Nonpharmacological Pain Management Approaches Research Articles

Utility of the PICOTS framework to assess clinical trial disruptions: monitoring the impact of COVID-19 in the Pain Management Collaboratory.

Despite careful design of clinical trials, unforeseen disruptions can arise. The PICOTS (Patient population, Intervention, Comparator, Outcomes, Timepoints, Setting) framework was used to assess disruptions in pain management research imposed by coronavirus disease 2019 (COVID-19) within the Pain Management Collaboratory. Rapid qualitative methods were employed to identify trial disruptions due to COVID-19 in 11 pragmatic clinical trials of nonpharmacological approaches for pain management. The PICOTS framework was applied by investigators of 4 Collaboratory trials selected to cover 4 types of trial designs (individually randomized, stepped-wedge, cluster, sequential multiple assignment randomized trial-SMART). Interviews with the lead investigators of these trials were completed, and findings were presented/discussed on video calls over a 6-month period (March-August 2021) from which themes/lessons learned were identified and consensus reached. Investigators indicated that patient populations remained generally stable. A major COVID-19 trial disruption was moving from in-person to virtual care affecting delivery of interventions/comparators and outcome assessments. The resultant mixed-mode of care delivery created issues with intervention fidelity posing analytic challenges. COVID-19 also induced ongoing/intermittent delays and other barriers to accessing primary and specialty care at some facilities, creating research capacity issues affecting delivery of experimental interventions requiring sustained, reliable participation of clinical partners. Study designs most affected by COVID-19 were stepped-wedge (intervention/comparator changing over time), cluster (increased site variability inflating intracluster correlation), and SMART (second-stage randomizations disrupted); stratified individually-randomized trials were less vulnerable because of individual-level randomization. PICOTS provides a framework for assessing the impact of trial disruptions in a structured manner. Given the COVID-19 experience, it is important for researchers to consider the potential impact of future trial disruptions during study planning.

Nonpharmacological pain management approaches among U.S. construction workers: A cross-sectional pilot study.

U.S. construction workers experience high rates of injury that can lead to chronic pain. This pilot study examined nonpharmacological (without medication prescribed by healthcare provider) and pharmacological (e.g., prescription opioids) pain management approaches used by construction workers. A convenience sample of U.S. construction workers was surveyed, in partnership with the U.S. National Institute for Occupational Safety and Health (NIOSH) Construction Sector Program. Differences in familiarity and use of nonpharmacological and pharmacological pain management approaches, by demographics, were assessed using logistic regression models. A boosted regression tree model examined the most influential factors related to pharmacological pain management use, and potential reductions in use were counterfactually modeled. Of 166 (85%) of 195 participants reporting pain/discomfort in the last year, 72% reported using pharmacological pain management approaches, including 19% using opioids. There were significant differences in familiarity with nonpharmacological approaches by gender, education, work experience, and job title. Among 37 factors that predicted using pharmacological and non-pharmacological pain management approaches, training on the risks of opioids, job benefits for unpaid leave and paid disability, and familiarity with music therapy, meditation or mindful breathing, and body scans were among the most important predictors of potentially reducing use of pharmacological approaches. Providing these nonpharmacological approaches to workers could result in an estimated 23% (95% CI: 16%-30%) reduction in pharmacological pain management approaches. This pilot study suggests specific factors related to training, job benefits, and worker familiarity with nonpharmacological pain management approaches influence use of these approaches.

Non-pharmacological intervention to reduce pain post-appendectomy: A rapid review of randomized controlled trial studies

