Nonpharmacologic Pain Treatments Research Articles

Investigating the Probability of Response Bias in Owner-Perceived Pain Assessment in Dogs With Osteoarthritis

Owners’ ability to recognize signs of chronic pain in dogs undergoing pharmacologic and nonpharmacologic pain interventions during a period of physical rehabilitation is not known. This study aimed to compare dogs with and without chronic pain, and to assess the relationship between explanatory factors, including the probability of owners’ response bias induced by pharmacologic and nonpharmacologic pain intervention, and chronic pain in dogs with osteoarthritis (OA). Seventy-one dogs with OA were included in this observational study. Owner-perceived pain interference was measured by Canine Brief Pain Inventory (CBPI) and owner-perceived pain behavior was assessed using Helsinki Chronic Pain Index. A dichotomous variable of Helsinki Chronic Pain Index was used in regression analysis to investigate the association between chronic pain and explanatory factors (body condition, anti-inflammatory medication, animal physiotherapy consultation once or more and owners’ perception of pain interfering). Seventy-five percent of the dogs had ongoing anti-inflammatory medication, 51% of were overweight and 45% had a physiotherapy consultation. Higher levels of overt pain behaviors were reported in items addressing activities. Body condition, physiotherapy consultation and medication were not associated with chronic pain. Odds ratio (OR) and 95% confidence intervals of OR for the CBPI were 1.74 (1.23-2.47) and significantly associated with chronic pain. The adjusted OR of the CBPI did not differ from the crude OR. Owner-perceived pain behavior was not confounded by the dogs’ medication. Results indicated that CBPI was not mediated by the medication. The CBPI pain interference score was not associated with response bias and may be used as clinical outcome measure of chronic pain and pain-related disability in dogs with OA along a period of physical rehabilitation comprising pharmacologic and nonpharmacologic pain interventions.

A Systematic Review of Clinical Practice Guidelines for Acute Procedural Pain on Neonates.

During hospitalization in neonatal intensive care units, neonates are exposed to many painful procedures within a stressful environment. To date, many evidence-based guidelines are available. However, the quality of these guidelines and their clinical application remain unclear. This systematic review aimed to determinie the quality of existing guidelines on the management of procedural pain in neonates and to summarize the recommendations provided by these guidelines. A structured search was conducted in Embase, PubMed, CINAHL, JBI database, and gray literature resources in November 2018 to identify relevant guidelines published from 2007 onward. Published guidelines and guidelines from complementary searches were included in the treating assessment or management of procedural pain in neonates. The methodological quality was analyzed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. A total of 1154 records were identified. After screening for eligibility, 17 guidelines were included in this review. Among these, 11 were identified to be high-quality guidelines. Besides the usual recommendations for pharmacological and nonpharmacological treatments, the inclusion of parents, improving interprofessional collaboration, and considering the setting were identified as important elements. The results of this review show that there is a need to improve the methodological quality of guidelines for procedural pain in newborns. The set of recommendations for procedural pain prevention needs to involve not only pharmacological and nonpharmacological pain treatment but also parents and interprofessional collaboration. It is also essential to take into account facilitators, barriers, and the context to improve pain management.

Current Status of Pain Management in Parkinson’s Disease

Pain is a non-motor symptom in Parkinson's disease (PD) which commonly goes underreported. Adequate treatment for pain in PD remains challenging, and to date, no clear guidelines for management are available. With the goal of understanding and organizing the current status of pain management in PD, we conducted a review of pharmacological and non-pharmacological treatments for pain in patients with PD. Suitable studies cataloged in PubMed and the Cochrane database up to October 31, 2019, were included prioritizing randomized controlled trials. Post-hoc analyses and open-label studies were also included. Treatment with levodopa increases pain thresholds in patients with PD. Apomorphine did not have similar efficacy. Duloxetine provided benefit in an open-label trial. Oxycodone-naloxone PR did not have a significant improvement in pain, but per-protocol analysis showed a reduction in pain when adherence was strong. Rotigotine patch had numerical improvement on pain scales with no statistical significance. Safinamide significantly improved the "bodily discomfort" domain in the PDQ-39 questionnaire. Botulinum toxin A had a non-significant signal toward improving dystonic limb pain in PD. DBS to the subthalamic nucleus may modulate central pain thresholds, and a pilot study of cranioelectric therapy warrants future research in the area. After optimizing dopaminergic therapy, understanding the type of pain a patient is experiencing is essential to optimizing pain control in PD. While recommendations can be made regarding the treatment options in each domain, evidence remains weak and future randomized controlled studies are needed.

