients. This review g enerated evidence-based recommendations and identified areas for future res earch. J Pain Symptom Manage 2000;20:374-387. (C) U.S. Cancer Pain Relief C ommittee, 2000.