Factors influencing nurses’ use of nonpharmacological pain alleviation methods in paediatric patients

Persistence of pain and suffering in cancer patients: challenges of pain management from the perspective of nurses

Purpose

Cancer patients often experience pain, which can greatly reduce their quality of life. It affects their emotions, cognitive function, and daily interactions. Healthcare providers need to understand the obstacles to pain management to create helpful programs for patients and families. This study focuses on Iranian nurses' views on pain management barriers in cancer patients.

Methods

The study utilized a qualitative content analysis method with a purposive sampling approach, involving 27 nurses. Participants were selected to ensure a wide range of perspectives and experiences by considering factors such as gender, age, work experience, education levels, and positions until data saturation was achieved. Inclusion criteria specified a minimum of six months of oncology ward experience and a bachelor's degree or higher in nursing. Nurses with less than six months of oncology experience or lacking a nursing degree were excluded. Data collection was conducted through semi-structured interviews and analyzed using Lundman and Granheim's qualitative content analysis method.

Results

One main theme, four main categories, and nine subcategories in the study reflected the nurses' experiences and viewpoints about barriers to pain management. These categories included the marginalization of complementary medicine, medical malpractice, inadequate organizational infrastructure, and personal barriers.

Conclusion

The study demonstrated that the barriers to pain management in cancer patients were complex. To improve patients' comfort and quality of life, it is important to identify and address issues from different angles. It is crucial to train patients and healthcare providers in pain management and to address weaknesses in the healthcare system.

Pediatricians' focus of sight at pain assessment during a neonatal heel puncture

OBJECTIVE

To evaluate the focus of pediatricians' gaze during the heel prick of neonates.

METHODS

Prospective study in which pediatricians wearing eye tracker glasses evaluated neonatal pain before/after a heel prtick. Pediatricians scored the pain they perceived in the neonate in a verbal analogue numerical scale (0=no pain; 10=maximum pain). The outcomes measured were number and time of visual fixations in upper face, lower face, and hands, in two 10-second periods, before (pre) and after the puncture (post). These outcomes were compared between the periods, and according to pediatricians' pain perception: absent/mild (score: 0-5) and moderate/intense (score: 6-10).

RESULTS

24 pediatricians (31 years old, 92% female) evaluated 24 neonates. The median score attributed to neonatal pain during the heel prick was 7.0 (Interquartile range: 5-8). Compared to pre-, in the post-periods, more pediatricians fixed their gaze on the lower face (63 vs. 92%; p=0.036) and the number of visual fixations was greater on the lower face (2.0 vs. 5.0; p=0.018). There was no difference in the number and time of visual fixations according to the intensity of pain.

CONCLUSIONS

At bedside, pediatricians change their focus of attention on the neonatal face after a painful procedure, focusing mainly on the lower part of the face.

Nurses' use of non-pharmacological pain management methods in intensive care units: A descriptive cross-sectional study

BACKGROUND

Pain is a common and unpleasant feeling among patients in intensive care units. Therefore, the use of proper pain management methods, such as non-pharmacological interventions, is a priority in intensive care units.

OBJECTIVE

This study aimed to ascertain the extent of the use of non-pharmacological pain management methods by intensive care unit nurses in Iran and to identify the obstacles that hindered the use of these methods.

MATERIAL AND METHODS

This study used a descriptive cross-sectional design which involved a convenience sample of 224 nurses who worked in 16 intensive care units across northern Iran. Data were collected using the non-pharmacological pain management questionnaire and a researcher-developed checklist of the obstacles that hindered the use of non-pharmacological pain management methods.

RESULTS

A moderate number of ICU nurses used non-pharmacological pain management methods (55.8 %). The most common method used by nurses was repositioning (M = 2.72), while methods such as acupuncture and reflexology were used less frequently. Furthermore, the most common obstacles to the use of non-pharmacological pain management methods were nurses' fatigue (M = 2.92) and multiple responsibilities (M = 2.91). Demographic variables such as age, gender, educational level, and work experience were not significantly associated with the use of non-pharmacological pain management methods.

CONCLUSIONS

Due to factors such as fatigue, multiple responsibilities, a heavy workload, and an insufficient number of nurses per shift, the rate of utilization of non-pharmacological pain management methods among intensive care unit nurses in Iran was low. Furthermore, most of the participants in this study had not attended courses on non-pharmacological pain management.