Non-pharmacological Treatments for Non-malignant and Malignant Pain

Non-pharmacological Treatments for Non-malignant and Malignant Pain

A Pain eHealth Platform for Engaging Obese, Older Adults with Chronic Low Back Pain in Nonpharmacological Pain Treatments: Protocol for a Pilot Feasibility Study.

BackgroundLow back pain is a costly healthcare problem and the leading cause of disability among adults in the United States. Primary care providers urgently need effective ways to deliver evidence-based, nonpharmacological therapies for chronic low back pain. Guidelines published by several government and national organizations have recommended nonpharmacological and nonopioid pharmacological therapies for low back pain.ObjectiveThe Pain eHealth Platform (PEP) pilot trial aims to test the feasibility of a highly innovative intervention that (1) uses an electronic health record (EHR) query to systematically identify a phenotype of obese, older adults with chronic low back pain who may benefit from Web-based behavioral treatments; (2) delivers highly tailored messages to eligible older adults with chronic low back pain via the patient portal; (3) links affected patients to a Web app that provides education on the efficacy of evidence-based, nonpharmacological, behavioral pain treatments; and (4) directs patients to existing Web-based health treatment tools.MethodsUsing a three-step modified Delphi method, an expert panel of primary care providers will define a low back pain phenotype for an EHR query. Using the defined low back pain phenotype, an EHR query will be created to identify patients who may benefit from the PEP. Up to 15 patients with low back pain will be interviewed to refine the tailored messaging, esthetics, and content of the patient-facing Web app within the PEP. Up to 10 primary care providers will be interviewed to better understand the facilitators and barriers to implementing the PEP, given their clinic workflow. We will assess the feasibility of the PEP in a single-arm pragmatic pilot study in which secure patient portal invitations containing a hyperlink to the PEP Web app are sent to 1000 patients. The primary outcome of the study is usability as measured by the System Usability Scale.ResultsQualitative interviews with primary care providers were completed in April 2019. Qualitative interviews with patients will begin in December 2019.ConclusionsThe PEP will leverage informatics and the patient portal to deliver evidence-based nonpharmacological treatment information to adults with chronic low back pain. Results from this study may help inform the development of Web-based health platforms for other pain and chronic health conditions.International Registered Report Identifier (IRRID)DERR1-10.2196/14525

Advanced Interventions for Common Pain Conditions in Women

Pain syndromes affecting women have a significant global impact. There is increasing evidence that chronic pain affects a higher proportion of women than men around the world; unfortunately, women are less likely to receive treatment. Moreover, women generally experience more recurrent pain, more severe pain and longer-lasting pain than men. Pain conditions are more prevalent in women such as fibromyalgia, chronic pelvic pain and lumbopelvic pain during pregnancy and postpartum. Gender differences in pain sensitivity, pharmacological therapy, and nonpharmacological pain interventions have also been reported. It is becoming evident that gender differences in pain and its relief arise from an interaction of genetic, anatomical, physiological, neuronal, hormonal, psychological and social factors that modulate pain differently.

Pain Care in the Department of Veterans Affairs: Understanding How a Cultural Shift in Pain Care Impacts Provider Decisions and Collaboration.

