Non-pharmacological Pain Management Strategies Research Articles

Impact of Preoperative Teaching Program among Patients undergoing Kidney Surgery on their both Pain Management outcome and Patient Satisfaction.

Abstract The aim of the present study is to evaluate the impact of preoperative teaching program on pain outcome & satisfaction for patients undergoing kidney surgery. Research design Quasi-experimental study design was be utilized. Sample data were collected from 60 patients undergoing kidney surgery at urology department El-minia university hospital. Research hypothesis mean scores of all aspect of pain management outcome questionnaire in study group would be better than that in control group. Tools utilized for data collection were patient assessment sheets, Teaching Program and Modified American Pain society patient Outcome Questionnaire (APS-POQ- 1995). The results regarding post-op. pain management outcome questionnaire there was statistical significance difference related to pain severity & pain relief as P-value=0.01, 0.00001** ,related to interference with function (activities in bed & out of bed – falling asleep & staying sleep) as P-value = 0.05*, 0.001** 0.020*, 0.001** ,There was statistical difference for Perception of care between study & control groups. Conclusion a highly significant difference in the study group regarding to all aspect of pain management outcome and length of hospital stay compared to the control group and there was positive correlation of using more than two methods of non-pharmacological pain management strategies with post-op. analgesic consumption. Recommendations further research studies are needed to focus on preoperative teaching programs of post-op pain management for patients undergoing surgery.

Pain and Self-Care Behaviours in Adult Patients with End-Stage Liver Disease: A Longitudinal Description

This prospective descriptive study investigated pain characteristics in 20 outpatients with endstage liver disease (ESLD) who were approaching the end of life, described variability in pain between and within patients, and described the pharmacological and nonpharmacological pain management strategies used. The instruments we utilized were the Brief Pain Inventory (BPI) and the self-care behaviour (SCB) log for pain. Data were collected once a month over a six-month period. BPI severity of, and interference from pain mean scores ranged from 5.52 to 6.03 and 5.36 to 6.64, respectively. The top three pain-relieving behaviours reported by patients were "taking pain medication," "taking a nap," and "asking for help." Pain medication intake-differed between patients who were pursuing a liver transplant and those who were not eligible for one. If we are to effectively improve care for ESLD patients, it is essential that we understand the ways in which these patients experience pain and the pain management strategies they employ.

Knowledge and attitude towards pain management. A comparison between oncology and non-oncology nurses in Jordan

Background: Knowledge and attitudes of nurses toward pain management have an influence on medical judgment and patients' perception of pain control. Aim: To assess and compare oncology and non-oncology nurses' knowledge and attitudes toward pain management. Method: A cross sectional descriptive comparative design was used. Nurses were recruited conveniently from one specialized oncology center and one main general medical city in Jordan. Participants were required to complete a specific questionnaire. The total number of participant was 207 nurses (124 oncology and 93 non-oncology nurses). Results: It was evident that oncology nurses received post-registration training or courses in the field of pain management more than non-oncology nurses. Both oncology and non-oncology nurses exhibited an appropriate knowledge and attitude toward pharmacological and non-pharmacological pain management strategies. However, oncology nurses scored higher in the overall knowledge and attitude toward pain compared to non-oncology nurses. Nurses showed knowledge deficit in assuming the risk for addiction and the use of narcotics in pediatric patients. Conclusions: The study revealed that oncology nurses were more knowledgeable compared to non-oncology nurses in managing pain. Professional development for nurses in the field of pain management is required whether during academic preparations or post-graduation.

Pain of osteoarthritis in women: environment research (phase II)

