Non-Pharmacological Pain Management Strategies: Determining the Most Efficient Strategy

Pain is an unpleasant sensation. It is often an experience related to potential and/or real tissue damage. Although the phenomenon is mostly subjective, it is also considered a symptom for individuals requiring medical aid. The International Association for the Study of Pain defines the phenomenon as an unpleasant situation affecting ones emotion originating from an area of the body, which could be non-dependent or dependent on tissue damage from the individual’s past experiences (Anand & Craig, 1996). 

There is increased knowledge and development in the medical resources concerning pain management. Nevertheless, there is still a large number of patients who experience pain. As a result, the quality of life and their functional capabilities are greatly reduced, with significant increase in fatigue levels and impairments within their daily activities as well as social interactions (Rustøen, et al., 2012). Furthermore, it is likely that such a situation will affect the patient’s familial wellbeing economically because of their inability to be part of a workforce. The result is that there are both undesirable psychological and social outcomes. As a result, both caregivers and patients have resulted in searching for different approaches to pain management. This is why pharmacological treatment techniques are also considered against non-pharmacological and other complementary mechanisms. Their use has now become widespread and they have been found to be useful in managing pain. Patients with chronic lumbago have used massage therapy whereas complementary methods have been used to treat back pain and neck pain (Dryden, Baskwill, & Preyde, 2004; Kong, et al., 2013). 

Non-pharmacological therapies help standard pain management in achieving pain relief in patients. Whereas medical aspects are used for treating the physiological tenet of the individual, non-pharmacological therapies treat the cognitive, behavioral and socio-cultural dimensions of the individual. These treatment methods could serve as complementary or adjuvant in cases where there is severe pain for the patient. Non-pharmacological therapies are intended to, among other things, decrease individual feelings of weakness and improve feelings of control, reduce stress and improve activity levels of the individual, reduced focused pain levels and the need for the ingestion of analgesics, thereby reducing adverse side effects of treatment (Menefee & Monti, 2005). 

The widespread use of non-pharmacological pain management methods and the variety of their classifications is a subject of interest for this paper. There are both invasive and non-invasive methods, as well as physical, behavioral, cognitive and complementary methods. A number of non-invasive methods includes music therapy, hypnosis, progressive relaxation and meditation. Acupuncture is one of the famous invasive methods. These methods are considered to control pain receptors to the brain and release endorphins, thereby relaxing the individual (Menefee & Monti, 2005). The literature review examines different non-pharmacological methods to manage pain for all three categories of therapies. 

Significance of the Practice Problem 

This research proposal suggests a research model that would evaluate multiple non-pharmacological pain management methods to determine the most suitable and efficient alternative pain management method, as witnessed by research. By looking through different research articles offered by scholars, the research will adequately determine the most widely used non-pharmacological pain management method and its efficacy in achieving the outcomes mentioned above. By determining the most efficiency non-pharmacological pain management technique, this research could effectively change the terrain in pain management and offer more straightforward capabilities in recommending pain management routines for patients. 

PICOT Question 

Despite the multiplicity of non-pharmacological methods of pain management, there is minimal compilation of the efficacy of non-pharmacological methods in managing pain for patients. This is especially true for patients suffering from chronic diseases experiencing severe pain. This paper intends to conduct a qualitative study that collates information from various studies on the efficacy of different non-pharmacological pain management methods to provide a suitable research on the most effective forms of pain management methods that are non-pharmacological in nature. This strategy is intended to offer quick and lasting pain relief to the patient within the shortest timeframe. As a result, this research will seek to provide an answer to the following question: which non-pharmacological pain management techniques provides the highest efficacy to patients to relieve their pain swiftly and in a lasting manner? 