Over the past decade, the Department of Veterans Affairs (VA) has experienced a sizeable shift in its approach to pain. The VA's 2009 Pain Management Directive introduced the Stepped Care Model, which emphasizes an interdisciplinary approach to pain management involving pain referrals and management from primary to specialty care providers. Additionally, the Opioid Safety Initiative and 2017 VA/Department of Defense (DoD) clinical guidelines on opioid prescribing set a new standard for reducing opioid use in the VA. These shifts in pain care have led to new pain management strategies that rely on multidisciplinary teams and nonpharmacologic pain treatments. The goal of this study was to examine how the cultural transformation of pain care has impacted providers, the degree to which VA providers are aware of pain care services at their facilities, and their perceptions of multidisciplinary care and collaboration across VA disciplines. We conducted semistructured phone interviews with 39 VA clinicians in primary care, mental health, pharmacy, and physical therapy/rehabilitation at eight Veterans Integrated Service Network medical centers in New England. We identified four major themes concerning interdisciplinary pain management approaches: 1) the culture of VA pain care has changed dramatically, with a greater focus on nonpharmacologic approaches to pain, though many "old school" providers continue to prefer medication options; 2) most facilities in this sample have no clear roadmap about which pain treatment pathway to follow, with many providers unaware of what treatment to recommend when; 3) despite multiple options for pain treatment, VA multidisciplinary teams generally work together to ensure that veterans receive coordinated pain care; and 4) veteran preferences for care may not align with existing pain care pathways. The VA has shifted its practices regarding pain management, with a greater emphasis on nonpharmacologic pain options. The proliferation of nonpharmacologic pain management strategies requires stakeholders to know how to choose among alternative treatments.

Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews.

Background and Objectives: It is estimated that 28 million people in the UK live with chronic pain. A biopsychosocial approach to chronic pain is recommended which combines pharmacological interventions with behavioural and non-pharmacological treatments. Acupuncture represents one of a number of non-pharmacological interventions for pain. In the current climate of difficult commissioning decisions and constantly changing national guidance, the quest for strong supporting evidence has never been more important. Although hundreds of systematic reviews (SRs) and meta-analyses have been conducted, most have been inconclusive, and this has created uncertainty in clinical policy and practice. There is a need to bring all the evidence together for different pain conditions. The aim of this review is to synthesise SRs of RCTs evaluating the clinical efficacy of acupuncture to alleviate chronic pain and to consider the quality and adequacy of the evidence, including RCT design. Materials and Methods: Electronic databases were searched for English language SRs and meta-analyses on acupuncture for chronic pain. The SRs were scrutinised for methodology, risk of bias and judgement of efficacy. Results: A total of 177 reviews of acupuncture from 1989 to 2019 met our eligibility criteria. The majority of SRs found that RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. Heterogeneity between RCTs was such that meta-analysis was often inappropriate. Conclusions: The large quantity of RCTs on acupuncture for chronic pain contained within systematic reviews provide evidence that is conflicting and inconclusive, due in part to recurring methodological shortcomings of RCTs. We suggest that an enriched enrolment with randomised withdrawal design may overcome some of these methodological shortcomings. It is essential that the quality of evidence is improved so that healthcare providers and commissioners can make informed choices on the interventions which can legitimately be provided to patients living with chronic pain.

Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis.

