Psychological Approaches to the Management of Cancer-Related Pain - Essay Example

? A Proposal to Review the Effect of Progressive Muscle Relaxation Techniques on Chronic Pain in Cancer Patients Table of Contents 4 Chapter1: Introduction 5 1.1 Introduction 5 1.2 Background/Justification 6 1.3 Aims & Objectives 9 1.3.1 Aim 9 1.3.2 Objectives 10 1.4 Statement of the Research Problem with Rationale for a Review 10 1.5 The Review Question 11 2. Chapter Two: Methodology 11 2.1 Introduction 11 2.2 Research Strategy 12 2.3 Choice of Index and Database 13 2.3.1 Key Words 13 2.3.2 Databases Used 13 2.4 The Search and Output 14 2.5 Selection Criteria: Inclusion and Exclusion 14 2.5.1 Inclusion 14 2.5.2 Exclusion 14 2.6 Reading and Evaluation 15 2.6.1 Critical Appraisal 15 2.6.1 Data Analysis 16 2.6.2 Data Extraction 16 Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial 17 3. Chapter Three: Preliminary Literature Review 19 3.1 Progressive Muscle Relaxation 19 3.1.1Complete sequences of progressive muscle relaxation 20 3.2 Synthesis 23 Bibliography 26 Appendixes 29 Appendix 1 Time Table 29 Appendix 2 30 Abstract The proposed research for this study will discuss the progressive muscle relaxation and its techniques along with the effect that it has on chronic pain in patients with cancer. The techniques discussed can have a significant impact on reducing and relaxing chronic pain in patients with cancer. The research for this study will be conducted through an examination of secondary research as relevant literature provides valuable information and knowledge about PMR and its impact on chronic pain. Chapter 1: Introduction 1.1 Introduction Pain is the eternal companion of mankind, with medical practitioners spending a great deal of their time assessing and finding ways to alleviate pain. Chronic pain is extremely common in patients with cancer, especially those who are found in stage IV of the disease. Pain can be divided into four types of intensity: weak, moderate, sever, and very severe. All analgesic therapy in cancer patients is based on the use of non-narcotic, narcotic, and support (adjuvant) drugs, the use of which forms the basis of a three-step approach to pain management which was developed and proposed by the world health organization. It is estimated that one third of all cancer patients suffer from moderate to severe pain related to their cancer and over 50% of patients diagnosed with cancer suffer from some form of pain. The most common types of pain related to cancer are due to the cancer tumor and the treatment. Unlike those who suffer from chronic pain that is unrelated to cancer, those with cancer experience pain in more than on area; the pain can be both acute and chronic and often varies in presentation. Pain is associated with the consequences of changes in psychosocial relationships, decreased quality of life, and increased rates of depression and anxiety (Melzack 2005, p. 971-979). Unfortunately, patients and providers often find that pharmacologic therapy does not completely control pain associated with cancer. Pharmacologic management of pain often comes with side effects such as nausea, constipation, drowsiness, pruritus, sedation, and delirium. Complementary and alternative medical (CAM) therapies, including mind-body techniques, are often sought out. Mind-body therapies are recommended in addition to pharmacological approaches for cancer patients experiencing pain. 1.2 Background/Justification Cancer pain is a complex phenomenon that often occurs due to tumor progression and related pathology, surgery or other invasive procedures. Toxicities of chemotherapy and radiation can significantly contribute to that pain as well as infection which all lead to a multidimensional model of cancer pain that can include the five components of: (1) physiologic (organize etiology of the pain); (2) sensory (intensity, location, quality); (3) affective (depression and anxiety); (4) cognitive (the meaning attached to the pain); and (5) behavioral (activity level, analgesic intake). This model is similar to the conceptual framework of acute pain and provides a foundation for nurses to use in planning and implementing pain relief strategies for cancer patients (Devine 2003, p. 75089). Findings from studies that used adjunct measures such as relaxation hypnosis, operant techniques and back massage for pain relief in cancer patients are inconclusive. However, Yates (2012) reveals studies that show as much as 45% of all cancer patients who engage in PMR and similar relaxation techniques to experience reductions in pain (p. 393). Although pharmacologic methods continue to be the most common mode for cancer pain relief, problems may occur with continued use of analgesics which includes inadequate and inconsistent pain relief, diminishing effectiveness over time, and negative side effects. Ventafridda, Tamburini, Caraceni, De Canno, & Naldi,. (2006) write that 52% of non-opioid users report that pain returns within a few weeks of beginning to use these types of pain control medications. A shift to medications with opioids was seen in 92% of patients because of inefficiency in pain reduction with 8% shifting because of poor side-effects (p. 850). Because of the potential complications from analgesics, there is increased emphasis on