Integrative oncology: Addressing the global challenges of cancer prevention and treatment.

The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low- and middle-income countries (LMICs) when it comes to receiving evidence-based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence-based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence-informed, patient-centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment-related adverse effects (eg, pain, insomnia, fatigue); and 3) disseminating and implementing evidence-based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence-informed, and culturally sensitive cancer care.

Cancer-Related Fatigue Outcome Measures in Integrative Oncology: Evidence for Practice and Research Recommendations.

Cancer-related fatigue (CRF) is one of the most common symptoms across the cancer continuum and is often underreported and undertreated. Defined as a distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or its treatment, CRF includes physical, emotional, cognitive, and spiritual dimensions. Patient-reported outcome (PRO) measures are the most widely used tool to screen for and assess fatigue and the associated negative impacts on quality of life. However, selecting subjective CRF measures can be complex. This has resulted in the availability of and inconsistent use of numerous PROs, limiting the ability to cross-compare outcomes clinically and within research. To address this, the PROs that are most widely reported in the literature are recommended to support the standardization of a core set of validated measures. The National Comprehensive Cancer Network single-item tool for clinical significance is recommended for quick use in clinical environments; the Brief Fatigue Inventory allows for fast, easy, helpful cutoffs on severity threshold for triage, and measures both severity and interference with daily functioning; while the MD Anderson Symptom Inventory allows for multisymptomatic assessment. In addition, a fundamental consideration for any PRO use is the administrative burden on the patient and clinician. In this review, we aim to summarize current, validated PROs specific to CRF to aid clinicians and researchers in patient care and in study design and implementation. We conclude with suggestions for future directions in CRF research that can increase the possibility for long-term impact on future guidelines of fatigue management.

Traditional, complementary, and integrative medicine evidence map: a methodology to an overflowing field of data and noise.

Every day there is criticism about lack of evidence on traditional, complementary, and integrative medicine (TCIM). But is this narrative evidence-based? Are we really missing research about TCIM? Or are we just not looking correctly at the evidence? Evidence maps are a useful method with the dual function of synthesizing available evidence on a specific topic and identifying knowledge gaps. This article presents a six-step evidence map methodology along with recently published TCIM evidence maps, including one related to COVID-19. TCIM evidence maps are useful instruments to inform decision-making for policymakers, health practitioners, and patients.

Es habitual que se critique la falta de evidencia con respecto a las medicinas tradicionales, complementarias e integrativas. Sin embargo, ¿se basa en la evidencia este discurso? ¿Falta realmente investigación sobre las medicinas tradicionales, complementarias e integrativas o es que simplemente no estamos analizando la evidencia de forma adecuada? Los mapas de evidencia son un método útil que tiene una función doble: sintetizar la evidencia disponible por temas específicos y determinar si hay alguna laguna en el conocimiento. En este artículo se presenta una metodología de elaboración de mapas de la evidencia en seis pasos, junto con los mapas de la evidencia de las medicinas tradicionales, complementarias e integrativas publicados recientemente, incluido un mapa sobre la COVID-19. Los mapas de la evidencia de las medicinas tradicionales, complementarias e integrativas son instrumentos útiles para fundamentar la toma de decisiones por parte de los encargados de las políticas, el personal de salud y los pacientes.

A crítica é diária de que faltam evidências em medicinas tradicionais, complementares e integrativas (MTCI). Mas será que esta narrativa se baseia em evidências? Realmente faltam pesquisas em MTCI? Ou será que simplesmente não estamos atentando corretamente às evidências? Os mapas de evidências consistem em uma metodologia útil de dupla função: sintetizar as evidências existentes em um determinado tópico e identificar as lacunas de conhecimento. Neste artigo é apresentada uma metodologia de mapa de evidências de seis passos junto com mapas de evidências de MTCI recém-publicados, incluindo um relacionado à COVID-19. Os mapas de evidências de MTCI são instrumentos úteis para subsidiar a tomada de decisão dos responsáveis por políticas, profissionais da saúde e pacientes.