Background: Appendicitis leads to post-appendectomy pain with significant physical and mental implications, necessitating non-pharmacological pain management approaches. Objective: This study aimed to determine which non-pharmacological interventions can effectively reduce postoperative pain following an appendectomy. Design: A rapid review study design was employed. Data Sources: The databases used were EBSCOhost-CINAHL and PubMed. The article search was conducted on March 14, 2022. Review Methods: The identified articles were described using PRISMA guidelines and sorted based on inclusion criteria. These criteria included patients with appendicitis aged 18-59 years who underwent appendectomy, non-pharmacological pain management interventions, studies utilizing the Randomized Controlled Trial (RCT) method, full-text articles available, English language, and articles published between 2012-2022. Studies involving pediatric and elderly appendectomy patients, as well as studies with insignificant results, were excluded. Results: Four articles were analyzed, revealing four types of interventions: Foot and Hand Reflexology (Massage), Lavender Aromatherapy and Almond oil (Aromatherapy), Inhalation aromatherapy with sweet-scented geranium essential oil, and Acupressure Le7. These interventions were then classified into two categories: aromatherapy-based interventions and neurostimulation-based interventions. All interventions were found to significantly reduce pain in appendectomy patients. Conclusions: Non-pharmacological therapies, such as lavender and almond oil aromatherapy, sweet-scented geranium aromatherapy, foot and hand reflexology, and Le7 acupressure, have demonstrated positive effects in reducing long-term pain after an appendectomy.

Nonpharmacological pain management practices among nurses working in multiple centers in Saudi Arabia: A cross-sectional study

Objective: The aim of the study was to investigate the prevalence, and determinants, of nonpharmacological pain management practices among nurses in multiple settings. Materials and Methods: A cross-sectional examination was conducted involving 324 nurses from 16 hospitals in Hai’l, Saudi Arabia. Participants completed a self-reported survey utilizing established tools to assess the frequency of nonpharmacological pain management interventions utilization and identify associated barriers. Data analysis was performed using SPSS version 29.0. Results: Nonpharmacological pain management practices were found to be utilized “sometimes,” with a score of 2.89 ± 0.48. Commonly employed techniques included placing patients in comfortable positions and providing a tranquil environment. Gender was the sole demographic factor significantly affecting the use of these techniques (P < 0.001), with female nurses demonstrating higher utilization. Barriers to implementation varied based on the hours of recent pain management education (P = 0.004), with prevalent barriers including nurse shortages, multiple responsibilities, heavy workloads, and nurse fatigue. Conclusion: The study reveals moderate utilization of nonpharmacological pain management approaches, primarily focusing on patient positioning and creating a calm environment. Female nurses exhibited higher adoption rates of these techniques. Barriers to implementation, such as nurse shortages and heavy workloads, were influenced by recent pain management education. Consequently, enhancing education and fostering supportive work environments are crucial for surmounting these barriers and promoting pain management awareness among nurses.

Clinicians’ Practices In Pain Assessment And Management For Elderly With Heart Failure