adjunct NPPRI (Seers 2001, p. 466-475). Using methods that are not based upon pharmacologic methods have the advantage of connecting the mind to the body in order to use the self as a resource for pain control and management. Current models of management of acute pain are through pharmacologic interventions. Several classes of analgesic agents are currently available which include non-opioids, opioids, and agonist analgesics. Each class acts at different sites to produce analgesia (Kwekkeboom 2008, p. 604-614). Non-opioid analgesics (aspirin acetaminophen) and non-steroidal anti-inflammatory drugs relieve mild or moderate pain by interfering with the production of bradykinins and prostaglandins at the peripheral site of injury. Weak opioids (codeine, oxycodone); strong opioids (fentanyl, meperidine, morphine) and agonists (buprenorphine) act by attaching to one or several opiate receptor sites (mu, kappa, sigma) on neurons in the central nervous system, thus preventing the transmission of nociceptive impulses from one neuron to the next (Astin, p. 131-147). Opioids and agonists are effective for moderate or severe pain while analgesics administers on “pm” or as needed basis often result in inadequate pain relief because of insufficient amounts of medications given arid lengthy intervals occurring between administration of pain medications. Due to these and other problems, the practice of administering analgesics on a “pm” basis is becoming obsolete (Kwekkeboom 2008, p. 185-194). With the rise of the opinion that pharmacologic pain management is largely ineffective in the long term, non-pharmacologic pain relief intervention (NPPRI) is becoming a vital component in a comprehensive approach to pain management. NPPRI complements of enhances the effectiveness of analgesics and are not usually considered for their pain relief measures, but as an adjunctive to interventions (Haase 2005, p. 1955-1963). Non-pharmacologic modalities, used by themselves or in combination with pharmacologic approaches, can be very useful in the management of either acute or chronic pain. NPPRI methods are classified as cutaneous stimulation, e.g. massage/pressure and transcutaneous electrical stimulation, and cognitive behavioral e.g., relaxation techniques and biofeedback. Most NPPRI have few, if any side effects and are beneficial for individuals at risk for developing adverse effects from analgesics. In addition, NPPRI requires that clients and families actively participate in pain management decisions. Active participation is a significant determinant in pain relief (Godfrey 2005, p. 846-852). Relaxation techniques create a powerful distraction as well as reduce muscle tension. Researchers contend that relaxation reduces pain by decreasing anxiety and the distress associated with pain which significantly alters the perception of pain. Relaxation techniques including PMR may also improve the effectiveness of analgesics by interrupting the cycle of pain, anxiety, and muscle tension. Effective relaxation relies to some extent on behaviors already associated with relaxing such as deep breathing; abdominal breathing, yawning or reflecting on peaceful experiences (Gansler 2008, p. 1048-1057). Theories on pain and pain management have changed dramatically in the past 2000 years since the time of Aristotle in which he contended that pain was an experience of the mind, an emotion that was associated with an increased sense of sensation in the body (Lewandowski 2004, p. 233-241). During the past decade, laboratory and clinical research on non-pharmacologic approaches to pain management have increased dramatically but the results have been mixed. A gap remains in the literature on the effectiveness of NPPRI modalities within specific patient populations through the use of controlled studies. Identifying the existing literature and creating a framework through which further research can be done will allow for the subject to be discussed through a comprehensive overview. The focus of this study is to determine if the technique of (PMR) can be used as NPPRI towards successfully relieving pain in patients with cancer. (PMR) is a technique specifically designed to decrease muscle tension and anxiety. This involves the systematic tensing and relaxing of various skeletal muscle groups of the body. Progressive muscle relaxation, which uses fewer muscle groups, is particularly suitable for use in the clinical setting with patients experiencing acute pain. Research is limited, however, about how to modify the techniques for use for relief of acute pain. 1.3 Aims & Objectives 1.3.1 Aim This study is undertaken to determine evidence from literature through evaluating the effect of PMR in reducing chronic pain among cancer patients. 