Equity, intercultural approaches, and access to information on traditional, complementary, and integrative medicines in the Americas.

Access to information and intercultural approaches in the field of health are essential for the elimination of inequities in health access and care. Intercultural models such as traditional, complementary, and integrative medicine (TCIM) are an important part of health care in most countries and often contribute to expanding access to primary health care. Despite legal recognition and policies to integrate TCIM into health systems, their contribution to health, well-being, and people-centered care to achieve universal health is still underestimated. This article presents the progress (2017-2020) achieved by the Virtual Health Library specialized in the TCIM (VHL TCIM Americas), an initiative created as a tool to reduce the gaps in the production and access to validated information on TCIM. Through collaborative network work, VHL TCIM Americas contributes to the democratization of health, access to verified scientific data, visibility of non-conventional knowledge, strengthening of research capacities, and exchange of experiences for informed decision-making.

El acceso a la información y los abordajes interculturales en el ámbito de la salud son esenciales para la eliminación de inequidades en el acceso a los servicios de salud y la atención sanitaria. Los modelos interculturales, como las medicinas tradicionales, complementarias e integrativas (MTCI) son una parte importante del cuidado de la salud en la mayoría de los países y frecuentemente contribuyen a ampliar el acceso a la atención primaria de salud. A pesar del reconocimiento legal y de la existencia de políticas para la integración de las MTCI en los sistemas de salud, aún se subestima su contribución a la salud, el bienestar y la atención de la salud centrada en las personas para alcanzar la salud universal. En este artículo se presentan los avances (2017-2020) alcanzados por la Biblioteca Virtual en Salud especializada en las MTCI (BVS MTCI Américas), iniciativa creada como herramienta para disminuir las brechas en la producción y el acceso a la información validada sobre las MTCI. Mediante el trabajo colaborativo en red, la BVS MTCI Américas contribuye a la democratización de la salud, el acceso a datos científicos verificados disponibles, la visibilización de conocimientos no convencionales, el fortalecimiento de capacidades de investigación y el intercambio de experiencias para la toma informada de decisiones.

O acesso à informação e as abordagens interculturais no setor da saúde são essenciais para eliminar as desigualdades no acesso aos serviços de saúde. Os modelos interculturais, como as medicinas tradicionais, complementares e integrativas (MTCI), são uma parte importante da atenção à saúde na maioria dos países e frequentemente contribuem para ampliar o acesso à atenção primária. Apesar do reconhecimento legal e da existência de políticas para a integração das MTCI nos sistemas de saúde, a sua contribuição para a saúde, o bem-estar e a atenção centrada nas pessoas para alcançar a saúde universal ainda é subestimada. Este artigo apresenta o progresso (de 2017 a 2020) alcançado pela Biblioteca Virtual em Saúde especializada em MTCI (BVS MTCI Américas), uma iniciativa criada como ferramenta para reduzir as disparidades na produção e no acesso a informações validadas sobre as MTCI. Realizando um trabalho colaborativo em rede, a BVS MTCI Américas contribui para a democratização da saúde, o acesso a dados científicos verificados, a visibilidade dos conhecimentos não convencionais, o fortalecimento das capacidades de pesquisa e a troca de experiências para a tomada de decisões bem informada.

[Equity, intercultural approaches and access to information on traditional, complementary and integrative medicines in the AmericasEquidade, abordagens interculturais e acesso a informações sobre medicinas tradicionais, complementares e integrativas nas Américas]. / Equidad, abordajes interculturales y acceso a la información sobre las medicinas tradicionales, complementarias e integrativas en las Américas.

Access to information and intercultural approaches in the field of health are essential for the elimination of inequities in health access and care. Intercultural models such as traditional, complementary and integrative medicine (TCIM) are an important part of health care in most countries and often contribute to expanding access to primary health care. Despite legal recognition and policies to integrate TCIM into health systems, their contribution to health, well-being, and people-centered care to achieve universal health is still underestimated. This article presents the progress (2017-2020) achieved by the Virtual Health Library specialized in the TCIM (VHL TCIM Americas), an initiative created as a tool to reduce the gaps in the production and access to validated information on TCIM. Through collaborative network work, the VHL TCIM Americas contributes to the democratization of health, access to verified scientific data, visibility of non-conventional knowledge, strengthening of research capacities, and exchange of experiences for informed decision-making.

