Drug-Free Management Tools Provide Alternatives to Opioids in Kidney Cancer


An expert from University Hospitals touches on pain management guidelines that highlight moderate evidence in support of acupuncture, reflexology, and acupressure and massage as tools to manage general pain in patients with cancer.

During Kidney Cancer Awareness Month 2023, Santosh Rao, MD, spoke with CancerNetwork® about evidence from the “Integrative Medicine for Pain Management in Oncology” guidelines from the Society for Integrative Oncology (SIO) and the American Society for Clinical Oncology (ASCO) concerning the efficacy of integrative medicine for patients with solid tumors such as kidney cancer.

Although there was only moderate evidence supporting techniques such as acupuncture and reflexology in the management of general cancer pain and musculoskeletal pain, Rao, medical director of integrative oncology for University Hospitals Connor Whole Health and president-elect for the SIO, stated that these integrative strategies could be a safe alternative for managing pain compared with opioids.


I’ll go over the pain guidelines; it was pretty conservative. Although we may expand these guidelines in the future or the evidence might be more robust, it was really a statement of where we’re at right now. For general cancer pain, there was moderate evidence for the use of acupuncture, reflexology, or acupressure and massage. There was weak evidence for things like yoga and guided imagery.

For neuropathy, there was weak evidence for acupuncture, reflexology, or acupressure. For procedural pain, hypnosis had moderate evidence. For pain during palliative care, massage had moderate evidence. For surgical pain, acupuncture and music therapy had weak evidence.

You contrast [the guidelines] with the fact that these [therapies] are extremely safe. My interest in this kind of approach is that the contrast to using these modalities is to usually use opioids, which have lots of potential [adverse] effects. If you can potentially reduce opioid use with all their [adverse] effects, even if it’s just limiting the amount of opioid use, then that’s a win. You’re not going to get [adverse] effects from music therapy or massage, for example. And we have guidelines around that; it’s important for people to be educated on the safety guidelines when we use these things. That has been really useful.


Mao JJ, Ismaila N, Bao T, et al. Integrative medicine for pain management in oncology: Society for Integrative Oncology-ASCO guideline. J Clin Oncol. 2022;40(34):3998-4024. doi:10.1200/JCO.22.01357

Related Videos
Investigators are assessing the use of IORT in patients with borderline resectable or unresectable pancreatic cancer as part of the phase 2 PACER trial.
The approval for epcoritamab in patients with R/R follicular lymphoma was supported by encouraging efficacy findings from the phase 1/2 EPCORE NHL-1 trial.
A phase 1/2 trial assessed the use of menin inhibitor DSP-5336 in patients with acute leukemia overexpressing HOXA9 and MEIS1.
A phase 1 trial assessed the use of PSCA-directed CAR T cells in patients with metastatic castration-resistant prostate cancer.
A pooled analysis trial assessed the impact of acalabrutinib in patients with chronic lymphocytic leukemia across treatment lines.
Findings from a phase 1 study may inform future trial designs intended to yield longer responses with PSCA-targeted CAR T cells.
A phase 1 trial assessed the use of PSCA-directed CAR T cells in patients with metastatic castration-resistant prostate cancer.
Kamran Idrees, MD, MSCI, MMHC, FACS, discusses how factors such as vessel involvement can influence the decision to proceed with surgical therapy.
relapsed or refractory mantle cell lymphoma, glofitamab, Obinutuzumab, phase 1/2 study, NCT03075696, Tycel J. Phillips, MD
Milad Baradaran, PhD, DABR, outlines the design of Mobetron as an option for administering intraoperative radiation therapy in pancreatic cancer care.
Related Content