Table 6.

Psychological and Behavioral Interventions for Reducing Cancer Pain in Patients With Advanced Disease or at End of Life

Treatment	Key Findings	Design	Level of Evidence*
Training in pain coping skills	Coping skills for managing pain (eg, education with CBT and relaxation with imagery) improve pain severity and interference for patients across disease stage, including advanced disease	Meta-analysis, high-quality RCTs	Strong
	Results specific to coping skills training or other psychological or behavioral strategies for pain in patients with end-stage disease are small and inconclusive
Hypnosis	Hypnosis in support-group format improves pain in women with metastatic breast cancer, including some who are at end of life	Replicated high-quality RCTs	Strong

Abbreviations: CBT, cognitive behavioral therapy; RCT, randomized controlled trial.

^*Strong evidence: demonstrated to reduce pain outcomes in patients with cancer with advanced disease or at end of life based on meta-analysis or multiple RCTs. Moderate evidence: reduces pain outcomes in patients with cancer with advanced disease or at end of life based on ≥ two RCTs. Weak evidence: reduces pain outcomes in patients with cancer with advanced disease or at end of life based on single RCT or nonrandomized trials.