Theoretical Framework 

This research is contemplated in light of the Gate Control Theory. It asserts that when non-painful input is exerted, the gates to painful input are closed, thereby preventing pain from traveling to one’s nervous system. As a result, it is possible to suppress pain by providing non-noxious input (Melzack, 1996). This theory builds on the assertion that the perception of pain is a psychological concept and is one of the most influential theories of pain research. Moreover, the theory accounts for perceptions of pain in both the physical and psychological aspects. The gate control theory provides that activating nerves which do not transmit pain signals could interfere with pain fibers, thereby providing an inhibiting effect against pain. These nerves which do not transmit pain, known as nonnociceptive fibers, are large in diameter and can inhibit the activity of smaller pain nerves firing in the body, once activated. 

Review of Literature 

Peripheral Therapies 

Stimulation of the skin which provides natural analgesia to the patient without any harm can treat pain. Multiple peripheral treatments exist, including hot-cold treatment, acupuncture, positioning, exercise, massage, TENS and therapeutic touch. When used appropriately, these methods effectively work on inflammation, tissue damage, muscle spasms and the loss of function occurring during excessive pain. 

Transcutaneous Electrical Nerve Stimulation (TENS) 

TENS is a procedure involving applying electrical stimulation to the patient’s skin to manage pain. It could be used as an alternative to or in conjunction with pharmacological methods to provide relief for acute, post-operative and chronic pains. As an electro-analgesic method, it provides rapid stimulations to the nerves, thereby reducing or stopping the transmission of pain altogether. As a result, it reduces the use of narcotic drugs and levels of pain. Research has shown that patients using the TENS method experienced between two to four times less pain for post-operative management of pain whereas it reduced the usage of analgesics as well (Moran, et al., 2011). 

Hot-Cold Treatment 

Hot treatment normally revolves around moving reflex muscles that hold heat to reduce heat via vasodilation. When used regularly, there is minimal side effects and it is also quite cheap. It could be applied both deeply and on the surface. Application could be used using hot compresses, paraffin use or warm baths. Tissue up to five centimeters deep could be affected by the treatment. In contrast, cold treatment involves applying cold gel or ice packages on the skin using a towel or gauze to provide a cooling effect on the body. When done for approximately half an hour, an anesthetic effect could be achieved on the target area. Cold treatment will normally be experienced in four stages, namely: feeling cold, a burning sensation after 2-7 minutes, lethargy between 5-12 minutes and a breaking, where transmission of nerve fibers in the target area ceases. The tissue will be nourished by vasodilation in the area following 15 minutes after the cold treatment. Cold treatment increases pain threshold (Lolignier, et al., 2016). 

Acupuncture 

This procedure is a traditional Chinese procedure that is a common complementary pain management mechanism. Special pressure points on the body are stimulated with needles (Patil, et al., 2016). The Gate Control Theory attempts to explain the efficacy of this method as one which reduces the effect of the sensory stimulant by introducing another stimulant (needle picking) within the patient’s neural system. The Raising Pain Threshold theory also explains this phenomenon by stating that treating pain requires the introduction of the body’s analgesic mechanisms. Acupuncture stimulates endorphin production as well as serotonin (Chou, et al., 2017). Literature has it sated that acupuncture is effective in treating lumbago although patients must be willing to continue with the intensity of treatment. Even then, there is limited evidence indicating the effect of acupuncture in managing cancer-related pain. 

Exercise 

Exercise comprises both active and passive movements, ambulation and bed movements that increase the continuity of blood flow. As a result, spasms are removed and the contraction of muscles is promoted, thereby relieving pain. It is one of the methods of pain management (Ambrose & Golightly, 2015). However, there is little evidence regarding the efficacy of exercise as a pain management method. 

Positioning 

Positioning is applied so that it helps the patient to gain support. By using pillows, weightlifting and special beds, it is possible to provide the patient with position changes which hinder the development of pain as well as reduce acuteness. Positioning is most commonly used after operations. 

Movement Restriction/Rest 

Patients who require bedrest or who are in traction receive this pain management method. Where patients undergo back surgery or have fractures that render them immobile receive this treatment. 

