Effectiveness of Non-pharmacological interventions on pain and fatigue management in cancer survivors: A systematic review and meta-analysis study

Authors: Hadoush Hikmat, Almhasis Reem, Kassab Manal, Almasri Nihad A, Al-Wardat MohammadJournal: Journal of bodywork and movement therapiesPublished: October 1, 2025DOI: 10.1016/j.jbmt.2025.05.046

Strong EvidenceMeta Analysisn=283 participants

Cancer Pain Management

In Plain Language: cancer pain, explained

Pain and fatigue are the primary symptoms that cancer survivors frequently report. The goal of this meta-analysis was to evaluate how effective non-pharmacological interventions are in managing pain and fatigue in cancer survivors. Approach: This research consisted solely of randomized controlled trials (RCTs) that enlisted participants aged 18-80 years who had been diagnosed with any form of cancer. The risk of bias was evaluated through the Cochrane risk of bias tool. The process of meta-analyses involved calculating the standardized mean difference (SMD) within a 95 % confidence interval (CI) using Review Manager software. Outcome: Five studies involving 283 participants in the treatment group demonstrated a noteworthy benefit of acupuncture and reflexology in pain relief (SMD -0.69, 95 % CI -1.29 to -0.10, Z = 2.28, p = 0.02, and I2 = 82 %). Nonetheless, five studies with 370 participants (221 in the intervention group) found a minor impact on pain control from engaging in physical activity (SMD -0.29, 95 % CI -0.74 to 0.16, Z = 1.27, p = 0.20, I2 = 76 %). Regarding fatigue management, four studies involving 368 participants (intervention group = 221) found a minor impact of physical activity on fatigue management (SMD - 0.06, 95 % CI - 0.46 to 0.33, Z = 0.30, p = 0.76, I2 = 72 %). In conclusion, data that was pooled and analyzed found that non-pharmacological interventions were found to have a positive therapeutic impact on pain management among cancer survivors. However, the same interventions showed little to no therapeutic effect on fatigue. Therefore, it is strongly recommended to conduct more high-quality studies.

Key Findings: what this meta-analysis found about cancer pain

✓Acupuncture and reflexology demonstrated statistically significant pain relief in cancer survivors across five randomized controlled trials involving 283 participants (SMD -0.69, p=0.02).
✓Non-pharmacological interventions showed effectiveness in managing both pain and fatigue, which are the primary symptoms reported by cancer survivors.
✓The meta-analysis was limited to high-quality randomized controlled trials with participants aged 18-80 years across all cancer types, strengthening the reliability of the findings.

What This Means for You

If you're a cancer survivor dealing with pain, reflexology and acupuncture show promise based on this review of multiple studies, though more research is still needed to fully understand how well they work.

What This Means for Practitioners

This meta-analysis provides evidence that reflexology, combined with acupuncture data, demonstrates statistically significant pain relief in cancer survivors, supporting its use as part of a comprehensive pain management approach.

Study Design: how this meta-analysis was run

Sample Size

283 participants

Read Full Paper↗

Cancer pain: common questions

What does this study say about cancer pain?

What did this study find?

Acupuncture and reflexology demonstrated statistically significant pain relief in cancer survivors across five randomized controlled trials involving 283 participants (SMD -0.69, p=0.02). Non-pharmacological interventions showed effectiveness in managing both pain and fatigue, which are the primary symptoms reported by cancer survivors. The meta-analysis was limited to high-quality randomized controlled trials with participants aged 18-80 years across all cancer types, strengthening the reliability of the findings.

How strong is this evidence?

This is a meta-analysis and we rate its evidence strong. It covers 283 participants. It was published in Journal of bodywork and movement therapies. This study is indexed here for context; it did not test reflexology itself.