Persistent pain, a characteristic of osteoarthritis (OA), affects many older adults. There is a crucial need to better understand nonpharmacological management strategies for OA pain, particularly for older women who use more analgesics and experience a higher risk for polypharmacy than men. One such strategy, distraction, can be facilitated through engaging multisensory stimuli in outdoor environments abundant with nature. The aim for this study, part of a larger mixed-methods study, was to better understand the relationship between characteristics of older women with/without OA and the amount of time they spend outdoors. Participants were female independent-living residents (N=273, mean age =81.82+/-8.105) at four retirement community sites. Sites were selected for specific outdoor characteristics related to nature. Symptom Management Theory guided development of a 64-item self-administered survey. The anonymous survey included investigator-developed and well-established items. Fifty-one percent of participants reported provider-diagnosed OA. Spearman's rho was used to examine relationships between having or not having OA and age, bodily pain (BP), OA pain (Arthritis Impact Measure-2 Short Form; AIMS2), and time outdoors (number of days/week and usual time/day) in women with/without OA. Age was not related to OA diagnosis (r=.062, p=.325). Greater pain--both BP (r=-.309, p=.000) and arthritis-specific pain (AIMS2, symptom subscale) (r=.483, p=.000)--were significantly related to OA. Women with OA spent significantly fewer days outside (r=-.155, p=.014), but similar amounts of time on days when outside (r=-.037, p=.560). Women with greater BP spent significantly less time outside, both in terms of days/week (r=.251, p=.000) and usual time/day (r=.240, p=.000). The findings help to identify differences between women with/without OA, which will inform future research on nonpharmacological pain management strategies in outdoor environments. Potential future application of this research includes evidence-based design recommendations for senior living environments. Funding: NCRR Grant TL1 RR 025016 and the Hester McLaws Nursing Scholarship. Persistent pain, a characteristic of osteoarthritis (OA), affects many older adults. There is a crucial need to better understand nonpharmacological management strategies for OA pain, particularly for older women who use more analgesics and experience a higher risk for polypharmacy than men. One such strategy, distraction, can be facilitated through engaging multisensory stimuli in outdoor environments abundant with nature. The aim for this study, part of a larger mixed-methods study, was to better understand the relationship between characteristics of older women with/without OA and the amount of time they spend outdoors. Participants were female independent-living residents (N=273, mean age =81.82+/-8.105) at four retirement community sites. Sites were selected for specific outdoor characteristics related to nature. Symptom Management Theory guided development of a 64-item self-administered survey. The anonymous survey included investigator-developed and well-established items. Fifty-one percent of participants reported provider-diagnosed OA. Spearman's rho was used to examine relationships between having or not having OA and age, bodily pain (BP), OA pain (Arthritis Impact Measure-2 Short Form; AIMS2), and time outdoors (number of days/week and usual time/day) in women with/without OA. Age was not related to OA diagnosis (r=.062, p=.325). Greater pain--both BP (r=-.309, p=.000) and arthritis-specific pain (AIMS2, symptom subscale) (r=.483, p=.000)--were significantly related to OA. Women with OA spent significantly fewer days outside (r=-.155, p=.014), but similar amounts of time on days when outside (r=-.037, p=.560). Women with greater BP spent significantly less time outside, both in terms of days/week (r=.251, p=.000) and usual time/day (r=.240, p=.000). The findings help to identify differences between women with/without OA, which will inform future research on nonpharmacological pain management strategies in outdoor environments. Potential future application of this research includes evidence-based design recommendations for senior living environments. Funding: NCRR Grant TL1 RR 025016 and the Hester McLaws Nursing Scholarship.

Self-Management of Chronic Neck and Low Back Pain and Relevance of Information Provided During Clinical Encounters: An Observational Study

Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study. Objective To assess the relative influence of information provided during physical therapy on a patient's adherence to self-management strategies in relation to other predictors of adherence (patient and pain characteristics, use of self-management strategies before intervention). Design A longitudinal observational study of the relationship between the information provided during physical therapy and adherence to self-management strategies. Setting Data came from a clinical-based population in 8 primary health care centers. Participants Patients (N=184) with chronic neck or low back pain (77% under the age of 59y) were surveyed at the beginning and 1 month after completion of physical therapy. Interventions Not applicable. Main Outcome Measures Specific and overall adherence to 2 types of strategies: (1) nonpharmacologic pain management strategies, and (2) neck/back care in activities of daily life. Results Adherence to strategies of nonpharmacologic self-management of pain was more probable when patients received information explaining the effectiveness of the self-management strategies (adjusted odds ratio [AOR]=10.1; P<.05) and information about their illness (AOR=3.4; P<.05) during clinical encounters. Information provided by the physical therapist did not have any influence on the adherence to neck/back care in activity of daily life ( P>.05). Conclusions Information provided during clinical encounters is associated with adherence to different kinds of self-management strategies. While further study is required, it is suggested that more attention be given to clinical practice strategies for improving adherence to self-management of chronic pain.