O acesso à informação e as abordagens interculturais no setor da saúde são essenciais para eliminar as desigualdades no acesso aos serviços de saúde. Os modelos interculturais, como as medicinas tradicionais, complementares e integrativas (MTCI), são uma parte importante da atenção à saúde na maioria dos países e frequentemente contribuem para ampliar o acesso à atenção primária. Apesar do reconhecimento legal e da existência de políticas para a integração das MTCI nos sistemas de saúde, a sua contribuição para a saúde, o bem-estar e a atenção centrada nas pessoas para alcançar a saúde universal ainda é subestimada. Este artigo apresenta o progresso (de 2017 a 2020) alcançado pela Biblioteca Virtual em Saúde especializada em MTCI (BVS MTCI Américas), uma iniciativa criada como ferramenta para reduzir as disparidades na produção e no acesso a informações validadas sobre as MTCI. Realizando um trabalho colaborativo em rede, a BVS MTCI Américas contribui para a democratização da saúde, o acesso a dados científicos verificados, a visibilidade dos conhecimentos não convencionais, o fortalecimento das capacidades de pesquisa e a troca de experiências para a tomada de decisões bem informada.
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A review of the WHO strategy on traditional, complementary, and integrative medicine from the perspective of academic consortia for integrative medicine and health.

Despite important progress in modern medicine, widely regarded as an indispensable foundation of healthcare in all highly advanced nations and regions, not all patients respond well to available treatments in biomedicine alone. Additionally, there are concerns about side effects of many medications and interventions, the unsustainable cost of healthcare and the low resolution of chronic non-communicable diseases and mental disorders whose incidence has risen in the last decades. Besides, the chronic stress and burnout of many healthcare professionals impairs the therapeutic relationship. These circumstances call for a change in the current paradigm and practices of biomedicine healthcare. Most of the world population (80%) uses some form of traditional, complementary, and integrative medicine (T&CM), usually alongside biomedicine. Patients seem equally satisfied with biomedicine and T&CM, but in the field of T&CM there are also many challenges, such as unsupported claims for safety and/or efficacy, contamination of herbal medicines and problems with regulation and quality standards. As biomedicine and T&CM seem to have different strengths and weaknesses, integration of both approaches may be beneficial. Indeed, WHO has repeatedly called upon member states to work on the integration of T&CM into healthcare systems. Integrative medicine (IM) is an approach that offers a paradigm for doing so. It combines the best of both worlds (biomedicine and T&CM), based on evidence for efficacy and safety, adopting a holistic personalized approach, focused on health. In the last decades academic health centers are increasingly supportive of IM, as evidenced by the foundation of national academic consortia for integrative medicine in Brazil (2017), the Netherlands (2018), and Germany (2024) besides the pioneering American consortium (1998). However, the integration process is slow and sometimes met with criticism and even hostility. The WHO T&CM strategies (2002-2005 and 2014-2023) have provided incipient guidance on the integration process, but several challenges are yet to be addressed. This policy review proposes several possible solutions, including the establishment of a global matrix of academic consortia for IM, to update and extend the WHO T&CM strategy, that is currently under review.

Assessing the safety and use of medicinal herbs during pregnancy: a cross-sectional study in São Paulo, Brazil.

