Nonpharmacological Pain-Relief

1. Nonpharmacological Pain-Relief George Ann Daniels MS, RN

2. Nonpharmacolocial Interventions • Cognitive-behavioral and physical approaches • Goal • Change patients perceptions of pain • Alter pain behavior • Provide patients with a greater sense of control

3. Criteria for Nonpharmacological Interventions • Find such interventions appealing • By in effect • Express anxiety or fear • May benefit from avoiding or reducing drug therapy • Are likely to experience or need to cope with a prolonged interval of postoperative pain • Have incomplete pain relief after use of pharmacological interventions

4. Acupressure • Asian medicine • Opens congested energy pathways to promote a healthier state • Nurse therapist • Applies pressure along energy pathways

5. Relaxation • Mental and physical freedom from tension and stress. • Provides individual self control when discomfort or pain occurs • Reversing the physical and emotional stress of pain • Effective at any phase of health or illness • Meditation, Zen, guided imagery and progressive relaxation exercise

6. Common sensations • Decrease in temperature or numbness of a body part • Environment • Free of noise and other irritating stimuli • Body positioning • Light sheet or blanket for warmth • Comfort

7. Body Positions for Relaxation • Sitting • Sit with entire back resting against back of chair • Place feet flat on floor • Keep legs separated • Hand arms at the side or rest on chair arms • Keep head aligned with spine • Lying • Keep legs separated with toes pointed slightly outward • Rest arms at sides without touching sides of body • Keep head aligned with spine • Use thin, small pillow under head

8. Effects of Relaxation • Decreased pulse, blood pressure, and respirations • Decreased oxygen consumption • Decreased muscle tension • Decreased metabolic rate • Heightened global awareness • Lack of attention to environmental stimuli • No voluntary change of position • Sense of peace and well- being • Deep, awake, restful period of alertness

9. Guided Imagery • Creation of an image in the mind • Special place of comfort and/or rest • Concentration of the image • Less aware of pain more in tune with image • Nurse’s voice calm, soft voice, speaks continually

10. Progressive Relaxation • Relaxation of the entire body • 15 minutes • Tense areas are replaced with warmth and relaxation • Relax better with eyes closed • Soft music background • Combination of controlled breathing exercise and a series of contractions and relaxations of muscle groups

11. Distraction • The reticular activating system inhibits painful stimuli if the patient receives sufficient or excessive sensory input • Pleasurable stimuli cause the release of endorphins • Directs the patients attention to something else • Reducing the awareness of pain and increasing the tolerance of pain • Works best short term • Short intensive pain that lasts only for a few minutes • Singing, praying, describing photos or pictures aloud, listening to music, and playing games

12. Music • A form of distraction • Perform ( playing an instrument or singing) or listen to music • Music matches a person’s mood • Music with no vocals • Listen for at least 15 minutes

13. Music to Control Pain • Match musical selections to the patient’s taste. • Consider age and background • Use earphones to avoid annoying other patients or staff and help patient to concentrate on music • Be sure controls on the radio, CD, or tape player are easy to press, manipulate, and distinguish • Have family members bring tapes or CD’s from home • If pain is acure, increase the volume of the music. As pain decreases, reduce volume

14. If background music is provided, select general types suited to the patient’s preferences • Have the patient concentrate on the music and emphasize rhythm by tapping fingers or patting the thigh • Avoid interruptions by dimming lights and closing the drapes or door • Leave patients alone as they listen to the music

15. Biofeedback • Behavioral therapy • Gives the patient individual information about a physiological response • B/P, Tension • Ways to exhibit voluntary control over the responses

16. Reducing Pain Perception • Controlling painful stimuli • Tighten and smooth wrinkled bed linens • Position tubing on which patient is lying • Foley Bag • Loosen constricting bandages • Unless contraindicated • Change wet dressings and linens • Position patient in anatomical alignment • Check temperature of hot or cold applications, including bathwater

17. Lift patient in bed-do not pull • Position patient correctly on the bedpan • Avoid exposing skin or mucous membranes to irritants • Urine, stool, wound drainage • Prevent urinary retention by keeping Foley catheters patent and free flowing • Prevent constipation with fluids , diet, and exercise

18. Cutaneous Stimulation • Stimulation of the skin to relieve pain • Massage, warm bath, ice bag • Avoid cutaneous stimulation over sensitive skin • Burns, bruises, skin rashes, inflammation, and underlying bone fractures

19. Cold and Heat Applications • Relieve pain and promote healing • Application varies with problem • Heat may relieve pain from tension headaches • Cold may relieve pain from inflamed joints • Safety precaution • Check temperature • Avoid direct application • Caution in spinal cord injuries, confused patients, neuropathy

20. Massage • Application of touch and movement to muscles, tendons and ligaments without manipulation of joints • Blocks perception of pain impulses • Relaxes muscle tension and spasm • Back rub • 3-5 minutes