From the Guidelines
Withholding standard pain treatments in favor of relaxation techniques alone is not recommended and raises serious ethical concerns. While relaxation techniques like meditation, deep breathing, and progressive muscle relaxation can be valuable complementary approaches to pain management, they should not replace evidence-based pharmacological and interventional pain treatments when clinically indicated, as supported by the 2019 guidelines on adult cancer pain 1. The principle of beneficence requires healthcare providers to act in patients' best interests, which means offering treatments with the strongest evidence for effectiveness.
Key Considerations
- Patient autonomy must be respected, but informed consent requires full disclosure about the relative efficacy of all available options.
- There are also justice concerns if certain populations receive only non-pharmacological approaches while others receive comprehensive care.
- The most ethical approach is integrative pain management, combining appropriate medications (such as NSAIDs, acetaminophen, or opioids when indicated) with non-pharmacological techniques, as suggested by studies on cognitive-behavioral interventions 1.
- This approach respects patient preferences while ensuring access to effective pain relief, and is in line with the recommendations for adult cancer pain management 1.
Ethical Implications
- Patients should never be made to feel that their pain is "all in their mind" or that they must rely solely on self-management techniques when medical interventions could provide meaningful relief.
- Healthcare providers should prioritize a multimodal approach to pain management, incorporating physical, psychosocial, and spiritual modalities, and assessing cultural factors and spiritual needs, as highlighted in the guidelines on adult cancer pain 1.
From the Research
Ethical Implications of Withholding Standard Pain Treatments
The decision to withhold standard pain treatments in favor of relaxation techniques raises several ethical concerns.
- Patient autonomy: Patients have the right to make informed decisions about their care, including the use of relaxation techniques as an adjunct to or replacement for standard pain treatments 2, 3.
- Informed consent: Patients must be fully informed about the potential benefits and risks of using relaxation techniques as a primary pain management strategy, as well as the potential consequences of withholding standard pain treatments 4.
- Standard of care: Healthcare providers have a duty to provide patients with the standard of care, which may include the use of evidence-based pain treatments such as NSAIDs and acetaminophen 5.
- Potential harm: Withholding standard pain treatments could potentially lead to increased pain and suffering, as well as other negative outcomes such as decreased quality of life and increased disability 6, 4.
Considerations for Relaxation Techniques as a Primary Pain Management Strategy
When considering the use of relaxation techniques as a primary pain management strategy, several factors must be taken into account.
- Efficacy: The evidence suggests that relaxation techniques can be effective in reducing chronic pain, but the quality of the evidence is variable and more research is needed to fully understand their effects 2, 6, 3.
- Patient preferences: Patients' preferences and values should be taken into account when making decisions about pain management, including the use of relaxation techniques 4.
- Individualized care: Pain management should be individualized to each patient's unique needs and circumstances, taking into account their medical history, current health status, and personal preferences 5, 4.