Wu, T.H., Chiu, T.Y., Tsai, J.S., Chen, C.Y., Chen, L.C., & Yang, L.L. (2008). Effectiveness of Taiwanese traditional herbal diet for pain management in terminal cancer patients. Asia Pacific Journal of Clinical Nutrition, 17, 17–22.

To evaluate the effects of a Taiwanese traditional diet including paeony and licorice components on pain in patients with terminal cancer

Patients were randomly assigned to one of three groups: (a) Taiwanese traditional herbal diet (TTHD) group, consisting of analgesic herbs (paeony root and licorice root) and tonic vegetable soup (lilli bulbus, nelumbo seed, and jujube fruit), (b) reference group, receiving the regular hospital diet, (c) and control group, receiving the tonic soup without addition of analgesic herbs. All patients remained on the assigned diet for one week. Pain was assessed via patient self-report questionnaire on days 3 and 10.

• The study reported on a sample of 2,466 patients.
• Patient age ranged from 9 to 89 years; 87% were between 40–79 years old.
• The sample was 50.7% male and 49.3% female.
• A variety of cancer sites were included, with the most common being lung, liver, colorectal, and stomach.
• An estimated 90% of patients had pain that was from medical conditions other than cancer. Most patients had neuropathic pain.
• Patients on any analgesics were excluded from the study.

• Single site
• Inpatient setting
• Taiwan University Palliative Medicine Ward

The study was a randomized, parallel group trial.

• Numeric rating scale using a 100-point scale: without pain, minimal pain, mild but tolerable pain, moderately uncomfortable pain, and extreme pain
• Previous tool validation identified
• No information on reliability

All groups reported significant reduction in mean pain scores on days 3 and 10. Patients in the TTHD group reported a three-point improvement in pain (from 53 to 50), which was significantly greater than that in the reference and control groups (p < 0.01).

In this study, use of traditional Taiwanese analgesic herbs was effective for pain reduction, compared to control and reference groups, in palliative care patients who were not receiving other analgesic medications.

Patients on analgesics were excluded from this study, and authors stated that in 90% of cases, pain was not cancer-related. Application of findings to other groups with cancer-related pain who require substantial analgesic therapy is questionable. Though statistically significant, the clinical relevance of the change in average pain scores is questionable, with a change of 3 points on a 100-point scale. The pain scale is not clearly explained, and it appears its scoring is not a continuous variable, though the statistical analysis and summary data provided treats the data as continuous data.

Findings here suggest that traditional Taiwanese analgesic herbs may be helpful in managing pain in terminally ill patients. There are a number of study report issues that make these findings very limited, so applicability to other patients with cancer-related pain is questionable. Future research in this area should examine use of this approach as adjunctive therapy in concert with other analgesia in patients with pain that is truly cancer-related. Applicability in other cultures is needed.