Pain management in musculoskeletal conditions

This chapter describes a biopsychosocial model of pain and the way in which it can provide a basis for the assessment of pain and the use of non-pharmacological pain management strategies. Various non-pharmacological interventions for musculoskeletal pain are described and evaluated. These include physical, psychological and social/environmental interventions. Given the often complex nature of patients presenting with persisting pain, it is not surprising that single-modality treatments are rarely sufficient on their own, and combinations of interventions offer advantages, on theoretical grounds at least. However, a number of challenges facing clinicians and researchers in applying these methods, especially when done alongside invasive and/or pharmacological interventions, remains to be fully addressed. These challenges have implications for the roles of clinicians from all disciplines, as well as for their patients and the community at large.

Nonpharmacologic Pain Management Strategies in the Pediatric Emergency Department

Youth often arrive in the emergency department (ED) in a state of emotional and physical distress. This distress is exacerbated by unfamiliar environmental stimuli, perceived threat of procedures, and general discomfort inherent in many medical procedures. Pain itself is a highly individualized experience that is most effectively treated via a multimodal, multisystem approach. For this reason, it is imperative that nonpharmacologic pain and stress management strategies are a part of standard ED protocol. Cognitive-behavioral interventions aim to reduce fear, minimize distress and pain, and increase a child's and parents' sense of control. Emergency department staff should be trained on ways to prepare a child for a procedure. After preparation, youth can benefit from being offered brief training in coping strategies. Upon discharge, families should be equipped to continue implementing these newly learned skills at home and during future hospitalizations. This article offers the reader specific strategies to use with youth presenting to an ED.

Stereotyping and nurses' recommendations for treating pain in hospitalized children

The purpose of this study was to examine whether nurses' recommendations for managing children's pain were influenced by stereotypes based on children's personal attributes. Three vignettes, in which hospitalized children's sex, race, and attractiveness were experimentally manipulated, were mailed to a national random sample of 700 pediatric nurses; 334 nurses responded. Responses to vignette questions indicated little evidence of stereotyping. Nurses perceived similar levels of pain and recommended similar pain treatments, regardless of sex, race, and attractiveness. Nurses, on average, perceived children's pain at levels consistent with the children's self-reports and recommended assertive analgesic and non-pharmacologic pain management strategies. The results appear consistent with prevailing views on providing adequate pain treatment for children.

Attitudes to and knowledge about pain and pain management, of nurses working with children with cancer: A comparative study between UK, South Africa and Sweden

Pain is among the most common effects of cancer and its treatment. Children and young people with cancer often consider pain from procedures and treatment to be the worst aspect of their illness. This study aimed to i) identify and describe knowledge and attitudes to pain and pain management amongst nurses working with children with cancer and ii) compare the perspectives on pain and pain management of nurses from UK, South Africa and Sweden. 106 nurses working with children with cancer in UK, South Africa and Sweden completed Salanterä's (1999) questionnaire on nurses' attitudes to pain in children. Nurses had good levels of knowledge and positive attitudes to pain management, with Swedish nurses' having higher levels of knowledge and a more positive attitude to pain management than nurses from UK or South Africa. A high level of knowledge was correlated to a more positive attitude to pain management. Knowledge levels need to be improved to ensure more positive attitudes to pain management, especially for nurses in South Africa. Swedish nurses' level of knowledge about non-pharmacological pain management strategies has scope for improvement. British nurses may need to focus more on the sociology and psychology of pain.

Children's Expectations of Pain, Perceptions of Analgesic Efficacy, and Experiences With Nonpharmacologic Pain Management Strategies at Home Following Tonsillectomy

To document children's (ages 6-15 years) descriptions of their pain management at home following tonsillectomy. Audio-taped interviews of 80 children were transcribed and coded. Data for each response category were tabulated. Children reported they had more pain after surgery than expected, the pain medicine helped to take their pain away, taking the pain medicine was associated with a negative response by some children, and cold liquids/food by mouth provided pain relief. Findings provide insight into children's perspective of pain management at home following tonsillectomy and methods for relieving their pain.

