The Behavioral Adaptations and Barriers of Patients Employing Non-Pharmacological Strategies for Cancer Pain Management—A Qualitative Study
Abstract
:1. Introduction
2. Methods
2.1. Research Design
2.2. Sample and Setting
2.3. Data Collection Procedures and Data Analysis
3. Findings
3.1. Theme One: Finding Complementary Therapies
Seeking TCM Complementary Treatment
“I go to a Chinese medicine clinic for tuina, hot compresses, and hot steaming for about 20–30 min at a time. The treatment is effective in relieving pain”(Patient 2). Another participant stated,
“During each acupuncture session, the TCM physician would insert 2 to 3 needles into the masticatory muscle of my right cheek for about 20 min each time. My mouth muscles become more relaxed and less painful”(Patient 3). Another patient noted,
“Sometimes when I am in pain, I would go to a Chinese medicine practitioner to get help for the pain. The doctor would perform bloodletting cupping therapy on me for about 30 min per session, at my own expense. It relieves my pain for at least one day, but the pain resurfaces the following day”(Patient 14).
3.2. Theme Two: Utilizing Assistive Skills
3.2.1. Applying Hot Compresses
“When I experience a headache, my initial response is to use a hot towel as a compress and apply it directly to the affected area. I keep the compress on each area for approximately a minute, beginning with the forehead, chin, and cheeks, and gradually moving downwards…”(Patient 18);
“When I take a bath, I frequently apply a hot towel as a compress to painful areas of the body, such as my back. To experience less pain, I need to keep the compress on for more than 10 min each time”(Patient 2). One participant shared,
“Sometimes, I use a hair dryer to blow hot air to my body after taking a shower for about half an hour. Afterward, my body feels very relaxed without any pain, and I also sleep better”(Patient 1). One other participant noted,
“… I usually soak my feet in hot water for about half an hour each time, and afterward, my entire body feels free from tension and pain”(Patient 6).
3.2.2. Applying Cold Compresses
“Patients like me who have tongue cancer often suffer from jaw pain. Cold compresses are ineffective for throbbing pain and numbness, but they occasionally can be very helpful for swelling pain with a burning sensation. It can sometimes provide relief for stinging pain, such as an ant bite or bee sting”(Patient 3).
“I used to put ice cubes in a plastic bag and applied it to my chin when I experienced pain. The effect was not bad; at least it alleviated my pain to some degree”(Patient 4).
3.2.3. Applying Massage
“At times, I can’t sleep well because of pain in the middle of the night, so I would ask my friend to give me a massage… applying pressure to the feet is quite effective, given that many acupuncture points are located on the feet”(Patient 10). Patients feel more relaxed after massage. One participant stated,
“Sometimes, because of the pain, I would get a foot massage, and the masseur would apply oil prior to the massage… I typically feel very relaxed afterward”(Patient 15). Another participant said,
“Whenever I am in pain, I visit a health club for massage therapy… my muscles are very relaxed during the session, which lasts about an hour. After receiving pressure applied to all my muscles, my entire body feels less painful”(Patient 17).
3.2.4. Using Body Positioning
“I can only sleep sitting up at night, because cancer has metastasized to my neck. If I lie flat, my neck stretches, which causes pain. Hence, I can only sit upright and sleep sitting up”(Patient 12). Another patient stated,
“…my left shoulder blade hurts, so I always sleep on my right side. I have to adjust my sleeping position every night to ensure that I sleep on my right side. Otherwise, I would be in pain”(Patient 7).
3.2.5. Combining Multiple Assistive Skills
“…because of the pain, I applied ice to my cheeks every time… If the pain cannot be relieved, I quickly take painkillers. In addition to taking painkillers, I try to relieve the pain with ice cubes in my mouth…”(Patient 9). One patient noted,
“Sometimes, when it hurts too much, I sleep on my right side. At times, the left side still hurts, and the pain is unbearable, and my wife will take the initiative to give me a massage…”(Patient 13). Another participant shared,
“I first lie on my stomach in a fixed position, because this position is more comfortable. Before going to bed, I would ask my kids to give me a massage and apply a heat compress so that I can sleep better. Sleeping on the left side seems to press on my tumor, which hurts, so I must sleep on my right side”(Patient 18).