Background and Objectives: Among HIV infection symptoms, sensory neuropathy (HIV-SN) remains a main cause of suffering, with incidence varying from 13–50%. So far, numerous pharmacological and non-pharmacological treatments have been tested, although few evidence-based analgesic options are available. We conducted an up-to-date systematic review and meta-analysis of the literature in order to evaluate the efficacy and safety of pharmacologic and non-pharmacologic treatments for pain control, in patients with HIV neuropathy. Materials and Methods: We searched MEDLINE, EMBASE, Scopus/Elsevier, The Cochrane Central Register of Controlled Trials (CENTRAL), USA Clinical Trials registry, and The International Web of Science up to April 2019. All randomized controlled trials evaluating efficacy and safety of non-pharmacologic and pharmacologic therapies were included. Efficacy was defined as pain reduction during the study period. Safety was estimated from adverse events. A meta-analysis was performed whenever possible. Results: 27 randomized controlled trials (RCTs) were included for analysis (7 evaluating non pharmacologic interventions, 20 pharmacologic therapies). Non-pharmacologic studies (n = 742) involved seven different therapeutic modalities. Only Acupuncture/Moxibustion showed pain reduction over placebo, Gracely Pain Scale Mean (SD): Acu/Moxa 0.85 (0.12), placebo 1.10 (0.09), p = 0.05. Pharmacologic studies, involving 2516 patients revealed efficacy for capsaicin 8% over placebo (mean difference −8.04 [95% CI: −14.92 −1.15], smoked cannabis (where pooling data for meta-analysis was not possible) and recombinant Nerve Growth Factor. Conclusion: Despite various modalities for pain control in HIV-SN, strongest evidence exists for capsaicin 8% and smoked cannabis, although of low methodological quality. Among non-pharmacologic modalities, only Acu/Moxa gave a marginal beneficial effect in one study, possibly limited by inherent methodological flaws.

Efficacy of Precise Foot Massage Therapy on Pain and Anxiety Following Cardiac Surgery: Pilot Study

BackgroundPain is the most pervasive distressing symptom following cardiac surgery. Forty percent of postoperative cardiac patients report inadequate pain management. Undertreated acute pain results in increased anxiety, delayed wound healing, and increased chance of persistent chronic pain. Foot massage is a safe, visible complementary approach to manage acute pain following surgery. AimThe aim of this study is to evaluate the efficacy of integrating foot massage therapy for managing postcardiac pain. MethodA randomized placebo controlled single blinded trial comparing foot massage to placebo was conducted at a large hospital in Saudi Arabia. Thirty-one patients who had undergone cardiac surgery (16 in experimental and 15 in placebo group) participated in the study. Ten-minute foot massage was delivered to the experimental group by a nurse researcher, twice during one day, within 30 minutes after receiving an opioid pain medication. ResultsThe findings of this study indicate that foot massage significantly (p < .05) decreases pain intensity and anxiety in patients who have undergone cardiac surgery compared with a placebo control group. ConclusionProviding non-pharmacologic interventions for pain is the responsibility of the nursing staff. Foot massage is within the scope of nursing practice and is a safe and effective manner of improving patient care. Foot massage in conjunction with pharmacological interventions is effective in improving pain and anxiety. Future studies should consider focusing on frequency, dose, feasibility, acceptability, and participants’ satisfaction.

Do non-pharmacological interventions improve chronic pain in multiple sclerosis? - A Cochrane Review summary with commentary.

The aim of this commentary is to discuss the rehabilitation perspective in the recently published Cochrane Review "Non-pharmacological interventions for chronic pain in multiple sclerosis" by Amatya, Young & Khan.1, under the direct supervision of Multiple Sclerosis and Rare Diseases of the CNS group. This Cochrane Corner is produced in agreement with NeuroRehabilitation by Cochrane Rehabilitation.

Cochrane reviews on acupuncture therapy for pain: A snapshot of the current evidence

Cochrane is an international non-profit organization established in 1993 to produce and disseminate high quality and unbiased systematic reviews of evidence on health care interventions. At the forefront of systematic review methodology, Cochrane is generally accepted to be among the most carefully prepared and rigorous sources of systematic review evidence. There are numerous Cochrane reviews on nonpharmacologic interventions for pain and multiple Cochrane reviews evaluating acupuncture therapy in pain conditions. But how complete and up to date are those reviews relative to other rigorous systematic reviews with meta-analyses of acupuncture therapy for pain published in the literature? In this ‘snapshot’ overview, we found 22 relevant Cochrane reviews, some concluding that acupuncture therapy is probably useful for treating specific pain conditions. However, many of the conditions for which acupuncture is most commonly used are either not represented in Cochrane reviews or the existing Cochrane reviews are seriously outdated and do not reflect current evidence. This creates confusion with the risks of adverse effects and addiction liability associated with pain medications, the prevalence of chronic pain, the ongoing opioid epidemic and the need for evidence-based options for pain as part of comprehensive pain care. Clinicians and patients want clarification on safe and effective options to treat pain. Issues involving reviewed trials’ inadequate use of sham comparators, of acupuncture as a complex intervention with interactive components and a shift in research focus from efficacy trials to real-world pragmatic trials are discussed in relation to updating Cochrane reviews of acupuncture therapy for pain.