Massage 

It is the manipulation of the soft tissue using different techniques, including vibration and friction, thereby promoting recovery and health. Massage relieves the mind and muscles and also increases the pain threshold. Stimulants and the massage stimulates peripheral receptors and reach the brain via the spinal cord. In addition to pleasantness felt by the patient, relief is provided to the patient so that its effect is felt on chronic lumbago patients. However, patients using this alternative pain management method require integrated care to have effective outcomes. For instance, massage during labor decreases anxiety and pain levels, while promoting birth progression and the wellbeing of both mother and child (Field, 2016). 

Hydrotherapy 

Hydrotherapy involves using water treatment methods through its temperature effect. This includes thermal springs, steaming and other portable water resources which create the hydrothermal effect. Hot application will stimulate the individual’s immune system, provide hormones necessary to relieve stress and promote digestion and circulation. As a result, blood flow to the muscles is improved to provide relaxation of muscles. Sensitivity towards the pain is thereby reduced. 

Cognitive Therapies 

These are a number of multimodal approaches to pain management. Aside from affecting the pain levels, these methods also seek to develop the patient’s ability to manage themselves when dealing with the pain, leading to improved self-esteem and a cultivation of pain management behavior. As a result, these are normally applied by pain team members, who are specialists in pain management. Without fail, pain teams should contemplate these before the patient experiences pain. 

Relaxation 

Through respiration and dreaming, the patient experiences a slow in brain waves due to reduced oxygen consumption, pulse, respiration and blood pressure. As a result, sensitivity to pain is reduced via this mechanisms. Spiritual and physical relaxation is normally acquired through relaxation, where focus on calming thoughts is maintained while taking deep breaths slowly through the nose. Advanced muscle relaxation normally considers getting rid of unwanted contractions by avoiding thoughts that led to the patient’s muscle contraction. Alternatively, the patient could dream, where the patient focuses on something that makes them happy so as to get away from their pain for a period of time. 

Distraction 

By refocusing away from pain, one is able to reduce its severity. Distraction increases one’s pain tolerance by reducing sensitivity to pain. Distractions could include reading books, listening to music and dreaming. Various pieces of research support the use of distractions as pain management methods (Karakaya & Gözen, 2016). 

Praying 

Individuals with chronic pain are also known to use the praying method. Praying has been found to have positive results to reduce pain especially among elderly adults. Moreover, older adults have reported relief in their functional disorders, as praying reduces depression and anxiety resulting from pain (Olshansky, et al., 2015). 

Traditional Meditation 

Meditation involves focusing on the moment, or focusing on the present. The individual focuses on their own breathing, a picture or a specific word. The meditation could last as long as 30 minutes. Since it helps with relaxation, it is considered effective for pain management. Patients with chronic back pain have successfully used the meditation method to induce relaxation and relieve pain (Banth & Ardebil, 2015). 

Yoga 

Yoga provides relaxation through respiration exercises and additional meditation with minimal movements. It is considered useful for musculoskeletal pain due to its ability to stretch and increase individual strength. Studies have indicated that yoga has been helpful to individuals with chronic back pain so that such individuals have increased their functional sufficiency. 

Hypnosis 

This is a state of consciousness similar to being asleep. As such, the body remains in a relaxed position and is able to focus on an object of interest, whether it is a memory or a stimulant. In this state, one can reach their subconscious while they suspend important abilities. Consequently, it is easier to dominate the person under hypnosis. However, the mechanism of hypnosis to reduce pain is not established in evidence, neither is it known whether pain is reduced by a set of physiological changes occurring within this state. Hypnosis has been used in cancer pain management, as well as management of pain within the head and neck regions alongside phantom pain which is common for amputees. 