3.3. Theme Three: Adapting Assistive Skills
3.3.1. Adapting Assistive Skills Outside the House
“If I happen to be busy at work when the pain starts and I can’t go to the bathroom to spray on the pain medicine, I switch to patches. I put on six patches at once, two horizontally on the upper and lower back and two vertically on the front of the left and right thighs”(Patient 1). One patient described his practices,
“After undergoing radiation therapy, my neck was hot, scalded, and painful. It was very uncomfortable, especially when I went out. Ice water did not work well. Later I switched to ice towels and stored them in a plastic bag in the refrigerator. When I needed to leave the house, I would put them in a cooler. After radiation therapy, I used them as cold compresses to relieve the pain, which worked better”(Patient 12). One patient stated,
“…I initially tried to bring ice cubes and a towel with me to work to help relieve my pain… However, as I was already carrying tools, it was inconvenient to also bring ice cubes and a towel. Consequently, I stopped bringing ice cubes and switched to buying ice water instead. I drank ice water when I experienced pain and purchased more when I ran out…”(Patient 9).
3.3.2. Adapting Assistive Skills When Encountering Situational Barriers
“I take a walk to divert my attention from the pain, but on rainy days, it is inconvenient to go out for a walk… I would visit the supermarket to look at various products instead”(Patient 4). Another participant said,
“When I am in pain, sometimes I go for a jog in the park near my house to distract myself. If it rains, I opt for indoor swimming instead”(Patient 11). One other participant stated,
“I used to wear a corset under my clothes, and sometimes I would want to adjust the tightness of the corset when I didn’t feel the pain as much. Adjusting the tightness I have to do in a bathroom, which is quite inconvenient. I now wear the corset over my clothes, which makes it easy to adjust when necessary”(Patient 10). Another patient stated,
“I used to apply ice packs to my chin when it hurts, but this would leave my shirt wet in the chest area. So now I use special cold packs instead….”(Patient 3).
3.4. Theme Four: Diverting Attention
“I can draw everything, oil painting, watercolor, sketching, and when I paint, I feel less pain because I have to concentrate on composing the picture and on thinking about how to match colors better, so I don’t have pain when I paint”(Patient 6);
“…I follow drama series to divert my attention from pain by watching TV. Sometimes I go out to play mahjong with friends. After all, when playing mahjong I have to be involved and pay attention to what tiles the other party would take and what tiles to wait for. I am not in pain when I play mahjong, so my wife encourages me to play…”(Patient 3);
“I play video games on my mobile phone. I play Candy Crush often and have passed over 4000 levels. When I concentrate on progressing through the levels, I have to think about navigating through obstacles in the game, so I don’t feel any pain”(Patient 5).
3.5. Theme Five: Seeking Help
“Whenever I have a headache, I ask my family members to give me a massage… they would massage my shoulders, neck, and hands. Once my muscles are relaxed, my headache seems to be less severe”(Patient 18);
“I use pain relief patches when I am in pain… however, it’s hard to apply the patch to my waist because I cannot reach the affected area… I finally asked my husband to help”(Patient 2);
“Sometimes when the pain is too intense, I can’t even get ice cubes from the refrigerator… I would ask my wife to help me apply an ice pack to my chin”(Patient 3).
“… I would ask my husband to rub my back gently from top to bottom… the amount of force has to be small. A ten-minute back rub each time would relieve some of my pain, and I would feel less painful”(Patient 6).
