Discontinuation of Limb Constriction Avoidance
A number of strategies have been proposed to minimize potential stress to the lymphatic system of an at-risk limb (the limb on the same side of the body as the surgical removal of lymph nodes) among women who have had surgery for breast cancer. One of the common recommendations has been the avoidance of arm constriction by blood pressure cuffs or tourniquets on the affected side. Increased venous pressure as a result of excessive constriction may contribute to increased lymph production and precipitate swelling of the affected limb.
Diathermy and Interferential Therapy
Diathermy is a therapy using high frequency electric current to stimulate heat generation in tissue. Interferential therapy involves the use of two different frequencies of alternating currents, creating an electric field in a painful area with electrodes placed on the skin. This is aimed at improving blood circulation and relieving pain through the inhibition of pain signals in small diameter nerve fibers according to the gate control theory.
Cognitive Behavioral Interventions/Approach for Sleep
Cognitive behavioral interventions are designed to reflect concepts from cognitive behavioral therapy, which examines the association among thoughts, feelings, and behaviors. Cognitive behavioral interventions do not involve full cognitive behavorial psychotherapy; however, they do assist patients in identifying negative or unhelpful thoughts and beliefs to change them.
Caffeine
Caffeine is a stimulant commonly consumed in a variety of beverages. Caffeine administration, as an adjunct to analgesics, was examined in patients with cancer for its effect on pain.
Boswellia Serrata Cream
Boswellia serrata is a tree native to North Africa and the Middle East. Its resin has been used to create incense and medicines, and contains compounds that have been found to have anti-inflammatory effects.
B Vitamins
B vitamins include thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folate, and cobalamin. B vitamins are essential for normal nerve function, so they have been used to treat neuropathy.
Antipruritics for Immunotherapy-Related Pruritus
Antipruritics are medications that reduce itching. Antihistamines, such as diphenhydramine (Benadryl®), are commonly used to reduce itching. The use of antipruritics for relief of pruritus associated with immunotherapy has been suggested.
Antifibrinolytics
Antifibrinolytics are drugs that promote blood clotting by preventing clots from breaking down. A variety of antifibrinolytic medications exist, which work in different ways. Tranexamic acid, which is a type of antifibrinolytic, has more evidence than other agents, and is evaluated as a separate intervention in the PEP evidence.
Antidiarrheals for Low-Grade Diarrhea
Antidiarrheals, such as loperamide, are medications that help to stop or slow down passage of liquid or loose stool. Antidiarrheals have been suggested as a conservative measure for patients on immunotherapy experiencing low grade diarrhea. These agents are sometimes administered in combination with other immunotherapy-induced diarrhea treatments (i.e. steroids).
Analgecine
Analgecine is a biologic agent extracted from rabbit skin inflamed by a virus that has been shown to have therapeutic effects on neuropathic pain.