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Coping With Chronic Cancer Pain

Weill Cornell Study Compares Two Promising Therapies

NEW YORK (Jan 22, 2001)

Many cancer patients experience moderate or severe pain. While medical advances have led to more effective treatments for the management of pain, the presence of chronic pain in cancer remains a difficult problem and is often associated with suffering and distress.

Now physicians at New York Weill Cornell Medical Center are seeking participants with chronic pain from cancer to undergo two different kinds of psychotherapy to determine which may be more effective in helping them cope with their pain.

Over recent decades, it has become understood that a patient's thoughts and emotions and how they frame the meaning of pain can mediate levels of distress. Psychotherapists have gained experience in helping people who have chronic, severe pain.

The new Weill Cornell study, under the leadership of Dr. Susan Evans, Assistant Professor of Psychology in Psychiatry, seeks to compare therapeutic methods known as cognitive-behavioral therapy (CBT) and standard supportive psychotherapy (SSP).

Cognitive-behavioral therapy engages the patient in finding coping strategies to allow the patient to gain a sense of control and mastery over pain and the suffering associated with pain. This therapeutic approach has been used successfully for the treatment of headaches, lower back pain, and rheumatoid arthritis. One of its techniques is "cognitive restructuring," or having the patient become aware of his or her thoughts while experiencing pain. For example, when some patients engage in "catastrophizing" (thinking, "This will be the end of me"), their self-awareness at such moments can be made a basis for coping. CBT sometimes uses "guided imagery" and visualization to relax the patient and induce almost a kind of self-hypnosis or distraction.

Standard supportive psychotherapy is a more non-specific therapeutic approach, allowing the patient to discuss and explore issues with an empathetic therapist. It allows the patient to vent, and express feelings.

"Both cognitive-behavioral therapy and standard supportive psychotherapy are thought to be possibly useful in helping patients cope with chronic pain," said Dr. Evans. "In our study, we hope to refine our understanding of the proper application and the effectiveness of these two therapies."

She added, "While there have been many studies of pain management and different methods of therapy, this Weill Cornell study is unusual, possibly even unique, as a randomized study of the psychotherapeutic management of chronic cancer pain."

The 20 to 40 pilot participants of the study—all patients with chronic cancer pain—will first be assessed in a thorough interview. Over the course of a week, their experience of pain will be monitored. Then they will be randomly assigned to one of the two forms of therapy.

Each patient will receive six sessions of therapy, which will be videotaped and monitored to ensure adherence to the correct method. At the end, patients will meet with an assessor and fill out a questionnaire evaluating the effectiveness of their treatment. Patients will be reimbursed for participation.

Further information on the Coping with Chronic Cancer Pain study is available by calling (212) 821-0621.

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