Cancer pain management without drugs

Acupuncture may help some people with cancer pain. Some doctors think it may work by stimulating the body to produce endorphins, which are the body’s natural painkillers.

Acupuncture uses fine needles inserted just under the skin at certain points on the body. The needles are tiny, so it is not painful.

Acupuncture is generally safe and side effects or complications are rare. You should not have acupuncture if you are having cancer treatments that could lower your blood counts, such as chemotherapy. If you have lymphoedema, or are at risk of it, do not have acupuncture in the affected area.

Some specialist NHS pain and palliative care teams offer acupuncture. Your GP or cancer specialist can refer you. You may have to pay for this.

Massage therapy uses gentle pressure to your body to help you relax and improve your mood. Some people find it reduces pain.

There are different types of massage therapy. Cancer doctors and complementary therapists will usually advise you to try gentle massage and avoid vigorous, deep-tissue massage. Your therapist will be able to adjust the pressure for your comfort.

Some people worry that massage could cause cancer cells to spread to other parts of their body. Research has not found any evidence of this. But massage therapists will avoid any areas affected by cancer. Talk to your cancer doctor or nurse if you are worried.

Massage therapists working with people with cancer must be properly trained and qualified. They should have some knowledge of cancer and its treatments. They can sometimes teach relatives or friends how to do basic massage techniques, so they can support you at home.

There are different types of meditation but they all aim to relax and calm your mind. Some hospitals or hospices may have people who can help you meditate. Ask your doctor, specialist nurse or palliative care team.

To meditate, sit quietly and focus on your breathing without trying to control it. If you have a thought, try to let it go and only concentrate on your breathing. If you prefer, you can put an object in front of you and focus on that instead. For example, this could be a lighted candle or a picture.

If you are having treatment for any mental health problems, check with your doctor before doing meditation.

Mindfulness meditation is a particular type of meditation. The aim is to help people manage problems such as anxiety, stress or chronic pain. Types of mindfulness include:

• Mindfulness-Based Stress Reduction (MBSR)
• Mindfulness-Based Cognitive Therapy (MBCT).

Mindfulness classes may be available through your hospital, your GP or a cancer support charity.

Apps and CDs can help you meditate at home. Some people find it helpful to meditate in a group until they are familiar with the technique.

Learning to relax may also help control pain, even if you can only do this for a short time each day. Ask your doctor if there is a healthcare professional who can help you. This might be an occupational therapist, physiotherapist or psychologist. A technique called progressive muscle relaxation involves learning to tense and relax groups of muscles, individually or together.

You can also do relaxation exercises to relax your mind. This can be helpful if anxiety is making your pain worse. There are lots of relaxation CDs or apps available to guide you.

To practice relaxation, find a quiet, warm and dimly lit space. Make sure you will not be disturbed. Lie or sit in a well-supported position. Relaxation techniques are most helpful if you practise them for 5 to 15 minutes each day.

You may want to try different things until you find the relaxation exercise that works best for you.

Below is a sample of the sources used in our cancer pain information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Fallon M, Giusti R, Aielli F, et al. Management of Cancer Pain in Adult Patients: ESMO Clinical Practice Guidelines, Annals of Oncology, 2018; 29 (Suppl 4): 166–191. Available from:  www.esmo.org/guidelines/guidelines-by-topic/supportive-and-palliative-care/cancer-pain (accessed Jan 2022)

Pain and symptom control guidelines for adults; Greater Manchester and Eastern Cheshire Strategic Clinical Networks 2019. Available from: www.england.nhs.uk/north‑west/wp‑content/uploads/sites/48/2020/01/Palliative‑Care‑Pain‑and‑Symptom‑Control‑Guidelines.pdf (accessed Jan 2022)

Palliative cancer care – pain. National Institute for Health and Care Excellence March 2021. Available from: cks.nice.org.uk/topics/palliative‑cancer‑care‑pain (accessed Jan 2022)

Scottish Palliative Care Guidelines. Available from: www.palliativecareguidelines.scot.nhs.uk (accessed Jan 2022)

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical professionals and people living with cancer. It has been approved by our Senior Medical Editor, Dr Ollie Minton, Macmillan Consultant in Palliative Medicine.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.