Bio-feedback 

Biological feedback involved informing the patient so as to help them relax and control a physiological function. In tension headaches, for instance, electrical activity within the head and facial muscles is interpreted as colors for the patient. Consequently, as the patient observes the color changes, they are able to determine whether they have relaxed or not. Biofeedback is used in pain management for migraines, movement disorders and spinal cord injury. By seeing the color changes, the customer is able to control physiological reactions, including their body temperature, heart rate, muscle tension and brain wave activity among other vital signs. The desire of the patient to control these signs determines the efficiency of the treatment. Pain teams applying this mechanism teach patients to master their mental and physical processes using visualization and deep breaths. Bio-feedback has been seen to be effective for most types of chronic pain (McJunkin, Swing, Walters, & Lynch, 2017). 

Summarizing the Literature 

From the above literature, it becomes abundantly clear that pain has multiple ways of being effectively managed using both pharmacological and non-pharmacological methods. The development of alternative pain management method might provide a variety of opportunities to both patients and their families to experience more productive and comfortable lives. Both caregivers and health professionals have important roles in pursuing the developments within pain management to keep themselves abreast with changes in both pharmacological and non-pharmacological management techniques. Moreover, these techniques have showed promise in reducing pain and they must be encouraged as a section of comprehensive pain management tools. Where the patient is willing, both pharmacological and non-pharmacological methods should be introduced into their pain management plan. While it is recommended in some researches that non-pharmacological approaches be used to manage pain, little evidence is present regarding the efficacy of each method. This research model is prepared such that a preferred and most efficient non-pharmacological method is determined. 

Project Description 

Following the discussion provided above, the aim of this research is to determine the most effective non-pharmacological method of pain management currently available. In this section, an appropriate design will be selected such that it reflects the aims and objectives of this research, thereby providing an answer to the research question posed. 

A mixed approach was taken in approaching the study question. An explorative qualitative design was pursued in determining the professionals’ opinion regarding the efficacy of non-pharmacological pain management techniques. Physicians and care team members were approached and asked regarding the frequency and popularity of different non-pharmacological pain management mechanisms to determine the most frequently used mechanism. Furthermore, physicians were asked to rate the most effective pain management technique among the non-pharmacological alternatives. 

The quantitative aspect of the research revolved around literature surrounding the efficacy and efficiency of different non-pharmacological pain management mechanisms. This quantitative research would evaluate research on non-pharmacological pain management techniques to determine the take of various researchers on the subject. This information would supplement the survey data obtained in the course of the research, thereby proving or disproving the findings of the qualitative study. 

Essentially, this design enables the researcher to actualize findings from the field regarding the professional opinion of healthcare providers regarding efficacy of different non-pharmacological pain management techniques by comparing them with existing literature on the subject. 

Setting and Resources 

This study will be set in the local hospital setting where there is sufficient access to healthcare providers and pain management teams. This research will require access to a number of healthcare providers to obtain the required information regarding professional opinions on non-pharmacological pain management methods and their popularity among patients. As a result, the first location will be within a healthcare setting. A number of resources will also be required to facilitate this research, namely access to a host of research articles covering the efficacy of non-pharmacological pain management techniques. The school online library will be used for this purpose, thereby enabling the researcher to obtain both abstracts and full articles that discuss the efficacy of non-pharmacological pain management techniques. 

Study Population 

The study will involve pain management teams and healthcare providers in providing information regarding efficacy of alternative pain management methods. In this manner, the study aims to contact twenty healthcare providers and provide them with a questionnaire requiring the practitioners to answer related questions. These questions will seek to espouse on alternative pain management methods and their use, efficacy and popularity within care settings. Potential respondents will be recruited via mail through an email message containing a consent form. The consent form will discuss the aims and objectives of the study, the importance of the study and provide them with the choice to proceed with the questionnaire once they understood the requirements from the consent form. 

