Developing cognitive behavior therapy based inclusive-approach for assessment and management of pain among cancer patients in Bangladesh

Abstract

Pain is a complex sensory and emotional experience that is mostly related to actual or potential tissue damage. People with cancer often experience pain and their manifestation of pain is far more complicated than any other type of chronic pain due to its multidimensional and widespreading nature. The traditional medical management of cancer pain only addresses the physiological aspect ignoring the psychological and sociocultural dimension of pain resulting compromise in optimal patients care. Therefore, a holistic approach addressing physical, emotional, cognitive, behavioral, and social facets of pain is preferred for its better management. The present study was aimed to develop a cognitive behavior therapy based inclusive approach for assessment and management of pain among cancer patients in Bangladesh. Stage model of psychotherapy manual development was followed to develop the present therapeutic protocol. Through systematic evaluation of literature, text books, findings of lab researches and case studies, a twelve sessions manual was initially developed which was later reduced to six sessions followed by judge evaluation and pilot study. To investigate the appropriateness of the developed manual, quasi-experimental design in the form of comparison group pretest-posttest study was adopted where one group received cognitive behavior therapy (CBT) and the other group received breathing relaxation. A total of 47 participants were non-randomly enrolled in two groups with CBT group having 28 participants and breathing relaxation group having 19 participants. During the courses of the study 21 participant were dropped out from the study due to progression of disease, death, non-compliance, transportation, and changing of treatment regimen issues. In both, CBT and breathing relaxation groups data retention rate among female patients with breast cancer were highest. Feedback of participants on different assessment strategies revealed satisfactory results where majority reported that subjective mood checking, qualitative description of pain and body diagram were helpful in expressing their pain. Between group analysis of pretest scores revealed that the level of depression in breathing relaxation group was higher (t=-2.347, p=0.024) than CBT group prior to intervention. Post score analysis also yielded a change in anxiety level (t=-1.934, p=0.065) and ability to decrease pain (t=-2.394, p=0.026) due to variations of interventions. From baseline to post-intervention, a significant improvement was observed in terms of pain interference (t=4.259, p=0.001), anxiety (t=4.029, p=0.002), pain control (t=-5.283, p<0.01), and ability to decrease pain (t=-3.895, p=0.002) domain in CBT group. Conversely, in breathing relaxation group a change was observed from baseline to post-intervention in pain interference domain, albeit statistically nonsignificant (t=2.032, p=0.065). Participants in CBT group found most of the intervention techniques to be helpful. However, a majority of them preferred relaxation over cognitive coping skills. The results of the present study indicate that the developed CBT protocol is helpful in assessing and managing cancer related pain which will be helpful to the oncology nurses to minimize the amount of nursing time in busy clinical setting if they can be trained properly.