1.3.2 Objectives To identify the significance of progressive muscle relaxation techniques on chronic pain in cancer patients To determine the effectiveness of progressive muscle relaxation techniques on chronic pain in cancer patients To determine the degree to which PMR techniques can be used in the relief of pain in cancer patients To determine the gap between pharmacological treatments and the degree of pain that remains that can be eliminated through PMR 1.4 Statement of the Research Problem with Rationale for a Review The research problem is justified by means of PICO analysis which refers to Population; Intervention; Comparison; and Outcome’ Population is identified through cancer patients Intervention is identified as Progressive Muscle Relaxation Technique (PMRT) Comparison is identified as the effect of Pharmacological and Non-pharmacological methods Outcome is expected to be that PMRT produces a relaxation that breaks the pain-muscle-tension dynamic and facilitate chronic pain reduction through the effect of calming the patient from the tensions that increase pain episodes or chronic pain. The research aims to discuss the problem of chronic pain in cancer patients and the technique of reduction through the help of progressive muscle relaxation techniques. Through investigating previous research, the identification of concepts that support the review questions will begin to fill the gap between what is known about PMR and its effectiveness and the clinical use of PMR. 1.5 The Review Question The following review questions will frame the inquiry in order to form a structure through which to investigate the topic: 1. How can progressive muscle relaxation (PMR) techniques significantly reduce chronic pain in cancer patients? 2. Is there a significant effect of progressive muscle relaxation on chronic pain? 3. What degree of relief is created by PMR? 4. How should PMR be used in conjunction with other pain management techniques, including pharmacological methods of management? 2. Chapter Two: Methodology 2.1 Introduction Secondary research will be used to build a framework through which the inquiry will gain meaning and definition. Through the use of grounded theory, the development of outcomes to the research will support hypotheses that emerge from the exploration of the information that comes from the data. Grounded theory allows the researcher to develop theories that are empirically extracted from real life experiences, providing for discovery to create theory rather than theory to inform discovery. Theory is then available to those who would use the concepts in order to inform them on methods of practice (Oktay 2012, p. 5). Through exploring the literature that is relevant to PMR and its uses by cancer patients as a methodology of pain management, this study will develop theories on the topic that can be used by further research in order to support the development of experimental frameworks of inquiry. 2.2 Research Strategy The research strategy will be defined by centering inquiry on secondary data collection. Through qualitative approaches to inquiry, the study will use several approaches of collecting data which may be primary or secondary in nature, all of which will be based on a literature review. Creswell (2009, p. 26) states that a qualitative study is exploratory and is intended to build a set of theories based on the discovery that occurs during the search for understanding the experience. Although literature reviews are not typical for qualitative inquiry, in this instance, the literature will serve as the voice of the participants who were the focus of inquiry in the various pieces of literature used for this review. Through exploring experience in a variety of studies, the variables will begin to emerge within the commonly found experiences. This type of study is less expensive than quantitative studies but provides the capacity for the collection of a large volume of information through which common elements will begin to emerge. The data will be uncovered through journals, articles, and books from which the topic will be further explored. Secondary studies describe material collected without conducting primary experimental research and without the exploration of human fields. Although some sources may be primary, when used in this study they will become reported and thus will be then defined secondary within this study. 2.3 Choice of Index and Database 2.3.1 Key Words In order to create the best possible search for this inquiry, key words will be used in order to frame the inquiry. The key words that will be used for this study will be: pain, PMR, cancer, NPPRI, pharmacology, analgesics, muscle massage, and pain relief. Key words were combined using the word and or through other methods of finding information through which one or more concepts framed the inquiry. 2.3.2 Databases Used The databases that will be used for this inquiry include specialty journals, general searches to find what may not exist in those journals, and internet searches through which information will be defined as appropriate. According to Wood and Kerr (2011, p. 198) “Reliability and validity in research refer specifically to the measurement of data as they will be used to answer the research questions”. Validity of the articles that are used in the review will be established through peer review and credential checks on authors for which peer review is not available, as well as through time relevance as no article used in the study would be dated past 1994 to allow for a twenty-five year gap. Articles outside of this date range were used as peripheral, but not central to the inquiry. 