Nonpharmacological pain relief
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Nonpharmacological Pain-Relief George Ann Daniels MS, RN Nonpharmacolocial Interventions Cognitive-behavioral and physical approaches Goal Change patients perceptions of pain Alter pain behavior Provide patients with a greater sense of control

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Nonpharmacological pain relief l.jpg

Nonpharmacological Pain-Relief

George Ann Daniels MS, RN


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Nonpharmacolocial Interventions

  • Cognitive-behavioral and physical approaches

  • Goal

    • Change patients perceptions of pain

    • Alter pain behavior

    • Provide patients with a greater sense of control


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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


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Acupressure

  • Asian medicine

  • Opens congested energy pathways to promote a healthier state

  • Nurse therapist

    • Applies pressure along energy pathways


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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


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  • 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


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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


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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


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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


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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


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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


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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


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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


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  • 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


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Biofeedback to the patient’s preferences

  • Behavioral therapy

  • Gives the patient individual information about a physiological response

    • B/P, Tension

  • Ways to exhibit voluntary control over the responses


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Reducing Pain Perception to the patient’s preferences

  • 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


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  • Lift patient in bed-do not pull to the patient’s preferences

  • 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


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Cutaneous Stimulation to the patient’s preferences

  • 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


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Cold and Heat Applications to the patient’s preferences

  • 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


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Massage to the patient’s preferences

  • 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


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