Background: Despite the lack of evidence supporting the safety and clinical efficacy of herbal medicine (HM), its use among pregnant women continues to increase. Given the high prevalence of contraindicated herbs among the pregnant population in Brazil, it is crucial to examine the use of HM and evaluate its safety based on the current scientific literature to ensure that women are using HM appropriately. Methods: A cross-sectional study was conducted from October 2022 to January 2023 at a public teaching hospital in São Paulo, Brazil. A total of 333 postpartum women in the postnatal wards and postnatal clinic were interviewed using a semi-structured questionnaire. The survey instrument consisted of 51 items covering the use of HM during pregnancy, sociodemographic and health-related characteristics, COVID-19 experiences, and pregnancy outcomes. For data analysis, chi-square and multivariate logistic regression were conducted using SPSS ver. 26.0. Results: Approximately 20% of respondents reported using HM during their most recent pregnancy, with a higher use observed among women from ethnic minority groups and those with prior HM experience. Among the 20 medicinal herbs identified, 40% were found to be contraindicated or recommended for use with caution during pregnancy. However, only half of the women discussed their HM use with obstetric care providers. Conclusion: This study emphasizes the continued public health concern regarding the use of contraindicated or potentially harmful HM among pregnant women in Brazil, highlighting the need for sustained efforts to reduce the risk of inappropriate HM use. By updating antenatal care guidelines based on the latest scientific evidence, healthcare providers can make informed clinical decisions and effectively monitor pregnant women's HM use, ultimately promoting safer and more effective healthcare practices.

Broadening the horizon for children's health - A qualitative study on the Centro Latino-Americano de Medicina Integrativa Pediátrica.

OBJECTIVES: The aim of this article is to analyze the recently established structure of the unit for pediatric integrative medicine (Portuguese: Unidade de Pediatria Integrativa, UPI), its aims and activities at the Children and Adolescent's Institute and the Institute for the Treatment of Childhood Cancer of the Medical Faculty of the University of São Paulo. To give a complete overview, opinions and views of stakeholders were reflected in the analysis. DESIGN: An ethnographic approach was chosen to provide an overview of the work of UPI through semi-structured qualitative interviews and participant observation. Observational notes, informal conversations and informational material complemented the collected data. The analysis of the transcribed interviews focused on specific questions regarding the unique role of pediatric integrative medicine in a conventional hospital setting and a perspective for the future. RESULTS: The UPI is making use of Complementary and Integrative Medicine based on three major pillars - treatment, research and teaching. The unit is a pioneer for the field of Integrative Medicine in Latin America. Its goal is to improve the health and treatment of children using the methods of Integrative Medicine by generating positive outcomes in patient care and evidence-based research. Further expansion of the activities is planned for the future to promote the exchange and further dissemination of pediatric integrative medicine based on stringent research. CONCLUSIONS: UPI is a novelty on the Latin-American continent and has the potential to contribute significantly to the acceptance and expansion of integrative models by introducing complementary methods in conventional medicine.

Beyond the Standard of Care: An Exploratory Qualitative Study of an Implemented Integrative Therapeutic Care Program in a Brazilian Pediatric Oncology Unit.

Introduction: This article examines the feedback of health care providers within the implementation of an integrative care project in a clinic for pediatric oncology in São Paulo, Brazil. Since 2017, the project has implemented external anthroposophic therapies in the activities of daily nursing. The objective is to evaluate how the project evolved and what impact it had on the daily operation of the hospital. A special focus emphasizes the perspective of study nurses. Materials and Methods: Twelve qualitative semistructured interviews were conducted. Audio files were transcribed, translated to German, and underwent a MAXQDA software-assisted analysis. Using a thematic approach, coherent cross-case topics were defined. Results: Three main topics emerged from analysis of the data. (1) The implementation and its effects on daily patient care demonstrated positive outcomes in patients and were well accepted with minimal changes in daily activities. (2) The perspective of study nurses showed a large motivation due to beneficial and stress-relieving effects of the application and a growing patient-health care provider relationship. (3) Problems and aspirations for improvement were the lack of time and the urge to make the project grow in the future. Conclusion: Not only patients but also health care providers seem to benefit from integrative methods. They have the potential to improve the working atmosphere and to strengthen relations between patients, caregivers, and family members. General feedback was positive and acceptance in the team arose over time when beneficial effects became visible.

Meditation: Evidence Map of Systematic Reviews.