Introduction Although pain is not considered a hallmark heart failure (HF) symptom, 51% - 85% of patients with HF experience pain. Lack of accurate pain assessment can lead to ineffective pain management which may negatively impact HF management. Older adult patients (≥ 65 years old) with HF often under-report pain symptoms. Little is known about clinicians’ perspectives of pain assessment and the pain management that they provide to older adult patients with HF. Aim . To describe clinicians’ experiences of pain assessment and management in older adult patients with HF in an effort to improve the management of pain in this population. Methods This was a qualitative research study that employed in-depth interviews with clinicians who primarily take care of patients with HF across different states. Three coders reviewed transcripts using an approach and organized codes into themes from the pattern of descriptors. Results The median age of participants (N=20) was 42 years, 20% were male, and 90% were white. We identified 4 distinct themes: (1) general differences between elderly patients and younger adult patients while providing care; (2) strategies and challenges of pain assessment: (3) strategies and challenges of pain management; and (4) recommendations for improving pain assessment/management practice. Most participants noted that providing care to older patients was more complicated due to comorbid conditions such as high fall risk and kidney disease. Even though all participants assess pain briefly as a routine physical assessment, most stated that pain was not addressed as much as it should be. Participants also faced challenges with pain assessment in older patients who often express their experience of pain using descriptive words versus numbers on a pain scale. In terms of pain management, most recommended using analgesics for older adults, not so much using non-pharmacological interventions. Most participants were unaware of any educational materials or guidelines to manage pain or symptoms for patients with HF. A few participants suggested a higher integration between a HF clinic and pain specialists and developing non-pharmacological interventions such as routine physical therapy that could potentially be a helpful resource for pain management in this population. Conclusions Using consistent pain assessment for clinicians and integrating non-pharmacological pain management approaches into routine clinical care should be tested as methods for improving symptom control among older adult patients with HF. Although pain is not considered a hallmark heart failure (HF) symptom, 51% - 85% of patients with HF experience pain. Lack of accurate pain assessment can lead to ineffective pain management which may negatively impact HF management. Older adult patients (≥ 65 years old) with HF often under-report pain symptoms. Little is known about clinicians’ perspectives of pain assessment and the pain management that they provide to older adult patients with HF. . To describe clinicians’ experiences of pain assessment and management in older adult patients with HF in an effort to improve the management of pain in this population. This was a qualitative research study that employed in-depth interviews with clinicians who primarily take care of patients with HF across different states. Three coders reviewed transcripts using an approach and organized codes into themes from the pattern of descriptors. The median age of participants (N=20) was 42 years, 20% were male, and 90% were white. We identified 4 distinct themes: (1) general differences between elderly patients and younger adult patients while providing care; (2) strategies and challenges of pain assessment: (3) strategies and challenges of pain management; and (4) recommendations for improving pain assessment/management practice. Most participants noted that providing care to older patients was more complicated due to comorbid conditions such as high fall risk and kidney disease. Even though all participants assess pain briefly as a routine physical assessment, most stated that pain was not addressed as much as it should be. Participants also faced challenges with pain assessment in older patients who often express their experience of pain using descriptive words versus numbers on a pain scale. In terms of pain management, most recommended using analgesics for older adults, not so much using non-pharmacological interventions. Most participants were unaware of any educational materials or guidelines to manage pain or symptoms for patients with HF. A few participants suggested a higher integration between a HF clinic and pain specialists and developing non-pharmacological interventions such as routine physical therapy that could potentially be a helpful resource for pain management in this population. Using consistent pain assessment for clinicians and integrating non-pharmacological pain management approaches into routine clinical care should be tested as methods for improving symptom control among older adult patients with HF.

Prevalence of cannabis use for pain management in Quebec: A post-legalization estimate among generations living with chronic pain

ABSTRACT Background Medical cannabis has been legal in Canada since 2001, and recreational cannabis was legalized in October 2018, which has led to a widespread increase in the accessibility of cannabis products. Aims This study aimed to estimate the prevalence of cannabis use among adults living with chronic pain (CP) and investigate the relationship between age and cannabis use for CP management. Methods A cross-sectional analysis of the COPE Cohort data set, a large Quebec sample of 1935 adults living with CP, was conducted. Participants completed a web-based questionnaire in 2019 that contained three yes/no questions about past-year use of cannabis (i.e., for pain management, management of other health-related conditions, recreational purposes). Results Among the 1344 participants who completed the cannabis use section of the questionnaire, the overall prevalence of cannabis use for pain management was 30.1% (95% confidence interval 27.7–32.7). Differences were found between age groups, with the highest prevalence among participants aged ≤26 years (36.5%) and lowest for those aged ≥74 years (8.8%). A multivariable logistic model revealed that age, region of residence, generalized pain, use of medications or nonpharmacological approaches for pain management, alcohol/drug consumption, and smoking were associated with the likelihood of using cannabis for pain management. Conclusions Cannabis is a common treatment for the management of CP, especially in younger generations. The high prevalence of use emphasizes the importance of better knowledge translation for people living with CP, rapidly generating evidence regarding the safety and efficacy of cannabis, and clinicians’ involvement in supporting people who use cannabis for pain management.

Engaging Veterans and Military Service Members to Optimize Pragmatic Clinical Trials of Nonpharmacological Approaches for Pain Management.

Engaging Veterans and Military Service Members to Optimize Pragmatic Clinical Trials of Nonpharmacological Approaches for Pain Management.