2.4 The Search and Output The preliminary literature search created 26 results through which 6 were identified as appropriate for the review. The articles that were selected were defined and placed into a folders defining them as either quantitative or qualitative, and then grouped for the type of information that was made available through those studies. The literature was defined for its exploration of experiences with PMR and how the technique was experienced by those in the selected articles. To get the bets appropriate and efficient literature, many libraries and online data bases will be used. Certain online databases were identified as appropriate to the search: Blackwell, Ebsco, and Emerald among others provide industry specific articles that relate to the inquiry. Initially, the abstract of each journal will be evaluated for its relevance to the inquiry. 2.5 Selection Criteria: Inclusion and Exclusion 2.5.1 Inclusion Articles that will be included in the study will be written in English, less than twenty-five years old, and defined by both qualitative and quantitative methods of research. The topic of inquiry will be defined by the key words, with deeper exploration a possibility should the inquiry lead in unexpected directions. The inquiry will not, however, fall outside of the objectives as they have framed this study. 2.5.2 Exclusion The articles that will be excluded from this will be those that are not written in English, those whose validity cannot be established, and those that have information that is not clearly within the scope of this investigation. In addition, those articles whose validity cannot be established will be excluded from the study. 2.6 Reading and Evaluation The articles will be studied and evaluated for their relevance with an eye to whether or not they were established through relevant, ethical, and meaningful research practices. The peer reviews on the article will be examined to lend the authors credibility as well as the credentials of those who have conducted the research. In order to qualify for this study, the articles included must be thoroughly examined for their overall validity in relationship to credibility, reliability, and validity. 2.6.1 Critical Appraisal Critical appraisal is a method of studying and examining a research in a careful and elaborate way according to the context, in order to determine its trustworthiness. Critical appraisal also helps in determining the relevance of a research in a particular context. This method also facilitates studies which are evidence based in the field of medicine to be able to identify and utilize the research evidence in an efficient and reliable way. CASP Tool has been used for critically appraising the study sample which follows in order to best assess reliability and validity. The research of the study evaluated identifies information related to the effect of progressive muscle relaxation for the promotion of comfort and pain relief in advanced cancer patients. In this study there were 67 new admission patients selected from the oncology ward. The interventions given was relaxation training with comparisons between the control and the experimental group. Outcome was a significant reduction in subjective pain. It was a randomized control trial and the data analysis showed significant reduction in pain. The group was the same throughout the study and the group was treated equally except the treatment given to the experimental group. The participants were the same throughout the study. If analgesic treatment was not monitored, it could be a risk factor. The research had shown a significant reduction in subjective pain who had received relaxation training. (Slomon R et al. 1994) 2.6.1 Data Analysis In order to analyze the data that is collected from the studies that are included in this research, coded themes will emerge that can be developed into consistent ideas that answer the research questions that have been posed. Wood and Kerr (2009, p. 316) suggest that coding of data should result in dividing information into “broad descriptive labels to segments of words or sentences”. This will allow for the data to form meaning in relationship to the questions of the study, the correlations between the ideas creating ideas that can be transformed into theory. Coding creates organization so that trends can be established and utilized for the overall support of the study. The data will be placed in a grid that has been coded in order to find common emerging ideas that will help to form theories that will support the overall nature of the study. 2.6.2 Data Extraction Author Hypothesis/ question/ aim Design Methods (Population, Intervention, Comparison, Outcome-PICO) Findings Conclusion (Ackerman, 2000) (Dimeo, Thomas, Raabe-Menssen, Propper, & Mathias, (Cheung, Molassiotis and Chang, April/May 2003) The aim of the research is to use guided imagery to reduce pain and anxiety. Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. research used Institutional approach Participant based quantitative study. Quantified study using participants in two groups. The study took place in a hospital setting with a sample size of 500 patients. Participant based study with two groups post operative for cancer with one group using PMR and the other using aerobics. . Fifty-nine patients participated in the study and were randomised to a control group receiving routine care (n=30) and an experimental group receiving routine care and PMRT through two teaching sessions and practice at home for the first 10 weeks” (Cheung et al 2003) Author found that there was a significant effect of using guided imagery to reduce pain and anxiety. “Fatigue and global health scores improved in both groups during the intervention (fatigue: training group 21%, relaxation group 19%; global health of both groups 19%, p for all 0.01); however, there was no significant difference” (Dimeo et al 2004) Anxiety was decreased as aspects of physical health, psychological health, social concerns, and environment were increased in the group using PMR The results conclude that pain management programs need adequate documentation to facilitate care for patients, and quality improvement activities. While physical performance was better in those taking aerobics, those in the PMR group dealt with fatigue better. PMR should be used as a practice in long term care of cancer patients as an effective and low cost method of improved quality of life for cancer patients. 3. Chapter Three: Preliminary Literature Review 3.1 Progressive Muscle Relaxation Progressive muscle relaxation is a popular method for dealing with chronic pain. This method used for reducing stress related to chronic pain consists of two stages during which, a patient can contract and relax different muscle groups of the body. Progressive muscle relaxation is a useful method for chronic pain in patients with cancer (Arathuzik 2004, p. 207-214). It is essential that such patients practice progressive muscle relaxation therapy regularly. Muscle relaxation allows patients to be aware of complete relaxation of different parts of the body. This awareness of both tense and relaxed states allows patients to quickly identify the first signs of muscle tension that accompanies stress. As a result, patients are able to relax their mind gradually as their bodies relax. Progressive muscle relaxation can also be used in combination with deep breathing for more relaxed coping with chronic pain and stress(Apostolo 2009, p. 403-411): . In preparation for PMR, patients should: 1. Wear light clothing, take off their shoes, and put them at ease. 2. Take a few minutes to relax and breathe calmly taking deep breaths. 3. When patients begin to feel relaxed and ready to start, then they need to focus their attention on their right foot and take a moment to remember how they feel. 4. Foot and toes need to be squeezed gently as much as possible (without getting hurt of course) and start counting to 10. 5. Patients need to release tension on their right foot, feel the tension go and feel the way they perceive their foot then. 6. Patients need to stay in this position while continuing to breathe deeply. 7. When patients are ready, they can repeat the same sequence on their left foot. Patients need to continue this contraction / relaxation in stages over the rest of their body: legs, abdomen, neck, face (Apostolo 2009, p. 403-411):. One of the most important things is to focus on the feeling of relaxation after release of contraction. Patients suffering from chronic pain need to practice muscle relaxation two to three times a day to really feel the effects every day. 3.1.1Complete sequences of progressive muscle relaxation Thighs and Legs 1. Contraction and relaxation of the buttocks. 2. Contraction and relaxation of the legs. 3. Contraction and relaxation of the feet. Back, Chest, and Abdomen 1. Contraction and relaxation of the back. 2. Contraction and relaxation of the thorax. 3. Contraction and relaxation of the abdomen. Arm 1. Contraction of the fist. 2. Contraction and relaxation of the forearm. Neck and Shoulders 1. Contraction and relaxation of the muscles of the neck (chin on chest). 2. Contraction and relaxation of the shoulders (shoulders hunched in the neck). Face 1. Contraction and relaxation of the front. 2. Contraction and relaxation of the eyes. 3. Contraction and relaxation of the jaw. Relaxation exercises help to reduce muscle tension through specific body position, or by performing the appropriate movements. The purpose of such exercises is a conscious and controlled to enable the reduction of muscle tone or muscle relaxation (Anderson 2006, p. 207-214). These exercises are needed before treatment and initiation exercises, as well as during their implementation. If patients start muscle exercises without reducing muscle tension, they may face a great difficulty to perform any exercise. Practicing tight muscles will cause pain; it will stretch reflexes that will cause increased muscle tension (Ackerman 2000, p. 524-530). There are different types of techniques and exercises. The following is an example of sequences of exercises. Example 1 1. For a general relaxation of muscles through exercise, patients need to start with a comfortable patient positioning in the following positions: lying down in front, back, side, the upright, sitting, or by suspending the entire body. General relaxation of the muscles by laying on back their back and practicing putting on the mattress and placing a pillow under their knees. In the zero interest rate should be based on the soles of the bag with sand, arms slightly visited, and located in the crook of the forearms on the cushions. 2. Using a sitting position or laying, it is important to have the trunk and head respectively comfortable on the backrest. 