4. Discussions
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Frequency | Percentage | |
---|---|---|
Gender | ||
Male | 11 | 61.2% |
Female | 7 | 38.8% |
Age (years) | Mean = 54.9, SD = 7.3, range: 41–67 | |
Education | ||
College | 4 | 22.2% |
Junior college | 2 | 11.1% |
High school | 9 | 50.0% |
Middle school | 2 | 11.1% |
Elementary school | 1 | 5.6% |
Marital status | ||
Single | 2 | 11.1% |
Separated/divorced | 4 | 22.2% |
Married | 12 | 66.7% |
Living with friends or family | ||
Yes | 17 | 94.4% |
No | 1 | 5.6% |
Religion | ||
Buddhism | 7 | 38.9% |
Taoism | 6 | 33.3% |
Christian | 1 | 5.6% |
Other | 1 | 5.6% |
None | 3 | 16.7% |
Employment | ||
Full time | 7 | 38.9% |
Resigned | 2 | 11.1% |
Retired | 7 | 38.9% |
None | 1 | 5.6% |
Other | 1 | 5.6% |
Primary caregiver | ||
Spouse | 7 | 38.9% |
Parents | 1 | 5.6% |
Children | 5 | 27.8% |
Other | 5 | 27.8% |
Frequency | Percentage | |
---|---|---|
Diagnosis | ||
Head and neck cancer | 7 | 38.9% |
Lung cancer | 2 | 11.1% |
Colorectal cancer | 3 | 16.7% |
Breast cancer | 1 | 5.6% |
Bladder cancer | 4 | 22.2% |
Other | 1 | 5.6% |
Distal metastasis | ||
Yes | 13 | 72.2% |
No | 5 | 27.8% |
Frequency of pain | ||
Sometimes | 1 | 5.6% |
Frequent | 4 | 22.2% |
Always | 8 | 44.4% |
Persistent | 5 | 27.8% |
Opioid prescription pattern | ||
ATC basis | 18 | 100% |
Both ATC and PRN basis | 9 | 50% |
Prescribed opioid type | ||
Oxycodone | 12 | 66.7% |
Morphine | 8 | 44.4% |
Fentanyl patch | 7 | 38.9% |
Tramadol | 6 | 33.3% |
MST | 2 | 11.1% |
MXL | 1 | 5.6% |
Daily prescribed opioid dose | ||
Morphine milligram equivalents | Mean = 74.0, SD = 39.0, range = 18.8–180.0 | |
Side effect of opioids | ||
Yes | 18 | 100% |
No | 0 | 0.0% |
Type of opioid side effect | ||
Drowsiness | 8 | 44.4% |
Dizziness | 5 | 27.8% |
Constipation | 13 | 72.2% |
Nausea | 6 | 33.3% |
Vomiting | 6 | 33.3% |
Dry mouth | 4 | 22.2% |
Sweating | 4 | 22.2% |
Pain level in the past week | ||
Level of worst pain | Mean = 8.6, SD = 1.7, range: 5–10 | |
Level of least pain | Mean = 2.6, SD = 1.0, range: 1–4 | |
Level of average pain | Mean = 5.1, SD = 1.4, range: 3–10 | |
Level of a transitory increase in pain | Mean = 7.7, SD = 2.1, range: 4–10 | |
KPS (0–100) | ||
≥60 | 12 | 66.7% |
<60 | 6 | 33.3% |
(Theme) | (Category) |
---|---|
Finding complementary therapy | Seeking traditional Chinese medicine treatment |
Utilizing assistive skills | Applying hot compress |
Applying cold compress | |
Applying massage | |
Using body positioning | |
Combining multiple assistive skills | |
Adapting to assistive skills | Adapting to assistive skills outside of the house |
Adapting to assistive skills for situational barriers | |
Diverting attention | Adopting various methods to divert attention |
Seeking help | Seek help for using assistive skills |
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Liu, M.-T.; Liang, S.-Y.; Chao, T.-C.; Tseng, L.-M.; Rosenberg, J. The Behavioral Adaptations and Barriers of Patients Employing Non-Pharmacological Strategies for Cancer Pain Management—A Qualitative Study. Healthcare 2023, 11, 2911. https://doi.org/10.3390/healthcare11222911
Liu M-T, Liang S-Y, Chao T-C, Tseng L-M, Rosenberg J. The Behavioral Adaptations and Barriers of Patients Employing Non-Pharmacological Strategies for Cancer Pain Management—A Qualitative Study. Healthcare. 2023; 11(22):2911. https://doi.org/10.3390/healthcare11222911
Chicago/Turabian StyleLiu, Man-Ting, Shu-Yuan Liang, Ta-Chung Chao, Ling-Ming Tseng, and John Rosenberg. 2023. "The Behavioral Adaptations and Barriers of Patients Employing Non-Pharmacological Strategies for Cancer Pain Management—A Qualitative Study" Healthcare 11, no. 22: 2911. https://doi.org/10.3390/healthcare11222911