Non-Pharmacologic Therapeutic Nursing Interventions for Patients with Chronic Pain
It is imperative for any health worker to take cognizance of the fact that a huge population of people is experiencing chronic pain. As such, there is a need for a differentiated care that focuses on non-pharmacological nursing remedies in pain control and achievement of positive care outcomes. Chronic pain is a complex, subjective, and multifaceted experience that not only deteriorates the quality of life but also the position of an individual in the society. Chronic pain implicates on a person's daily activities, general well-being, and also their professional performance among others. Healthcare managers need to understand the adverse effects of chronic pain and avail necessary resources that would support non-pharmacological nursing intervention in controlling pain and maximizing the health gains. Some of the benefits that could be achieved from non-pharmacologic nursing interventions include improved functional capacity, increased the quality of life, pain control, solving psychological maladjustment, and bolstering health literacy among others. As such, hospitals should invest on non-pharmacological interventions of pain management as remedies in primary health care and in the hospital environment in general.
Chronic Pain as a Problem
Chronic pain is not only a problem to the physical health of an individual but also to the psychological well-being of an individual. The patients could develop low-self esteem due to the changed perceptions with regards to their body image hence compromising on their relationship with others. The nurses, therefore, have an immense challenge of taking care of the chronic pain patients because they require different therapeutic expertise and knowledge in accordance with the preferences of the patient, scientific evidence, and the goals of treatment. Research postulates that that close to 100 million people in the United States have reported cases of chronic pain. Despite the high prevalence of this health problem, nurses are poorly trained to manage the condition and have experienced much frustration that comes with the emotional toll required in the management of the condition. Chronic pain is usually defined as a type of pain that goes beyond 3 to 6 months or that which simply go longer than what the normal healing period is known. Understanding the patient experience in chronic pain requires the knowledge of the biopsychosocial model of chronic where the nurse has an opportunity to envision a host of factors including the biological and psychological characteristics of the patient with regards the social and cultural background.
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Interventions
Cancer is the second most common cause of death in the US. Oncology patients experience complicated issues in the course of their sickness which cause both physiological and psychological problems. Pain is one of the most common problems facing these patients. Most of the pharmacological treatment strategies have only worked to diminish the quality of life and increasing pain. As such, nurses should resort to non-pharmacological strategies in treating the chronic pain that comes with diseases such as cancer. Therapeutic massage is one of the strategies that have proved to show desirable results in patients. It involves the manipulation of soft tissue by means of kneading, rubbing, and rolling by a trained nursing professional. It is a reliable technique more so because it is noninvasive and inexpensive. Research has also proven that therapeutic massage has the ability to control adverse symptoms such as pain hence improving the quality of life in cancer patients. Nurses, especially in the developing countries lack sufficient knowledge in this intervention and thus have not yet applied it.
Chronic pain is a common problem especially in the aging population residing in the nursing homes. Abdulla et al. (2013) asserted that research has shown that 50% of the older people living in the community are experiencing chronic pain while the number almost doubles to 80% for those living in the nursing homes. Physical activity or exercise has been postulated as an effective non-pharmacological strategy that can reduce pain and further improve both the physical and the psychological functions of the patient. Research has further shown that the prevalence of chronic pain among the older adults is directly proportional with age and peaks at around the seventh decade of life. Some of the most common types of pains among these patients include low back pain, shoulder and knee pain, and neuropathic peripheral pain among others. Among these types of patients, pain increases physical disability, negatively impacts on the quality of life, and increases the cost of managing the patients. Therefore, nurses can prescribe regular and well-managed chronic pain as an addition to pharmacotherapy. However, nurses might experience a lot of challenges with this intervention because as people age, they adopt a more sedentary life hence failing to adhere to the physical activity recommendations outlined under the American College of Sports medicine (Ambrose & Golightly, 2015).
Nurses have a critical role in interacting with the patient. Through their engagement, the patient cannot acquire vital information and the nurse will also get the view of the patient that will help them in making decisions regarding the psychological well-being of the patient. As such, a form of intervention known as therapeutic communication is highly suggested as a non-therapeutic remedy for patients. Nurses can use this method in discussing, educating, or acquiring critical information about the patient that will be used in the analysis. Nursing is a science that also focuses on meeting the needs of the humans with regards to their spiritual and biosychosocial needs (Sarzi-Puttini et al . 2012). As such, scientific knowledge will not be enough unless interpersonal, technical, and intellectual skills are incorporated. As such, therapeutic dialogue or interpersonal communication becomes a pillar of this practice. Whereas therapeutic dialogue can do little in reducing the actual chronic pain experienced by a patient, it has several benefits that can improve the well-being of an individual. First, it ensures that the nursing practitioner understands the patient better giving the nurse an impetus to treat them effectively. As stated earlier, the therapeutic dialogue takes a biopsychosocial model hence potentially mitigating the effects of chronic pain that might impede on the psychological and social well-being of the patient.