3. In front of the head lying resting on a pillow should be paid to the side. Pillows arranged just like the back lying position - that is, the hips and belly, a pillow should be put under the legs, just to get their foot flexion and setting the zero position and the toes touching the ground. Arms are placed in slight visiting, bend arms, legs lying on the ground slightly to refer to the center. 4. In lying on the side of patient’s head on the pillow, pillow also under laid the limb are higher from the ground. Lower limbs bend in the knee and hip joints at an angle of 30-40°, the arms bend at the elbow and knee (Benson 2001, p. 117-124). Example 2 1. Position - the whole body suspension: Suspension, a complete relaxation of body muscles. For this purpose, special links and Pendants are used; this is fixed to a metal grill or frame. It is sometimes used for the suspension springs for better comfort practitioner. Separately suspended from any part of the body: chest, head, pelvis and lower extremities (knees, ankles, metatarsal joints) and upper limbs (elbows, metacarpal joints). 2. The patient's general muscle relaxation affects largely the creation of a suitable, pleasant atmosphere. Commands should be given quietly, in gentle tone, without haste. Breathing exercises are important in this context to be performed at the beginning and end, and during exercise (Syrjala 2005, p. 69-79). Not without significance is the alignment of the practitioner in a comfortable position to facilitate muscle relaxation. Good results give a relaxing, quiet music or recordings of birds singing, the noise of the sea (Benedict 2009, p. 34-40). In some cases, general muscle relaxation is not required. Sometimes it is necessary to obtain a relaxation only at a specific location such as the pelvic area. 3.2 Synthesis Relaxation approaches have been defined as a set of techniques that can result in a reduction of pain in those suffering from the pain associated with cancer. Relaxation approaches allow individuals to learn specific skills which increase their sense of control. This includes approaches that are in conjunction with medical care to promote optimal functioning and rehabilitation of the person with cancer and his or her family (Altice 2009, p. 49-56). Three relaxation approaches introduced in RMBG which will be discussed in this research are progressive muscle relaxation, guided imagery/visualization and suggestions/affirmations. Atsberger (2005, p. 2-8) discusses these approaches as they were taught in a group setting with the intent to offer skills to help individuals manage stress and anxiety associated with a cancer diagnosis. The area of psychosocial care for those with cancer has begun to receive more focus and advocacy within medical settings. The role of the oncology social worker in a medical setting is to provide psychosocial care to people affected by cancer and their families to educate the public on cancer survivorship (Barbour 2006, p. 56-60). Psychosocial concerns, specifically pain, have been found to be prevalent in those diagnosed with cancer. Although there have been varying rates of prevalence noted in research, anxiety is a common psychosocial concern among those with cancer, which can result in increased pain and suffering from the effects of cancer (Ahles 2005, p. 141-145). For the oncology social worker who would help those with cancer manage pain and the effects of pain, this research intends to add to the literature on the self-reported benefits of psychosocial interventions, specifically a psycho-educational group focused on teaching relaxation approaches to manage pain (Bacchiocco 2003, p. 266-271). Through PMR and other techniques of physical relaxation, relief from pain may be fundamentally improved. This study will examine this concept through a review of literature that provides context for the topic with the intention of discovering and exploring theory on the topic. The literature spanning these three approaches suggests positive results, concerning their effectiveness on a variety of concerns, including reducing anxiety, relieving pain, and reducing nausea and vomiting along with other issues that are tension provoking. These techniques have been applied alone or in combination to observe effects on pain. This study will explore the impact of introduction of all three of these approaches to individuals and group environments with the intent of helping participants to combat pain and to add to pain managment after a diagnosis of cancer and to approach the concept of pain relief through non-pharmacological methods (American Pain Society 2003, p. 15-56). The research study will add to the body of literature through looking at relaxation approaches as they are taught to individuals with the intent of offering skills to reduce stress and anxiety as it contributes to pain (American Cancer Society 2006, p. 4-10). The long term use of these approaches can be evaluated on the information that is provided, contributing to the overall body of knowledge on the subject as it can be used for further research. Bibliography Ackerman, C. (2000) Using guided imagery to reduce pain and anxiety. Home Health Care Nurse. p. 524-530. Ahles, T. (2005) Psychological approaches to the management of cancer-related