Convenient sampling will be used for this study, noting that respondents from a local health facility have been selected for this study. Specifically, practitioners within pain management units including labor, intensive care and post-operative units will be contacted regarding alternative pain management methods. This is because such groups are well-placed to provide answers concerning the subject, following the example of multiple pieces of research in the area. Respondents’ number of years’ experience will be collated, thereby determining if years of practice influence the practitioner’s opinions regarding suitable alternative pain management strategies. However, a minimum of three years’ experience in pain management will be required for participation in the study. Some of the variables being contemplated will include the age of the patient in pain management choices, their gender, socio-economic status, treatment preference and religion. The independent variable will be non-pharmacological pain management. 

Sources of Data 

Reputable databases will be used to obtain the quantitative data being used for the critical appraisal. Studies that meet the inclusion criteria will be selected and used for the purpose of determining evidence on the subject matter. Databases such as the US National Library of Medicine, Google Scholar and EBSCOHost will be used for this purpose. On the other hand, the qualitative data will be obtained from the study population, thereby providing the confirmatory assent to the literature. 

Project Evaluation Results 

Data Analysis 

Appropriate data collection mechanisms will be put in place. Collated data will be tabulated and appropriately using data extraction tools. Subsequently, the data will be fed into SPSS for data analysis and synthesis. The efficiency of the different non-pharmacological pain management methods will be tested using Chi-square tests to determine heterogeneity. The means will also be used to indicate the average preference response of caregivers towards each alternative pain management method. The results will be tabulated and explained for the purpose of providing comprehensible results. 

Quality 

Discuss the mechanisms you will use to assure the quality of the study, for example, the control of bias or the safe storage of data. 

Ethics and Human Subjects Protection 

This study has contemplated the ethical concerns that might be in place with regards to the study in question. To this end, the study does not require personal patient information to be provided in the responses. Furthermore, the administrative bodies from both the university and the hospital will be contacted and permission obtained for the purpose of conducting this study. The responses from the various respondents remains private and confidential. In the course of data extraction, responses will be marked such that they become random in nature and the identities of the respondents masked. Records from the individual responses will be discarded following the data extraction to maintain their confidentiality after the conclusion of the research. 

Timeframes or Timeline 

The project is expected to run over a period of six months from September of 2018 to March 2019. 

Implications for Nursing 

There are multiple alternative pain management approaches available in modern medicine. As seen above, there are three categories of non-pharmacological pain management approaches available today. These approaches have provided care professionals and patients with the chance to live better quality lives and become more productive members of society. Even with these advantages and with recommendations from studies to use non-pharmacological pain management methods collectively, this study poses the question to evaluate which of these techniques is the most efficient and/or the most popular. To this end, this study intends to pose these questions to care professionals and compare its findings to a qualitative study in a mixed approach study. The novelty of the research is in its pursuit of determining the most efficient and popular technique – an element which lacked clarity in the course of the literature research. Once this end is achieved, nursing can be revolutionized, as nurses become aware of evidence-based approaches to non-pharmacological pain management that is most efficient and offers relief from pain in the shortest time. As a result, caring for terminal and chronic disease patients in their pain becomes easier, as pain management resources and techniques are at their disposal. More so, this research promises to give a professionally-backed list of alternative pain management techniques that nurses can use in the course of care to provide adequate, long-lasting relief to patients experiencing excruciating pain thereby reducing instances of drug dependence among patients. 

Plans for Dissemination 

The particulars of this project will be presented before my supervisors. A number of the participating professionals will be invited to the presentation to offer constructive criticisms and suggest areas of future research that will be beneficial to the field of pain management. These professionals may also offer appraisals regarding the presentation of results and the interpretation of data, thereby offering alternative perspectives based on their extensive practice. 

Conclusion 

The problem of opioid drug abuse, among others, is the result of the lack of decisive and informative evidence on alternative pain management methods. By identifying this area of concern, this research proposes to go after efficient and effective non-pharmacological pain management methods to determine effective means of bringing relief to suffering patients. In light of this, the literature contemplates various forms of alternative treatments and suggests to approach healthcare practitioners for answers to the question of effectiveness, wide use and efficiency. 

References  

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