Real Bodies Not Required? Placebo Analgesia and Pain Perception in Immersive Virtual and Augmented Reality

Pain represents an embodied experience, wherein inferences are not only drawn from external sensory inputs, but also from bodily states. Previous research has demonstrated that a placebo administered to an embodied rubber hand can effectively induce analgesia, providing first evidence that placebos can work even when applied to temporarily embodied, artificial body parts. Using a heat pain paradigm, the present study investigates placebo analgesia and pain perception during virtual embodiment. We examined whether a virtual placebo (a sham heat protective glove) can successfully induce analgesia, even when administered to a virtual body. The analgesic efficacy of the virtual placebo to the real hand (augmented reality setting) or virtual hand (virtual reality setting) was compared to a physical placebo administered to the own, physical body (physical reality setting). Furthermore, pain perception and subjective embodiment were compared between settings. In this mixed design experiment, healthy participants (n = 48) were assigned to either an analgesia-expectation or control-expectation group, where subjective and objective pain was measured at pre- and post-intervention time points. Results demonstrate that pre-intervention pain intensity was lower in the virtual reality setting, and that participants in the analgesia-expectation group, after the intervention, exhibited significantly higher pain thresholds, and lower pain intensity and unpleasantness ratings than control-expectation participants, independent of the setting. Our findings show that a virtual placebo can elicit placebo analgesia comparable to that of a physical placebo, and that administration of a placebo does not necessitate physical bodily interaction to produce analgesic responses. PerspectiveThis study demonstrates that a virtual placebo treatment, even when administered to a virtual body, can produce placebo analgesia. These findings indicate that the efficacy of a virtual placebo is comparable to that of a physical placebo, which could pave the way for effective new non-pharmacological approaches for pain management.

Development and Implementation of the Military Treatment Facility Engagement Committee (MTFEC) to Support Pragmatic Clinical Trials in the Military Health System.

Within the population of military service members and veterans, chronic pain is highly prevalent, often complex, and frequently related to traumatic experiences that are more likely to occur to members of this demographic, such as individuals with traumatic brain injury or limb loss. In September 2017, the National Institutes of Health (NIH), Department of Defense (DOD), and Department of Veterans Affairs (VA) Pain Management Collaboratory (PMC) was formed as a significant and innovative inter-government agency partnership to support a multicomponent research initiative focusing on nonpharmacological approaches for pain management addressing the needs of service members, their dependents, and veterans. A Pain Management Collaboratory Coordinating Center (PMC3) was also established to facilitate collective learning across 11 individually funded pragmatic clinical trials (PCTs) designed to optimize the impact of the PMC as an integrated whole. Although the DOD and VA health care systems are ideal sites for the enactment of PCTs, executing these trials within the local context of DOD military treatment facilities (MTFs) can present unique challenges. The Military Treatment Facility Engagement Committee (MTFEC) was created to support the efforts of the PMC3 in its role as a national resource for development and refinement of innovative tools, best practices, and other resources in the conduct of high impact PCTs. The MTFEC is composed of experts from each service who bring experiences in executing clinical pain management trials that can enhance the planning and execution of the PCTs. It provides expertise and leadership in the execution of research studies at within MTFs and within the DOD health care system, with guidance from PMC3 Directors and in collaboration with NIH, DOD, and VA program and scientific officers. Considering the importance of enacting large-scale, pragmatic studies to implement effective strategies in clinical practice for chronic pain management, the MTFEC has begun to actualize its purpose by identifying potential barriers and challenges to study implementation and exploring how the PMC can support and aid in the execution of PCTs by applying similar approaches to stakeholder and subject matter engagement for their research.

Designing Trials with Purpose: Pragmatic Clinical Trials of Nonpharmacological Approaches for Pain Management.

