Predicting Cancer Pain Relief Using Nondrug Strategies

Kristine Kwekkeboom, PhD, RN

Guidelines for the treatment of cancer pain recommend combining analgesic medications with nondrug interventions to maximize pain relief. However, current research indicates individual differences in the effectiveness of nondrug pain treatments. An intervention that is helpful to one patient may be ineffective or even make pain worse for another patient. The Model for Cognitive-Behavioral Interventions suggests individual difference variables that may influence effects of specific nondrug treatments including (1) skill or ability to use the treatment, (2) outcome expectancy regarding the treatment, (3) previous history with the treatment, and (4) presence of concurrent symptoms. This pilot project will test the feasibility of studying these individual difference variables as predictors of success with two nondrug interventions (guided imagery and progressive muscle relaxation [PMR]), estimate the impact of the individual difference variables on short-term pain outcomes, and explore patients perceptions of factors that influenced their success with guided imagery and PMR. A crossover design will be used. We will recruit a sample of 60 inpatients with average cancer-related pain rated 3-7 (0-10 scale). After completing measures of individual difference variables, participants will be asked to complete one attention control trial and two trials of a nondrug intervention each day for two days. The order of interventions will be randomized, with participants trying the guided imagery intervention on one day and the PMR intervention on the other. Pain outcomes to be measured include pain intensity, pain-related distress, affect, and perceived control over pain.