Study Basis: This evidence map presents a summary of studies that addressed the effects of meditation on various clinical and health conditions. Meditation is a contemplative practice that has been used for the promotion of health, and the treatment of different conditions. Method: The study is based on the search of four electronic databases for the period 1994-November 2019 and includes systematic reviews, meta-analyses, meta-syntheses, and integrative reviews. 3iE evidence gap map was the methodology of choice, and AMSTAR 2 was used for the analyses. Tableau was used to graphically display the confidence level, number of reviews, health outcomes, and intervention effects. Results: This map encompasses 191 studies, with Mindfulness being the key word that retrieved the highest number of results. Several meditation techniques were evaluated in different contexts, and the confidence levels of 22 studies were high, 84 were moderate, and 82 were low. Two 2 meta-syntheses and 1 integrative review were also included. Most of the studies reported positive effects and a beneficial potential of the practice of meditation. Health outcomes were divided into five groups out of which mental health and vitality, and well-being and quality of life stood out with the largest number of studies. Conclusions: Meditation has been applied in different areas. This Evidence Map intends to be an easy visual tool to access valuable evidence-based information on this complementary therapy for patients, health professionals, and managers.

Pediatrics massage evidence map.

BACKGROUND: This evidence map describes Pediatrics Massage intervention research reporting health outcomes. Massage is a complementary therapy and can be defined as any form of systematic tactile stimulation by human hands, the type of massage typically used in pediatrics care is a gentle, slow stroking of each part of the body in turn. METHODS: The evidence map is based on the 3iE evidence gap map methodology. We searched four electronic databases from inception to November 2019 and included systematic reviews and non-systematic reviews. Systematic reviews were analyzed based on AMSTAR 2. We used tableau to graphically display confidence level, number of reviews, outcomes and a broad estimate of effectiveness. RESULTS: The map is based on 38 reviews. Most of the reviews were published in the last ten years. The Pediatrics Massage was the most researched intervention. Massage was evaluated as an intervention in several health outcomes, resulting in the following confidence levels: 11 high, 13 moderate and 14 low. Every outcome effect was classified: 6 as no effect; 1 mixed and 28 as positive. The outcomes were divided into four major groups: physical and metabolic effects; vitality, well-being and quality of life, mental health; and management. High quality studies presented no effect and positive effects, highlighting outcomes related to neuro-motor development (Badr et al., 2015; Bennett et al., 2013; Vickers et al., 2015), growth (Badr et al., 2015; Bennett et al., 2013; Vickers et al., 2015) and stress disorders (Bennett et al., 2013; Vickers et al., 2015). CONCLUSIONS: Pediatrics massage has been applied in different areas and these Evidence Gap Map provides an easy visualization of valuable information for patients, health practitioners and managers, in order to promote evidence-based complementary therapies.

Mind-Body Therapies From Traditional Chinese Medicine: Evidence Map.

Background: The mind-body therapies of traditional Chinese medicine include several intervention types and combine physical poses with conscious relaxation and breathing techniques. The purpose of this Evidence Map is to describe these different interventions and report related health outcomes. Methods: This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects. Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson's disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia. Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.

MUSIC INTERVENTIONS IN PEDIATRIC ONCOLOGY: Systematic review and meta-analysis.

BACKGROUND: Pain is a disagreeable and distressing feeling that affects human beings in multi-dimensional ways. A number of non-pharmacological interventions have had varying degrees of success in treating cancer-related pain, such as breathing and relaxation techniques, and music therapy, which have been identified as beneficial therapies for alleviating pain and anxiety. OBJECTIVE: Identify the therapeutic effects of music interventions in psychological and physiological terms and on the quality of life of children undergoing cancer treatment. METHOD: Systematic review of effectiveness based on the methodology of the Joanna Briggs Institute. RESULTS: Eleven articles were included with a total of 429 children, whose ages ranged from 0 to 18 years. The mean duration of the music intervention was 30.6 (±SD 9.8) min. In a combined estimate of five studies for pain and anxiety outcomes, there were benefits to using music when compared with the control group (SMD -1.05; CI 95 % -1.70 - 0.40 N = 453 I2 = 90 %). A combined analysis of five studies to assess quality of life showed that the use of music was favorable when compared with the control (SMD -0.80; CI 95 % -1.17-0.43 N = 457= I2 = 71 %). CONCLUSION: After completing this review, it was determined that there is evidence to support the use of music to reduce pain and anxiety and improve the quality of life of children undergoing cancer treatment.