Another common type of pain among patients is fibromyalgia. It is a disorder that is characterized by fatigue, memory problems, lack of sleep, and mood issues. Research has postulated that fibromyalgia is a chief cause of pain sensation in the body because it affects the way the brain processes signals carrying pain. Symptoms of pain mainly occur after surgery, trauma, psychological stress, or infection. People suffering from this disorder have different types of pains including tension headaches and abdominal pains. Fibromyalgia has no cure but pharmacological and non-pharmacological interventions can be suggested to manage the situation. One of the interventions suggested by nursing practitioners is the use of wool underwear especially in patients with chronic back pain. According to Gatchel et al. (2014) illustrated that a study conducted showed that patients who use wool underwear have an 84% drop in the pain experienced due to the disorder. Nurses should recommend the use of wool clothing in patients with fibromyalgia not only because it reduces pain but because it is inexpensive. Wool plays an important role in reducing pain mainly by increasing warmth which increases blood flow hence increasing blood flow. It also reduces the chances of moisture accumulation hence preventing the muscles of an individual from getting chilled. Nurses must understand that the pain associated with fibromyalgia increases in the winter and as such, they should encourage more of the patients to wear the underwear at that particular time.
Back pain is another common type of pain that is mostly experienced by patients that are recovering from accidents, injuries sustained in sports, and muscle strains. One of the nursing non-pharmacological interventions that could be applied is the use of chiropractors. The machines use hands-on spinal manipulation and aim at aligning the body's musculoskeletal structure enabling it to health promptly without necessarily using medication or surgery. It manipulates the body's skeletal system hence restoring mobility of the joints which might have been impeded by a traumatic event (Gatchel et al . 2014).Other areas that can benefit from the chiropractic include the cartilages, tendons, ligament, bones, and connective tissues among many more.
Diet is also at the center stage of pain management. Nursing has an important role in ensuring that the patients adhere to nutritional practices that are important in alleviating the chronic pain experienced in different types of patients such as cancer and fibromyalgia patients. Nurses must also ensure that they educate their patients appropriately on the risk and benefits of the food agents with regards to the chronic pain. It is important for the nurses to classify the pain supplements and evaluate their effectiveness in reducing adverse reactions in patients. For example in the treatment of joint pain, the nurses can advise the patients to focus on dietary supplements that inhibit the production of pro-inflammatory mediators or in some instances the lipoxygenase inhibition. For instance, Sarzi-Puttini et al . (2012) pointed out that turmeric has an active ingredient known as curcumin which inhibits the production of pro-inflammatory inhibitors such as the nuclear factor-kappa. Treating migraine headaches might require nurses to take a different approach where they can ask the patients to focus more on foods rich in vitamin B2.
Lastly, nurses can also use the distraction strategy as a non-pharmacological way of managing pain. It has proved to be an effective way of helping the patients shifts their attention to a different thing hence leading to a temporary relief. However, it is vital for the nurses to note that not everything can work as destruction on an individual. They, therefore, have a role to identify what works best for an individual. Some examples of activities that can cause an individual to change their focus from their source of pain include watching television, listening to music, reading, writing or walking among others. In attempting to improve the senses of an individual, nurses can also engage in what is referred to as guided imagery. However, it remains vital for hospital managers to invest heavily in the process of non-pharmacological intervention because other than requiring the proper qualification of the nurse practitioner, its success also depends on the availability of certain important facilities
In conclusion, chronic pain remains a major problem in many hospital facilities. As shown by the data, almost 30% of the Americans are suffering from the disorder. Other types of patients especially oncology and terminally ill individuals suffer to a great extent due to the chronic pain. Despite the success of pharmacological therapy, in some instance, they have fallen short and subsequently require the non-pharmacological methods as supplements. Examples of the non-pharmacological methods that could be utilized by the nurses include physical activity, therapeutic dialogue, therapeutic massaging, nutritional consideration, and destruction among others. However, it is vital to note that this has remained a major challenge for two reasons. One, the nurses have minimal skills in managing chronic pain and lack of adequate and appropriate facilities. As such, the hospital management should focus on remedying these two areas to enhance positive care results among chronic pain patients.
References
Abdulla, A., Adams, N., Bone, M., Elliott, A. M., Gaffin, J., Jones, D. ... & Schofield, P. (2013). Guidance on the management of pain in older people. Age and ageing , 42 , i1-57.
Ambrose, K. R., & Golightly, Y. M. (2015). Physical exercise as non-pharmacological treatment of chronic pain: why and when. Best Practice & Research Clinical Rheumatology , 29 (1), 120-130.
Gatchel, R. J., McGeary, D. D., McGeary, C. A., & Lippe, B. (2014). Interdisciplinary chronic pain management: past, present, and future. American Psychologist , 69 (2), 119.
Sarzi-Puttini, P., Vellucci, R., Zuccaro, S. M., Cherubino, P., Labianca, R., & Fornasari, D. (2012). The appropriate treatment of chronic pain. Clinical drug investigation , 32 (1), 21-33.