Improved pain management in pediatric postoperative liver transplant patients using parental education and non‐pharmacologic interventions

A pain management intervention, consisting of pretransplant parental education and support, pre- and postoperative behavioral pediatrics consultation, postoperative physical and occupational therapy consultation, and implementation of non-pharmacologic pain management strategies, was introduced to all pediatrics patients receiving liver transplants at Lucile Packard Children's Hospital beginning August 2001. Children receiving transplants pre-intervention (May, 2000 to February, 2001) and post-intervention (August, 2001 to March, 2002) were compared using pain scores, parent perception of pain ratings, length of stay, ventilator days, total cost, and opioid use. A total of 27 children were evaluated (13 historical control, 14 intervention). The two populations did not differ on age at transplant (mean age 53.8 vs. 63.6 months), sex (46.1% vs. 50% male), ethnicity (53.8% vs. 57.1% white, non-Hispanic) weight at transplant (17.5 vs. 24.7 kg), percent with biliary atresia as the primary reason for transplant (42.9% vs. 69.2%), percent with status 1 transplant listing score (38.5% vs. 50.0%), or public insurance status (30.8 vs. 57.2% with Medicaid). No differences were found in mean pediatric intensive care unit (PICU) postoperative length of stay (6.7 vs. 5.3 days), total postoperative length of stay (17.5 vs. 17.5 days), total inpatient length of stay (27.0 vs. 24.4 days), time to extubation (30 vs. 24.3 h), total cost (dollar 147,983 vs. dollar 157,882) or opioid use through postoperative day (POD) 6 (0.24 vs. 0.25 mg/kg/day morphine equivalent). A decrease in mean pain score between POD 0 and 6 (2.82 vs. 2.12; p = 0.047), a decrease in mean parental pain perception score (3.1 vs. 2.1; p = 0.001), and an increase in number of pain assessments per 12 h shift (3.43 vs. 6.79; p < 0.005) were seen. A comprehensive non-pharmacologic postoperative pain management program in children receiving a liver transplant was associated with decreased pain scores, improved parent perception of pain, and an increased number of pain assessments per 12 h shift. No increases in lengths of stay (PICU, postoperative, total), time to extubation, or total cost were found.

Longitudinal Assessment of Pain, Coping, and Daily Functioning in Children with Sickle Cell Disease Receiving Pain Management Skills Training

Objective. To conduct intensive pain management skills training (IST) in children with sickle cell disease (SCD) and their parents and to comprehensively evaluate pain, coping, and daily functioning in children pre, immediately post, and 3 months following treatment. Methods. Three children who received IST in nonpharmacological and pharmacological pain management strategies completed a Coping Strategies Questionnaire (CSQ) at pre, post, and follow-up assessments, and daily pain and activity diaries for 18 weeks, spanning from 1 week pretreatment to 11 weeks posttreatment. Results. From pre- to posttreatment, 1 child receiving IST indicated increased report of active coping attempts and all 3 children indicated decreased report of negative thinking on the CSQ. Participants in IST used coping skills on 90% of days with pain and reported the skills to be moderately helpful on the daily diaries. For daily activities such as eating dinner, playing with friends, and hours slept, children participated similarly on days with pain and days without pain during the posttreatment period. Given the small number of participants in this study, individual cases are discussed to highlight similarities and differences in how participants responded to the treatment and during the 3-month follow-up period. Conclusions. In this pilot study, each participant showed improvement in coping and daily functioning after completing the IST program. Individual differences in response to treatment indicate the need for more targeted intervention programs that incorporate pharmacological and nonpharmacological components. The results of this study highlight both the promise and the complications of conducting comprehensive pain intervention and functional outcome studies in children with SCD.

Pain Education and Management in the Rehabilitation from Sports Injury

This article addresses the essential role that pain plays in the rehabilitation of sports injury. It will describe important information and approaches that applied sport psychologists can use to more effectively manage pain in injured athletes. The article includes a brief discussion of the most accepted theories of pain. Types of pain that injured athletes may experience and how they can learn to discriminate between them will be discussed. The article will also consider how pain can be a useful tool as information about injured athletes’ current status in recovery and the need to modify their rehabilitation regimens. The value of measuring pain will be examined with emphasis on determining a simple and easy means of assessing pain. Next, the article will examine why nonpharmacological pain management may be a useful adjunct to pharmacological pain control. Then, a brief description of the most commonly used pain medications and a detailed description of common nonpharmacological pain-management strategies will be furnished. A discussion of how nonpharmacological pain management can be incorporated into the traditional rehabilitation process will be offered. Finally, the article will describe the role that sport psychologists can play in the management of sport injury-related pain. The objective of this article is to provide applied practitioners with the knowledge and tools necessary to assist injured athletes in mitigating the pain they will experience during recovery as a means of facilitating their rehabilitation and return to sport.