Acupuncture

Efficacy

The available evidence suggests acupuncture to be effective for pain. The evidence derives from 12 SRs, including 5 to 47 mixed design studies.

Safety

Generally safe when administered by a professional qualified practitioner.  Mild adverse effects, such as pain or bleeding at the acupuncture site, can be expected in 10% of all cases.  Serious complications seem to be very rare. 

Read the full version of the acupuncture for cancer pain summary.

Aromatherapy

Efficacy

The available evidence suggests aromatherapy to be effective for pain. Benefits were reported for aromatherapy-massage over no treatment on medium and long-term pain but effects were small. There is insufficient evidence on adding aromatherapy to massage over massage alone (3 SRs).
The results are based on three SRs (n=3 RCTs, n=19 RCTs, n=43 mixed study designs) and two additional RCTs (n=39, n=57). 

Safety

Generally safe and only associated with minimal adverse effects when used in appropriate dilutions. 
Allergic reactions can occur with all oils. Should not be used undiluted.

Read the full version of the Aromatherapy summary.

Hypnotherapy

Efficacy

The available evidence suggests hypnotherapy to be effective for cancer-related pain. The evidence derives from nine RCTs and one CCT (ranging from 3 to 201 participants). Eight of the studies showed a significant reduction in pain. 

Safety

Generally considered safe when administered by qualified professionals. Contraindications include acute psychoses, severe personality disorders, and an inability to be hypnotized.

Read the full version of the Hypnotherapy summary.

Massage (Classical/Swedish)

Efficacy

The available evidence suggests massage to be effective for cancer pain. The evidence is derived from nine SRs, including five to nineteen mixed-design studies. 

Safety

Generally considered safe when administered by a qualified professional. Contraindications include strong, forceful massage in patients suffering from haemorrhagic disorders, low platelet counts, and blood thinning medication.

Read the full version of the Massage (Classical/ Swedish) summary.

Music interventions

Efficacy

The available evidence suggests that music-based interventions combined with standard care seem to be more effective than standard care alone to reduce cancer-related pain. An overview of systematic reviews (n=6 SRs on pain) and three additional SRs (ranging from 7 to 25 mixed design studies) reported improvements compared to various controls such as standard care, wait-list, bed rest, or wearing headphones with no music. 

Safety

Generally considered safe with no safety issues on record.
Caution is advised for acutely distressed and/or emotionally fragile patients, particularly in patients with serious and life-threatening cancers.

Read the full version of the Music therapy summary.

Progressive Muscle Relaxation (PMR)

Efficacy 

The available evidence suggests PMR to be effective for pain. The results derive from one SR (n=12 RCTs) and nine additional CCTs (including 30 to 148 participants). The effect of PMR on pain among colorectal cancer surgical patients is conflicting. 

Safety 

Generally considered safe when administered by a qualified practitioner.  

Some concern has been raised about the use of relaxation therapy interventions among individuals who have a history of psychiatric disorders. 

Read the full version of the Progressive Muscle Relaxation summary. 

Autogenic therapy

Efficacy

The evidence for effects of autogenic therapy on pain is inconclusive as only few trial data are available. One RCT (n=60) found significant reductions in pain among the group getting autogenic therapy pre- and post-treatment but not compared to controls or in analgesic use.

Safety

The safety of autogenic therapy has not been systematically assessed. No adverse events were reported in the studies analysed for this summary. Concerns exist for children under the age of five, individuals with schizophrenia, or who are actively psychotic.

Read the full version of the Autogenic therapy summary. 

Biofeedback

Efficacy 

The evidence for the effects of biofeedback on pain are unclear. One SR (n= 6 mixed design studies) and a small RCT (n=37) concluded biofeedback could be helpful in alleviating pain, but both studies have significant methodological limitations.   

Safety 

Biofeedback is generally considered safe, and no adverse events have been reported in the included studies. Some concern for individuals with a history of psychiatric illness.  

Read the full version of the biofeedback summary.

Homeopathy

Efficacy 

The evidence is inconclusive as very few trial data are available. One observational study (n=40) found a significant difference in joint pain among women treated with Ruta graveolens 5CH and Rhus toxicodendron 9CH. However, the quality of the study design was low.  

Safety 

Generally safe and there are no serious direct risks associated with homeopathy.   

There are indirect risks if homeopathic preparations are used in place of conventional cancer treatment. 

Read the full version of the homeopathy summary. 

Mindfulness (MBCT)

Efficacy 

Mindfulness-based cognitive therapy (MBCT): Few trial data are available. One RCT (n=121) suggests MBCT reduced pain and pain medication use.  

Safety 

Mindfulness-based approaches are generally considered to be safe in supportive cancer care. However, no rigorous assessment of the safety of mindfulness-based approaches in cancer patients is available. 

