Nonpharmacologic Interventions for Pain Management

Effect of Reflexology on Decreasing Postoperative Pain and Anxiety After Total Abdominal Hysterectomy

Surgical patients experience both postoperative pain and anxiety, as they try to cope with pain. Despite technological advances, pharmacological methods are inadequate for decreasing postoperative pain and anxiety. Reflexology has been implemented and considered effective in these areas in many countries. The aim of this study was to determine the effect of reflexology on decreasing postoperative pain and anxiety after a hysterectomy. The study was an intervention randomized study. The population of the investigation is all patients who had a hysterectomy between February 2012 and December 2014 in the Istanbul University Obstetrics and Gynecology service. The sample was 100 women chosen after a power analysis (minimum: 74) (experimental: 54, control: 46) within the population of the investigation who agreed to participate in the study. Using a table of random numbers, patients in the sample were divided into groups. Data was collected using the patient information and vital signs form, State-Trait Anxiety Inventory (STAI-I), Visual Analog Scale (VAS) Pain and Anxiety Scales, and BRIEF pain inventory. All women in the groups had similar sociodemographic, obstetric, and pain characteristics, past experience of illness, and characteristics related to their hysterectomy. All of the patients in the reflexology group stated that reflexology helped them feel better. The reflexology group compared with the control group had lower than the average VAS pain and VAS and STAI anxiety at all assessment times. Reflexology is effective in reducing anxiety and pain.

Hypnosis for pain management in the older adult

Pain is a physical, emotional and psychologic phenomenon that is often ignored in older adults causing depression and poor quality of life. Older adults report the use of complementary and alternative medicine in some form with 80% of these users reporting improvement in their health conditions. Although physical pain in the older adult is usually managed with pharmacologic interventions, methods that may reduce the use of prescription drugs may decrease adverse effects that can compromise the physiologic state of the older adult. Hypnosis has continued to gain acceptance within mainstream medicine as an appropriate treatment and can be integrated safely with conventional medicine as an effective treatment for a variety of conditions in the older adult. It is an intervention that can be used for relaxation and pain control, especially when conventional pharmacologic regimens have failed. The purpose of this article is to review the concepts related to pain in older adults; the use of complementary and alternative medicine in the older adult; hypnosis and the older adult (i.e., background, definition, benefits, research, mechanism of action, hypnotizability, and the process); and the implications of using hypnosis for pain management in the older adult.

Pediatric pain management in the emergency department

Over the past 25 years, pediatric emergency medicine research and literature have progressively augmented our knowledge of safe and effective pediatric pain management strategies. Yet there is still much more we need to do to understand the painful experiences of children, and to develop optimal safe ways of addressing their needs within the context of a busy pediatric emergency department (ED). In this article, the authors review the history of ED pediatric pain management and sedation, discuss special considerations in pediatric pain assessment and management, review various pharmacologic and nonpharmacologic methods of alleviating pain and anxiety, and present ideas to improve the culture of the pediatric ED, so that it can achieve the goal of becoming pain-free.

Pain Management in the Prehospital Environment

Pain measurement and relief is complex and should be a priority for prehospital providers and supervisors. The literature continues to prove that we are poor pain relievers, despite the high prevalence of pain in the out-of-hospital patient population. Lack of education and research, along with agent availability, controlled substance regulation, and many myths given credence by health care providers, hinder our ability to achieve adequate pain assessment and treatment in the prehospital setting. Protocols must be established to help guide providers through proper acknowledgment, measurement, and treatment for prehospital pain. Nonpharmacologic therapies must also be taught and reinforced as important adjuncts to pain management. Finally, formation of quality improvement pain programs that evaluate patient outcomes and provider practice patterns will help EMS systems understand the pain management process and outline areas for improvement. Only through emphasis on pain education, research, protocol and program monitoring development will the quality of pain assessment and management in the prehospital setting improve.

Systematic relaxation to relieve postoperative pain

BACKGROUND

Unrelieved pain after surgery can lead to complications, prolonged hospital stay, and delayed recovery. Because of side effects from opioids and differences in response, it is important to use non-pharmacological methods in addition to analgesics to decrease patient discomfort and anxiety.

AIMS

We examined the effects of a systematic method of relaxing the body on the sensory and affective components of postoperative pain, anxiety, and opioid intake after initial ambulation.

DESIGN

A randomized controlled trial with relaxation and control groups was used.

METHOD

The convenience sample of 102 adults underwent abdominal surgery at a large hospital in Thailand. Systematic relaxation was used for 15 minutes during recovery from the first ambulation after surgery. Pain was measured with 100 mm Visual Analogue Sensation and Distress of Pain Scales before and after the intervention. State anxiety was measured before surgery and after the intervention; opioid intake was recorded 6 hours later.

RESULTS

The relaxation group had less post-test sensation and distress of pain (26 and 25 mm less, respectively) than the control group (P = 0.001). Relaxation did not result in significantly less anxiety or 6-hour opioid intake. However, group differences in state anxiety were in the expected direction and fewer participants in the relaxation group requested opioids. Nearly all reported that systematic relaxation reduced their pain and increased their sense of control.

CONCLUSION

Substantial reductions in the sensation and distress of pain were found when postoperative patients used systematic relaxation. Although tested in Thailand, we recommend that nurses in other countries try systematic relaxation with postoperative patients, in addition to analgesic medication, measuring pain scores and asking about cultural acceptance.

Strategies for implementing a guided imagery program to enhance patient experience

The patient in acute care settings can have severe emotional and physical stresses that are also experienced by family and significant others. The experience in a hospital has often been described as overwhelming; it can evoke feelings of fear, anger, helplessness, and isolation. Guided imagery, one of the most well-studied complementary therapies, is used increasingly to improve patients' experiences and healthcare outcomes. More and more, patients are relying on the use of guided imagery to provide a significant source of strength, support, and courage as they prepare for a procedure or manage the stresses of a hospital stay. This article provides a brief review of the research base for guided imagery and broad indications for its use. It describes key elements of the therapy and outlines steps to implement a program of guided imagery that can be used in variety of settings.

Validation of cutaneous stimulation interventions for pain management

The purpose of this study was to identify and validate specific activities considered important in the implementation of selected cutaneous stimulation pain management interventions including heat and cold application, massage and Transcutaneous Electrical Nerve Stimulation (TENS). A two-round Delphi survey was completed by nurses selected for their expertise in pain management. Data were analyzed using a modification of Fehring's diagnostic content validity method. Consistently high scores were obtained by the raters for each intervention and activity, with most activities perceived as critical to the intervention. From this process, a list of activities for each cutaneous stimulation intervention evolved that are applicable to education, clinical practice and clinical nursing research.