Older people's use of non-pharmacological interventions for chronic, non-cancer pain and comfort.

Many older people experience chronic pain, so increased comfort and pain relief are important for older residents in assisted and/or supported-living environments. While several studies have found that people using non-pharmacological interventions without taking pain medication experienced significant differences in pain, the effect of non-pharmacological interventions on comfort and chronic pain in older people has not been studied. To assess differences in comfort and pain among older people in assisted and supported-living facilities who had chronic, non-cancer pain and who used or did not use non-pharmacological interventions. A descriptive, comparative, cross-sectional pilot study with a convenience sample of 82 participants from 11 assisted and supported-living facilities. Three questionnaires were used to obtain data on the independent variable of use/non-use of non-pharmacological interventions and the dependent variables of perceived comfort and pain. Multivariate analyses of variance were computed to measure differences between the use/non-use groups, and Roy-Bargmann stepdown analyses were computed to further subdivide and analyse the groups who were using and not using pain medication. No significant differences were found in chronic pain and perceived comfort between participants who did or did not use non-pharmacological interventions if they were not also taking pain medication. However, when participants were also taking pain medication, chronic pain and perceived comfort scores were significantly affected by the use of non-pharmacological interventions. The most common non-pharmacological interventions were exercise, heat therapy, spiritual activity/religion and listening to music. Older people using non-pharmacological interventions and taking pain medication had higher perceived comfort scores and lower pain scores than those using pain medication only. Relationships between non-pharmacological interventions and comfort should be explored further. With minor changes, this pilot study design could be used with a larger sample.

Knowledge and practice regarding neonatal pain management in the opinion of nurses and midwives working in Polish neonatal units

Nurses and midwives working in neonatal units play a key role in the assessment and treatment of pain. Due to their nature of work, which is based on continuous observation of the patient, they constitute a professional group that responds to changes in the child’s general condition. Thanks to this, the physicians get information about pain intensity or the need of pain treatment, which is relevant among patients who cannot report any symptoms of pain by themselves. The aim of the study was to describe nurses’ and midwives’ basic knowledge about pain and the practice regarding procedural pain assessment and management in Polish neonatal care units. The studies were carried out among 617 nurses and midwives working in neonatal units in Poland. We collected data by using a researcher-developed questionnaire. The significance level was set at p&lt;0.5. 30% of nurses never used nonpharmacological methods of pain relief before painful procedures. Moreover, the higher the level of reference, the more often no non-pharmacological methods were used. Knowledge related to the basic problems associated with pain can be described as insufficient (Me = 4). Frequent use of sedation drugs has also been reported (III level NICU: phenobarbital per os/per rectum 72.8% of respondents, opioids – 34.9%, II level NICU: phenobarbital per os/ per rectum 45.2%, opioids: 4.5%). The longer nurses and midwives worked, the lower the frequency of use of pain assessment tools was (p = 0.0048, R = -0.113). The lack of appropriate pharmacological and non-pharmacological pain treatment and lack of use of pain scales are a significant problem in the care of newborns. Our research indicates the need for education in the field of pain assessment and treatment methods in newborns.

Outcomes research in non-specific low back pain : Knowledge transfer in clinical practice.