Read the full version of the  Mindfulness summary. 

Reflexology

Efficacy  

The available evidence suggests reflexology to improve pain but is of low methodological quality. One SR (n=12 RCTs) and two additional RCTs (n=72, n=115) found reflexology had a significant effect on improving pain. Two CTs (n=30, n=72) found no significant effect on pain from reflexology.  

Safety 

Generally considered safe when administered by a qualified practitioner.  

Read the full version of the reflexology summary. 

Reiki

Efficacy 

The available evidence of reiki for pain is contradictory. One review (n= 6 mixed design studies) showed a reduction in cancer pain, but the results are not reliable due to the quality of the included studies. Another SR (n=9 RCTs) concluded that there was insufficient evidence to report the effect of reiki on pain.  

Safety 

Generally considered safe when administered by a qualified practitioner.   

Read the full version of the reiki summary. 

Tai chi

Efficacy 

The evidence is contradictory on the effect of tai chi on pain. Two SRs (n=26 mixed design studies, n=9 RCTs) found no effect of tai chi on pain. However, one SR (n=15 RCTs) and one additional RCT (n=100) found that tai chi reduces pain. 

Safety 

Generally considered safe when administered by a qualified practitioner.  

As it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis or musculoskeletal difficulties. 

Read the full version of the Tai chi summary. 

Therapeutic touch

Efficacy  

Therapeutic touch may reduce pain, but evidence is currently inconclusive due to methodological limitations of the studies. These findings are based on one SR including 4 RCTs. 

Safety 

Generally considered safe when administered by a qualified practitioner, no serious safety concerns are known. 

Read the full version of the therapeutic touch summary. 

Yoga

Efficacy 

Pain and range of shoulder motion: The available evidence suggests yoga to be effective for pain and range of shoulder motion. Two RCTs (n=40, n=62) found small/moderate beneficial effects from yoga on pain.  

Safety 

Generally considered safe when administered by a qualified practitioner. Few adverse events are reported in clinical trials, and serious adverse effects appear to be rare. Overall, injury rates are comparable to other exercise types. 

Read the full version of the Yoga summary. 

Cannabis and cannabinoids  

Efficacy 

The evidence suggests cannabis not to be effective for pain among cancer patients. Results are derived from one SR (n= 5 RCTs) that showed no significant improvement in pain and low quality of evidence. 

Safety 

Cannabis and cannabinoids are generally considered safe. Adverse effects on the central nervous system are common (e.g., mood changes, memory disorders, blurred vision, and dizziness); these are dose dependent. Caution is advised during pregnancy and lactation. The risk of drug interactions is low. 

Read the full version of the cannabis summary. 

Massage (Classical/Swedish) 

Efficacy

Among children, two SRs (n=3 mixed-design studies, n= 7 RCTs) found massage not to be effective for pain.  

Safety 

Generally considered safe when administered by a qualified professional. Contraindications include strong, forceful massage in patients suffering from haemorrhagic disorders, low platelet counts, and blood thinning medication. 

Read the full version of the  Massage (Classical/ Swedish) summary. 

Mindfulness (MBSR) 

Efficacy 

Mindfulness-based stress reduction (MBSR): The evidence suggests MBSR not to be effective for pain. One SR (n=14 mixed-design studies) and one additional RCT (n=98), were assessed to reach this result. 

Safety 

Mindfulness-based approaches are generally considered to be safe in supportive cancer care. However, no rigorous assessment of the safety of mindfulness-based approaches in cancer patients is available. 

Read the full version of the  Mindfulness summary. 

Pomegranate

Efficacy 

The evidence is inconclusive as few trial data are available on the effect of pomegranate on pain. One RCT (n=102) found that pomegranate had no effect on pain among advanced prostate cancer patients.  

Safety 

Pomegranate is generally considered safe with only transient and mild adverse effects. Adverse effects include allergic reactions and diarrhoea. Among those with hypotension or undergoing surgery it may lower blood pressure. 

Read the full version of the pomegranate summary. 

Qigong

Efficacy 

The evidence suggests qigong not to be effective on cancer-related pain based on one SR (n=22 CCTs).  

Safety 

Generally considered safe when administered by a qualified practitioner.  

As it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis or musculoskeletal difficulties. 

Read the full version of the Qigong summary.

Yoga

Efficacy 

Pain: The available evidence suggests yoga not to be effective on pain. The conclusion is reached from the results of 2 SRs (n=4 RCT, n=5 RCTs). 

Safety 

Generally considered safe when administered by a qualified practitioner. Few adverse events are reported in clinical trials, and serious adverse effects appear to be rare. Overall, injury rates are comparable to other exercise types. 

Read the full version of the Yoga summary.