Pain is one of the most significant causes of morbidity and disability worldwide. The efficacy of several nonpharmacological approaches for pain management has been established, but significant gaps exist between this evidence and their limited availability and use in routine clinical practice. Questions remain about their effectiveness and how best to integrate them in usual care to optimize patient-centered outcomes. Pragmatic clinical trials (PCTs) may help address this gap. Informed by the Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2), we sought to describe the key features of optimized PCTs of nonpharmacological approaches for the management of pain and common co-occurring conditions. To accomplish this objective, we searched the published literature on PCTs of nonpharmacological pain management approaches from 2010-2019 and applied the PRECIS-2 criteria. We discuss key PRECIS-2 domains of interest for designing and performing PCTs and cite specific examples from the published literature as potential models for future PCTs. We found 13 nonpharmacological PCTs. They were heterogeneous in size, recruitment, follow-up time, and location. The lessons learned from these studies led us to explicate key features of trials on the explanatory-pragmatic continuum across the PRECIS-2 domains that can be used by future investigators when designing their clinical trials of nonpharmacological approaches to pain management. We encourage the increased application of PCTs to produce timely and valuable results and products that will inform the development of safe and effective integrated pain care plans that optimize important patient-centered outcomes.

Treatment of Pain in European Nursing Homes: Results from the Services and Health for Elderly in Long TERm Care (SHELTER) Study

To identify pharmacological and nonpharmacological pain management approaches and associated factors in nursing home residents across Europe. Cross-sectional study with 4156 residents who were assessed using the interRAI instrument for Long Term Care Facilities (interRAI LTCF), including pharmacological and nonpharmacological pain management modalities. Those reporting pain were included in the analyses (n= 1900). A deeper analysis was performed for the subsample of residents who reported "current pain," defined as pain at least 1 day within the past 3 days (n= 838), and those who reported "current pain of moderate to severe intensity" (n= 590). Up to 24% of residents who reported pain did not receive any pain medication and up to 11% received it only PRN (as-needed basis), independent of current pain-intensity levels; 61% did not receive any nonpharmacological treatment and 21% received neither pharmacological nor nonpharmacological pain modalities. Considerable differences could be demonstrated across European countries. Factors positively associated with pharmacological pain management were being of female gender, reporting cancer, and having moderate or severe pain. High turnover rates of regular staff and low-to-moderate physicians' availability were negatively associated. Factors positively associated with nonpharmacological treatment were fractures and need of assistance in activities of daily living. Dementia, large nursing home facilities, above-average and high turnover rates of nursing staff, a low physicians' availability, and severe pain intensity were negatively associated. Despite some advances in recent years, pain treatment in European nursing home residents remains to be suboptimal and requires further improvement.

Nonpharmacological treatment of pain in rheumatic diseases and other musculoskeletal pain conditions.

Pain is a complex phenomenon affected by biological, psychological, and social factors. Treatment of pain is most effective when using a multidisciplinary approach consisting of a careful selection of pharmacological and non-pharmacological interventions based upon disease factors, pain characteristics, psychological coping abilities, and lifestyle factors. In this review we focus on research-based evidence for non-pharmacological intervention including psychological intervention, physical exercise, patient education, and complementary approaches for pain management for patients with rheumatic diseases and common musculoskeletal pain conditions, such as low back pain. The vast majority of research studies on chronic pain conditions are focused on adults but pediatric studies are also reviewed wherever possible, to give the reader a more inclusive view of non-pharmacological approaches for pain management across the lifespan.

Treatment of symptomatic diabetic neuropathy

Painful diabetic neuropathy is a common and particularly unpleasant long-term complication of diabetes that affects a significant minority of patients with distal polyneuropathy. After exclusion of other causes of neuropathic pain, attention should be focused on achieving optimal and stable glycaemic control avoiding flux of blood glucose levels, which have been shown to aggravate pain. Most patients will require pain control therapy and whilst the tricyclic drugs remain a first-line approach, their use is often hampered by predictable but troublesome side effects. Gabapentin, the only agent specifically licensed for the treatment of neuropathic pain in the United Kingdom, is useful in diabetic neuropathy and is generally better tolerated than the tricyclics. Additionally, other pharmacological and non-pharmacological pain management approaches may be useful. Patient education has a significant role to play in the avoidance of late neurological complications.