SummaryObjectiveThe aims of this article are to provide an overview and discuss current concepts and future trends in outcomes research in non-specific low back pain, specifically considering the perspective of patients, patient-reported outcomes and outcome measures as well as to facilitate knowledge transfer into clinical practice.Review strategyThe breadth of this work and the required brevity of this article were not amenable to a formal approach, such as a systematic literature review or a formal scoping review. Literature sources were identified through medical databases but different sources of information and of various methodologies were also included. Furthermore, outcomes meaningful for patients and examples of outcome measures that are applicable in clinical practice were extracted. Areas for future research were identified and discussed.ResultsPatient-reported outcomes and outcome measures are essential in patient-centered care. The assessment of the patients’ perspective is important to ensure motivation, active involvement, self-management and adherence, especially in non-pharmacological interventions for low back pain. To facilitate the use of outcome measurements for low back pain in clinical practice, future studies should focus on a clinically feasible index, which includes patient-reported as well as clinician-reported or performance-based variables. Relationships between different types of outcomes and outcome measures as well as resource and outcome-based healthcare constitute important topics for future research. New digital technologies can support continuous outcome measurement and might enable new patient-driven models of care.ConclusionActive patient involvement is an essential part of non-pharmacological treatment in low back pain and needs to be considered in terms of outcomes and outcome measurement.

Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model.

Markov model. Examine the 1-year effectiveness and cost-effectiveness (societal and payer perspectives) of adding nonpharmacologic interventions for chronic low back pain (CLBP) to usual care using a decision analytic model-based approach. Treatment guidelines now recommend many safe and effective nonpharmacologic interventions for CLBP. However, little is known regarding their effectiveness in subpopulations (e.g., high-impact chronic pain patients), nor about their cost-effectiveness. The model included four health states: high-impact chronic pain (substantial activity limitations); no pain; and two others without activity limitations, but with higher (moderate-impact) or lower (low-impact) pain. We estimated intervention-specific transition probabilities for these health states using individual patient-level data from 10 large randomized trials covering 17 nonpharmacologic therapies. The model was run for nine 6-week cycles to approximate a 1-year time horizon. Quality-adjusted life-year weights were based on six-dimensional health state short form scores; healthcare costs were based on 2003 to 2015 Medical Expenditure Panel Survey data; and lost productivity costs used in the societal perspective were based on reported absenteeism. Results were generated for two target populations: (1) a typical baseline mix of patients with CLBP (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain) and (2) high-impact chronic pain patients. From the societal perspective, all but two of the therapies were cost effective (<$50,000/quality-adjusted life-year) for a typical patient mix and most were cost saving. From the payer perspective fewer were cost saving, but the same number was cost-effective. Assuming all patients in the model have high-impact chronic pain increases the effectiveness and cost-effectiveness of most, but not all, therapies indicating that substantial benefits are possible in this subpopulation. Modeling leverages the evidence produced from clinical trials to provide more information than is available in the published studies. We recommend modeling for all existing studies of nonpharmacologic interventions for CLBP. 4.

Patient-Centered Pain Management in Obstetrics Through Use of a Comfort Menu

An important part of a woman’s experience during and after birth is her perception of pain management. To increase awareness of available choices for pain management, a comfort menu displaying options for nonpharmacological and pharmacological pain management was created for an obstetrics unit. Five categories, including comfort, comfort actions, relaxation, personal care items, and medication, were developed. Within each of these categories, specific options for pain management were listed. After development, staff and provider education took place and comfort menus were placed in each patient room. Random samplings of 100 patients pre- and postimplementation were obtained, and interviews were conducted from each group. The interviews included questions about patients’ perceptions of pain management and their use of the comfort menu. An increase in nonpharmacological pain interventions was reported in the intrapartum period. Of the patients who responded, percentages of nonpharmacological pain method use increased from 44% preimplementation to 53% postimplementation. Although no significant difference was reported between the postpartum pre- and postimplementation groups, nonpharmacological pain methods continued to be used from the comfort menu. Details of the comfort menu and steps taken to successfully implement this practice improvement project are presented and detailed.

From pain treatment to opioid dependence: a qualitative study of the environmental influence on codeine use in UK adults

ObjectivesTo investigate the views and experiences of people who use codeine in order to describe the ‘risk environment’ capable of producing and reducing harm.DesignThis was a qualitative interview study. Psychological...

