title: A systematic review: non-pharmacological interventions in treating pain in patients with advanced cancer.
abstract: OBJECTIVE
  To assess and synthesize the evidence of the effects and safety of non-pharmacological interventions in treating pain in patients with advanced cancer.
  
  
  BACKGROUND
  Pain is a common symptom experienced by patients with advanced cancer; the treatment of such pain is often suboptimal. To manage it, non-pharmacological interventions are recommended after pharmacological treatments have been re-evaluated and modified. However, there remains a lack of knowledge about the effects and safety of such interventions.
  
  
  METHODS
  A systematic review was conducted based on the procedure of the Centre of Reviews and Dissemination.
  
  
  METHODS
  Research papers published between 2000-2013 were identified from the following databases: CINAHL, MEDIC, MEDLINE (Ovid) and PsycINFO. The references in the selected studies were searched manually.
  
  
  METHODS
  The studies selected were reviewed for quality, using Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria.
  
  
  RESULTS
  There was limited evidence that some of the non-pharmacological interventions were promising with respect to reducing cancer pain. Relatively, few adverse events were reported as a result of using such interventions.
  
  
  CONCLUSIONS
  It was not possible to draw conclusions about the effects and safety of the non-pharmacological interventions in reducing cancer pain. Some interventions showed promising short-term effects, but there is a need for more rigorous trials. Qualitative studies are required to collect information about patients' perceptions. There are several research gaps: we found no studies about music, spiritual care, hypnosis, active coping training, cold or ultrasonic stimulation.
authors.affiliation: Institution of Health Sciences, University of Oulu, Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Hökkä
authors.affiliation: Institution of Health Sciences, University of Oulu, University Hospital of Oulu, Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Kaakinen
authors.affiliation: Institution of Health Sciences, University of Oulu, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Pölkki
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000209:etiology*; D059408:Pain Management / Q000379:methods*
keywords: adult care; cancer; complementary therapy; holistic care; literature review; non-pharmacological intervention; nursing; pain; palliative care