Effect of Progressive Muscle Relaxation Techniques on Chronic Pain in Cancer Patients - Dissertation Example

Systematic Review Protocol Main A Systematic Review of the Effect of Progressive Muscle Relaxation Techniques in Chronic Pain in Cancer Patients. Review group Section Protocol Author (s) Month/year of publication November 2012 Contact details Institutional base Advisory group Conflict of interest (if any) Acknowledgements 1. Background The objective of this systematic review is to gather evidence from literature aimed at evaluating the effect of progressive muscle relaxation (PMR) in reducing pain among cancer patients. Pain in cancer is as a result of toxicities in chemotherapy and radiation coupled to infections. Available pharmacological drugs regimes are commonly used to relieve pain in cancer patients and they include non-opioids, opioids and agonist analgesics. As pharmacological drugs become ineffective in relieving cancer pain, attention is shifting towards non-pharmacological pain relief intervention (NPPRI). However, studies relating to methods of pain relief in cancer patients using alternative methods of pain relief, other than pharmacological-based methods, are inconclusive on the effect of relaxation towards alleviating pain. In view of the fact that pharmacological methods use is prominent among cancer patients, these drugs exposes them to serious side effects such as loss of effectiveness with time or even inadequate pain relief among other side effects. NPPRIs are complementary pain management approaches and they include cutaneous stimulation such as massages, transcutaneous electrical stimulation and cognitive behavioral such as relaxation techniques. Muscle tension is minimized through relaxation techniques as they create powerful distractions. Cancer pain relief through relaxation techniques such as PMR is gaining ground among patients. PMR, as a relaxation technique, may break the cycle of pain, anxiety and reduce muscle tension. This review will examine evidence of PMR where it is linked to relieving chronic pain in cancer patients. Data will be mined from systematic literature and analysed so as to identify the role, effectiveness and degree onto which PMR techniques can be used to relief pain in cancer patients. 1.1 What is pain? Pain is an experience of the mind which is linked with an increased sense of sensation in the body (see Appendix 1. for a detailed definition). Cancer pain is as a result of treatment procedure (chemotherapy and radiation) or it may be due to infections. 1.2 What is progressive muscle relaxation? Progressive muscle relaxation, a non pharmacological pain relief intervention (NPPRI) technique, involves the systematic tensing and relaxing of skeletal muscles of the body. PMR may involve a few muscles for patients in acute pain in a clinical environment 1.3 How is muscle relaxation and pain relief linked? Pain is a common feature of cancer and usually arises from tumor progression, pathology, surgery, chemotherapy and radiations. The form of pain in cancer is multilayered involving (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). Muscle relaxation reduces muscle tension which has an effect of creating a powerful distraction through reduction of anxiety and distress associated with pain. This changes the patient’s perception of pain. These muscle relaxation techniques may involve behaviors such as yawning, reflecting on peaceful experiences, deep breathing and abdominal breathing. 1.4 Review questions Primary objectives The objective is to provide a systematic review of the evidence from literature on the effect of PMR in reducing pain among cancer patients” Secondary objectives In this systematic review we will gather, synthesize and analyze evidence regarding the following questions; i) How can progressive muscle relaxation (PMR) techniques significantly reduce chronic pain in cancer patients? ii) Is there a significant effect of progressive muscle relaxation on chronic pain? iii) What degree of relief is created by PMR? iv) How should PMR be used in conjunction with other pain management techniques, including pharmacological methods of management? 1.5 Review Team 2 Methods The systematic review aims to synthesize qualitative information associated with the effect of progressive muscle relaxation on alleviation of pain in cancer patients. 2.1 Study selection criteria 2.1.1 Inclusion criteria Articles written in English Articles must be less than 25 years old and defined by both qualitative and quantitative methods of research Key words will define the topic of inquiry Inquiry will not go beyond the scope of the objective 2.1.2 Exclusion Criteria Non-English articles Articles whose validity cannot be established Article with information that is not clearly within the scope of this investigation 2.1.3 How selection will be undertaken (role of analyst) 2.1.4 How agreement among analyst will be evaluated 2.1.5 How any differences between analyst will be resolved 2.2 Search strategy The following search strategy was followed and adapted to the research requirements. A literature review will be implemented through qualitative approaches to inquiry. Participants’ voice will be heard through literature. Data will be mined from journals which will form the secondary materials for this study. The search strategy will rely on key words to search in various literature databases. Such words include pain, PMR, cancer, NPPRI, pharmacology, analgesics, muscle massage and pain relief. Boolean operator “AND” and “OR” will be used to combine key words so as to have more refined results. General databases PubMed Conchrane controlled Trials Register (CENTRAL) NLM Gateway HINARI Subject-specific databases CANCERLIT(a cancer database from the national car Institute, USA) - www.cancer.gov/search/cancer_literature/ CINAHL (a database for nursing, occupational therapy, physical therapy and other allied health fields) – http://www.cihahl.com/ LILACS (a medial database on Latin American and Caribbean literature) – http://www.bireme.br/bvs/I/ibd.htm Other literature sources Google scholar 2.3 Data analysis Data will be extracted from the papers by the reviewers and where uncertainty is identified, clarification form the original will be sought. The data will not be included in the meta-analysis until all the unclear information is availed. 2.4 Communication plan The findings of this systematic review will be form part of a thesis as well as being published in a reputable scientific journal and presented in scientific forums. 2.5 Plans for updating the review Review may be updated after a period of 2 years if there is a significant amount of new primary study evidence is available. 3 Timetable Start date End date Selection and confirmation of research topic and formulation of research question - 01/02/2012 29/02/2012 Literature review and formulation of an abstract - 01/03/2012 31/03/2012 Search strategy and methodology formulation - 01/04/2012 30/04/2012 Proposal submission - 01/05/2012 31/05/2012 Collection of data - 01/06/2012 31/07/2012 Data extraction and analysis - 01/07/2012 30/09/2012 Preparation of initial draft - 01/10/2012 31/10/2012 Final draft preparation - 01/11/2012 30/11/2012 Preparation of dissertation - 01/12/2012 31/12/2012 APPPENDICES Appendix 1. Glossary Pain Cancer Progressive muscle relaxation Appendix 2. Database searched Appendix 3. Search terms Read More