Pain Module. Nonpharmacologic Approaches to Pain Management

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1 Pain Module Nonpharmacologic Approaches to Pain Management

2 Examples of Nonpharmacologic Interventions Physical Measures Heat/cold Repositioning Bracing Physical therapy Occupational therapy Spinal manipulation

3 Examples of Nonpharmacologic Mind-Body Practices Massage therapy Yoga/Tai Chi exercises Interventions Stretching/Therapeutic movement Deep breathing techniques Music therapy/art therapy Journaling/Poetry Guided imagery/visualization Spiritual practices/meditation MBSR (Mindfulness-Based Stress Reduction) Distraction (e.g., TV, movies, games) Psychological/Counseling Cognitive-behavioral therapy Self-regulated treatments (e.g., biofeedback, hypnosis) Sharing/Feedback via support groups

4 Nonpharmacologic Approaches Can Contribute physically to pain relief by decreasing inflammation, increasing blood flow, reducing muscle tension Release endorphins which help decrease the perception of pain Decrease fatigue, increase activity Diminish the emotional components of pain through cognitive approaches: Strengthen coping abilities Reducing perceived threats Provide a sense of control Reduce anxiety Promote muscle relaxation, reduce heart rate and blood pressure Restore hope and improve quality of life

5 Selecting Nonpharmacologic Pain Treatments 1. Consider the patient s. previous experience and present attitude about nonpharm techniques preferences and coping styles physical and mental abilities ability to access to the modalities financial resources 2. Ascertain if the nonpharm approach requires involvement of family & friends? in-depth patient education and instruction? 3. Determine if there any safety issues that prohibit using a technique.

6 Note: Nonpharmacologic interventions are not to be used instead of effective analgesics/anesthetics for moderate-severe pain. A combination of an analgesic/anesthetic and nonpharm technique(s) is appropriate for moderatesevere pain. Examples: Ice and analgesics after knee surgery Local anesthesia and listening to music during suturing What other examples can you think of?

7 Superficial Cold Indicated for acute trauma (first 48 to 72 hrs), bleeding, swelling, arthritis, acute low back pain, episiotomy pain, headaches. Cold usually relieves more pain, relieves it faster, and the relief lasts longer than using heat. Cold should not be applied to tissue that has been damaged by radiation therapy and is contraindicated for any condition in which vasoconstriction increases symptoms, such as in peripheral vascular disease, Reynaud's syndrome, or other vascular or connective tissue diseases. In some patients, cooling painful joints will increase range of motion, but in others, it may increase joint stiffness and should therefore be avoided.

8 Using Ice Safely Ice packs, towels soaked in ice water, or commercially prepared chemical gel packs can be used. Cold packs should be: sealed to prevent dripping flexible to conform to body contours applied so as to produce a comfortable and safe intensity of cold adequately wrapped (e.g., in one layer of towel or pillowcase) to prevent skin irritation especially with chemical gel packs which can burn the skin. The ice application is usually 15 to 20 minutes at a time. Ice can be applied many times during the 24 hour period, but should not be used for more than 20 minutes at a time.

9 Superficial Heat Indicated for low back and neck pain, arthritis, decubiti, superficial boils, superficial thrombophlebitis, anorectal pain, nipple pain due to breastfeeding, and hematoma resolution Superficial heat can be applied by: Hot pack Hot water bottle Hot and moist compresses Electric heating pad (dry or moist) Chemical and gel packs Immersion in water (tub, basin, or whirlpool)

10 Using Heat Safely The temperature of the heat source must be measured in order to prevent burns. A cloth should be placed between the heat source and the skin. Burn precaution: Discourage patients from lying directly or sleeping on the heat source. Check the patient s skin periodically. Heat should not be applied to tissue that is burned or has been exposed to radiation therapy.

11 Summary Nonpharmacologic interventions are very effective in reducing the perception of pain at the peripheral nervous system and/or the central nervous system. The nurse s role in assisting patients with nonpharmacologic interventions is to: evaluate the appropriateness of their use determine the patient s willingness and readiness to use them teach the patient how to use the available options support and reinforce correct use evaluate and document the effectiveness of the intervention.

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