By Daniel B. Hinshaw, MD
Member, Palliative Care in Oncology Symposium Program and Steering Committees
In her groundbreaking work with patients experiencing distress in advanced cancer, Dame Cicely Saunders coined the term “total pain” to describe the multidimensional nature of suffering.1 From her careful observations of dying cancer patients over several years, she realized that the human experience of distress associated with advanced life-threatening illnesses embraces at least four different but interconnected domains within a person: the physical, psychological, social, and spiritual. This holistic vision of care for the patient with cancer has at times collided with the biomedical model of medicine as applied biology. Within the reductionist approach of the biomedical model it has been much easier and more satisfying scientifically to form testable hypotheses, where technology can support accurate measurement focused on very specific questions. Thus, visualized and measurable pathologic anatomy or deranged physiology will often trump attempts to examine phenomena that defy reductionist approaches. And yet, for patients struggling to survive in the face of a life-threatening illness, therapies that only address their apparent pathologic biology may not entirely relieve their distress. The extensive use of complementary and alternative medicine (CAM) therapies in the US (e.g., 38.3% of adults reported use of CAM therapies in 2007)2 may be a powerful reflection of many patients’ frustration with perceived limitations of care based purely on the biomedical model. Whereas complementary therapies are intended to supplement conventional medical treatment, alternative therapies, as the name implies, have been promoted as substitutes for conventional medical care. Integrative medicine is an attempt to more fully integrate different complementary therapies into conventional medical care with the goal of holistically addressing the needs and distress associated with serious illnesses as they are experienced by the person who is ill, transcending treatment focused only on the disease causing the illness.
At the second annual Palliative Care in Oncology Symposium, we are very pleased to offer our first concurrent session devoted to an in-depth exploration of three of the more commonly used and popular nonpharmacologic integrative therapies: acupuncture, therapeutic massage, and music therapy. The presenters, experts in their respective disciplines, will present the evidence base for each of the therapies as well as provide a sense of the process and proposed mechanisms of action of each of the therapies. To the extent they are focused on treating the whole person, integrative therapies, like those highlighted in this concurrent session, may have the potential to address all four domains of Cicely Saunders’ total pain. We look forward to a lively discussion with the audience.
Dr. Hinshaw, of the University of Michigan, has served as founding director of the Palliative Care Consultation Service at the Veterans Administration Medical Center, and his primary clinical research interests focus on end-of-life care, spiritual distress in advanced illness, and the use of massage in the relief of pain and suffering. He also serves as a visiting professor of palliative care at St. Vladimir’s Orthodox Theological Seminary, where he published Suffering and the Nature of Healing.
- Clark D. Total pain, disciplinary power and the body in the work of Cicely Saunders, 1958-1967; Soc. Sci. & Med. 1999;49:727-36.
- National Center for Complementary and Alternative Medicine: The Use of Complementary and Alternative Medicine in the United States. Accessed at https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm 27 August 2015