Evidence map on the contributions of traditional, complementary and integrative medicines for health care in times of COVID-19.

BACKGROUND: Due to the pandemic, there is a significant interest in the therapeutic resources linked to TCIM to support potentially therapeutic research and intervention in the management of Coronavirus - 19 (COVID-19). At the date of this evidence map´s publication, there is no evidence of specific treatments for COVID-19. This map organizes information about symptoms management (especially on dimensions related to mental health and mild viral respiratory infections, as well as immune system strengthening and antiviral activity). METHOD: This evidence map applies methodology developed by Latin American and Caribbean Center on Health Sciences Information based on the 3iE evidence gap map. A search was performed in the Traditional, Complementary and Integrative Medicine Virtual Health Library and PubMed, using the MeSH and DeCS terms for respiratory viral diseases associated with epidemics, COVID-19 symptoms, relevant mental health topics, pharmacological and non-pharmacological interventions related to TCIM. RESULTS: For the map, 126 systematic reviews and controlled clinical studies were characterized, distributed in a matrix with 62 interventions (18 phytotherapy, 9 mind-body therapies, 11 traditional Chinese medicine, 7 homeopathic and anthroposophic dynamized medicines and 17 supplements), and 67 outcomes (14 immunological response, 23 mental health, 25 complementary clinical management of the infection and 5 other). CONCLUSION: The map presents an overview of possible TCIM contributions to various dimensions of the COVID-19 pandemic, especially in the field of mental health, and it is directed to researchers and health professionals specialized in TCIM. Most of the antiviral activity outcomes described in this map refers to respiratory viruses in general, and not specifically to SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2). This information may be useful to guide new research, but not necessarily to support a therapeutic recommendation. Finally, any suspicion of COVID-19 infection should follow the protocols recommended by the health authorities of each country/region.

A twelve-week, four-arm, randomized, double-blind, placebo-controlled, phase 2 prospective clinical trial to evaluate the efficacy and safety of an anthroposophic multimodal treatment on chronic pain in outpatients with postpolio syndrome.

INTRODUCTION: Chronic pain and fatigue are the main symptoms of postpoliomyelitis syndrome (PPS). This study aimed to evaluate the efficacy and safety of an anthroposophic multimodal treatment for chronic pain in PPS outpatients. METHODS: A twelve-week, four-arm, randomized, double-blind, placebo-controlled, phase 2 prospective clinical trial was designed to compare four groups (n = 48): groups A and B received daily active experimental transdermal gel (ETG) or placebo gel (PTG), respectively; groups C and D received weekly external therapies, art therapies, and neurofunctional reorganization, plus either daily ETG or PTG, respectively. The pain symptoms were evaluated through a visual analogue scale (VAS), the McGill questionnaire, and thermography. Quality of life and resilience were evaluated by the WHOQOL-BREF and Antonovsky sense of coherence questionnaires applied at baseline and after the interventions. RESULTS: No related adverse events occurred, and 10% of the patients reports dysphagia improvement. In the groups C and D, pain reduction was statistically significant in both the placebo group (p = .02, d = 1.315) and in the ETG (p = .005, d = 2.035). However, following the week-to-week evolution of pain with the concomitant use of the ETG, this significant pain reduction occurred earlier from the 4th week and continued to decrease (p = .016, d = 1.369). In the group that received the complete multimodal treatment, the greatest significant benefit in increasing quality of life occurred in the physical domain and elevation in resilience with an emphasis on meaning and comprehension domains. CONCLUSIONS: The anthroposophic multimodal treatment group presented both safety and efficacy as an analgesic in the groups that received the nonpharmacological therapies, much earlier when associated with the ETG. The multimodal approach corresponded to the pattern of better efficacy for both pain reduction and improvement in quality of life and resilience.