pain. Seminars in Oncology Nursing. p. 141-145. Altice, N. Fn. & Jamison, G. B. (2009) Interventions to facilitate pain management in myocardial infarction. Journal of Cardiovascular Nursing. p. 49-56. American Cancer Society (2006) Cancer facts and figure. Atlanta, American Cancer society. p. 5- 10. American Pain Society (2003) Principles of analgesic use in the treatment of acute pain and cancer pain. American Pain Society. p. 15-56. Anderson, K. (2006) Brief cognitive-behavioral audiotape interventions for cancer-related pain. Cancer. p. 207-214. Apostolo, J. (2009) The effects of guided imagery on comfort, depression, anxiety and stress of psychiatric in patients with depressive disorders. Archives of Psychiatric Nursing. p. 403-411. Arathuzik, D. (2004). Effects of cognitive-behavioral strategies on pain in cancer patients. Cancer Nursing. p. 207-214. Astin, J. (2003). Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract. p. 131-147. Atsberger, D. (2005) Relaxation therapy: Its potential as an intervention for acute postoperative pain. Journal of Post Anesthesia Nursing. p. 2-8. Bachiocco, V. (2003) Individual pain history and familial pain tolerance models: Relationships to post-surgical pain. The clinical Journal of Pain. p. 266-271. Barbour, L. (2006) Non-analgesic methods of pain control used by cancer outpatients. Oncology Nursing Forum. p. 56-60. Cheung, Yuk Lung, Molassiotis, Alexander, and Chang, Anne M. (April/May 2003). The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psycho-Oncology. Vol. 12, No. 3, 338. Creswell, John W. 2009. Research design: qualitative, quantitative, and mixed methods approaches. Los Angeles: Sage. Benedict, S. (2009) The suffering associated with cancer. Cancer Nursing. p. 34-40. Benson, H. (2001)The Relaxation Response. New York: Avon Books. p. 117-124. Devine, E. (2003). Meta-analysis of the effect of psychoeducational interventions on pain in adults with cancer. Oncology Nurse Forum. p. 75-89. Dimeo, Fernando C., Thomas, Frank, Raabe-Menssen, Cornelia, Propper, Felix and Mathias, Michale. (2004). Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomized controlled trial. Supportive Care in Cancer. Vol. 12, No. 11, 774-779. Eller, L. S. (2003). Guided imagery interventions for symptom management. Annual Review of Nursing Research. p. 57-84. Gansler, T. (2008). A population-based study of prevalence of complementary methods use by cancer survivors: A report from the American Cancer Society’s studies of cancer survivors. Cancer. p. 1048-1057. Godfrey, H. (2005). Understanding pain, part 1: Physiology of pain. British Journal of Nursing,14, p. 846-852. Haase, O. (2005). Guided imagery and relaxation in conventional colorectal resections: A randomized, controlled, partially blinded trial. Diseases of the Colon and Rectum, 48, p.1955-1963. Kwekkeboom, K. (2008). Individual difference variables and the effects of progressive muscle relaxation and analgesic imagery interventions on cancer pain. Journal of Pain and Symptom Management. p. 604-615. Kwekkeboom, K. (2008). Patients perceptions of the effectiveness of guided imagery and progressive muscle relaxation interventions used for cancer pain. Complementary Therapeutics in Clinic Practice. p. 185-194. Lewandowski, W. (2004). Patterning of pain and power with guided imagery. Nursing Science Quarterly. p. 233-241. Melzack, R. (2005). Pain mechanisms: A new theory. Science. p. 971-979. Oktay, Julianne S. 2012. Grounded theory. Oxford: Oxford University Press. Seers K, (2001) Relaxation techniques for acute pain management: a systematic review. J Adv Nurs. p. 466-475. Slomon R, Brow P, Aldana E, Chee E. (1994) The use of relaxation for the promotion of comfort and pain relief in persons with advanced cancer. Content Management, Vol.3, Issue 1, p.6-12. Syrjala, K. (2005). Evidence for a biopsychosocial model of cancer treatment-related pain. Pain. p. 69-79. Ventafridda, V., Tamburini, M., Caraceni, A., De Canno, F, & Naldi, F. (20 June 2006). A validation study of the WHO method of cancer relief. Cancer. 59(4): 850-856. Wood, Marilynn J., and Janet C. Kerr. (2011). Basic steps in planning nursing research: from question to proposal. Sudbury, Mass: Jones and Bartlett. Yates, R. (2012). Barriers to effective cancer pain management: A survey of hospitalized cancer patients in Australia. Journal of Pain and Symptom Management. 23 (5): 292-405. Appendixes Appendix 1 Time Table The following of a Gantt chart is used, which is a graphical representation of a project to show how the work has been carried out; Activity Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Select a research topic and formulate a research question Meeting Supervisor and confirming the topic Reviewing literatures Formulating Abstract Formulating search strategy and methodology Submission of proposal Data Collection Data Analysis and Extraction Initial draft Feedback from supervisor Final draft Feedback from supervisor Dissertation Associated Costs: Since it is a secondary research, not much money has been spent. The only money will be spent is for acquiring data from internet and printing of relevant articles. Appendix 2 CASP tool for critical appraisal i.e.…, Randomized Control Trial Tool present at this website - http://www.cebm.net/index.aspx?o=1097 Read More