Music-Enhanced Analgesia and Antiseizure Activities in Animal Models of Pain and Epilepsy: Toward Preclinical Studies Supporting Development of Digital Therapeutics and Their Combinations With Pharmaceutical Drugs.

Digital therapeutics (software as a medical device) and mobile health (mHealth) technologies offer a means to deliver behavioral, psychosocial, disease self-management and music-based interventions to improve therapy outcomes for chronic diseases, including pain and epilepsy. To explore new translational opportunities in developing digital therapeutics for neurological disorders, and their integration with pharmacotherapies, we examined analgesic and antiseizure effects of specific musical compositions in mouse models of pain and epilepsy. The music playlist was created based on the modular progression of Mozart compositions for which reduction of seizures and epileptiform discharges were previously reported in people with epilepsy. Our results indicated that music-treated mice exhibited significant analgesia and reduction of paw edema in the carrageenan model of inflammatory pain. Among analgesic drugs tested (ibuprofen, cannabidiol (CBD), levetiracetam, and the galanin analog NAX 5055), music intervention significantly decreased paw withdrawal latency difference in ibuprofen-treated mice and reduced paw edema in combination with CBD or NAX 5055. To the best of our knowledge, this is the first animal study on music-enhanced antinociceptive activity of analgesic drugs. In the plantar incision model of surgical pain, music-pretreated mice had significant reduction of mechanical allodynia. In the corneal kindling model of epilepsy, the cumulative seizure burden following kindling acquisition was lower in animals exposed to music. The music-treated group also exhibited significantly improved survival, warranting further research on music interventions for preventing Sudden Unexpected Death in Epilepsy (SUDEP). We propose a working model of how musical elements such as rhythm, sequences, phrases and punctuation found in K.448 and K.545 may exert responses via parasympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Based on our findings, we discuss: (1) how enriched environment (EE) can serve as a preclinical surrogate for testing combinations of non-pharmacological modalities and drugs for the treatment of pain and other chronic diseases, and (2) a new paradigm for preclinical and clinical development of therapies leading to drug-device combination products for neurological disorders, depression and cancer. In summary, our present results encourage translational research on integrating non-pharmacological and pharmacological interventions for pain and epilepsy using digital therapeutics.

(152) Nurses’ Perceptions and Attitudes towards the Management of Patients’ Pain

The experience of pain is different for everyone and there is considerable variability regarding pain perceptions. The recent opioid epidemic is a major source of stress for patients and clinicians alike. There is a significant need for comprehensive pain assessment and nonpharmacological treatments for pain. However, research suggests that nurses experience barriers related to the assessment and treatment of patients’ pain. Such barriers may include not having enough time to work with patients, subjective pain assessments, medication-seeking behaviors, and lack of support from treating physicians. The current study examined the perceptions of nurses regarding barriers to pain assessment, documentation, and treatments in a midwestern hospital system. A survey monkey questionnaire was sent to nurses working in hospital units (N=111) and regional clinics (N=29). Results suggest that nurses in both hospital and clinic settings are willing to recommend certain non-pharmacologic interventions (e.g., relaxation, stretching) for pain management. Hospital nurses are willing to administer non-pharmacologic interventions at a much higher rate compared to their clinic counterparts. The most frequently cited barrier to assessing pain was a disconnect between patients’ self-report of pain and nurses assessment of patients’ pain behavior. Nurses requested several trainings to enhance competency for overall pain management including education regarding medication-seeking behavior, functional or objective pain assessment, and cognitive and behavioral interventions for pain management. The results of the current study will be used to create an educational program that will be developed and administered to allied health professionals to increase awareness of assessing and managing pain from a more holistic perspective. Additionally, a new pain management model will be proposed that incorporates patients’ self-report of pain, biopsychosocial factors, objective assessment information, and clinical factors. (Topolovec-Vranic, American Journal of Clinical Care, 2017; Winslow, The American Journal of Nursing, 1998).