Nurses' experiences of providing nonpharmacological pain management in palliative care: A qualitative study

AIM AND OBJECTIVES

To explore the experiences and views of nurses who provide nonpharmacological therapies for chronic pain management in palliative care.

BACKGROUND

Nursing expertise in palliative care is essential in providing pain relief to patients with chronic diseases. Examinations of the use of nonpharmacological therapies for chronic pain management in palliative care have revealed what nonpharmacological therapies have been used, but there is insufficient knowledge regarding nurses' attitudes, views and experiences regarding pain therapies in this context.

DESIGN

A qualitative descriptive design was chosen.

METHODS

Data were collected through individual interviews in a purposive sample with 15 nurses to ensure maximum variation. The data were analysed using qualitative content analysis. This study aligns with the consolidated criteria for reporting qualitative research (COREQ) checklist.

RESULTS

The analysis yielded four categories, as follows: "building and sustaining favourable therapeutic relationships" involved the creation of trust and a solid relationship; in "recognising the diversity of patients' needs," person-centred care is expressed as being vital for individualised nonpharmacological pain management; "incorporating significant others" describes how nurses can help to ease the patient's pain by identifying positive encounters with family members or friends; and in "recognising the existence of barriers," nurses highlight vulnerable groups such as children, for whom nurses require special education to enable optimal nonpharmacological pain management.

CONCLUSION

The unique knowledge that nurses gain about the patient through the nurse-patient relationship is central and crucial for successful nonpharmacological pain management.

RELEVANCE TO CLINICAL PRACTICE

This study emphasises the need for nurses to get to know their patient and to be open and sensitive to patients' descriptions of their unique life situations, as this provides the necessary knowledge for optimal care and pain management. Nurses should be encouraged and given the opportunity to attend specialised training in palliative care and pain management.

Paediatric pain management: knowledge, attitudes, barriers and facilitators among nurses - integrative review

AIMS

To identify and synthesize evidence regarding the knowledge and attitudes of nurses, and barriers and facilitators to effective pain assessment and management in infants and children.

BACKGROUND

Pain among children is a common experience. Relief from pain is a fundamental human right, yet hospitalized children continue to experience unrelieved pain. Provision of effective pain management is an integral part of the nurse's role.

METHODS

Guided by Whittemore & Knafl's five-stage framework, primary peer-reviewed studies published in English between 2000 and 2018 were searched using CINAHL, PubMed, ProQuest, PsycINFO and Scopus. The initial search yielded 292 papers. Twenty-seven papers were included in this review: quantitative (n = 18), qualitative (n = 5) and mixed-methods (n = 4).

RESULTS

Findings showed that nurses internationally have poor knowledge and attitudes of basic pain assessment and management principles. Barriers to effective pain management include the absence of pain education and assessment tools, parents' reluctance to report pain and insufficient prescription of analgesia by physicians. Facilitators for the effective management of pain include parental participation in care, trusting and respectful relationships between nurses and children, and adequate nurse-patient ratios.

CONCLUSION

The review findings suggest a need to improve education for nurses, doctors and the patients' family in relation to paediatric pain management, communication and interprofessional collaborations. There is a need to maximize facilitators and overcome barriers, such as those identified in this review, to ensure the quality of paediatric pain management.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nursing and health policy should mandate the prioritization of paediatric pain management and the clinical roles and responsibilities of the interdisciplinary team members. Undergraduate, postgraduate and in-service education for nurses and other health professionals should also address paediatric pain management. In-service education on paediatric pain management should be compulsory for all health professionals caring for children.

Nurses' perceptions of pain assessment and management practices in neonates: a cross-sectional survey

AIMS

This study aimed to describe pain assessment and management practices for neonates based on nurses' perceptions in neonatal intensive care units (NICUs).

DESIGN

A descriptive cross-sectional survey was conducted in Finland.

METHODS

Of all nurses (N = 422) working in the NICUs in the country's five university hospitals, 294 responded to a questionnaire. The data were analysed by statistical methods.

RESULTS

Nurses agreed that pain assessment is important, but over half of them reported being able to assess pain in a reliable way without using pain assessment scales. Physiological parameters and changes in neonate's behaviour were reported as routinely observed, but many specific facial expressions indicative of pain were less often observed. Only a few pain assessment scales were known, and they were not routinely used in clinical practice. Most nurses reported using physical methods and giving oral sucrose along with non-nutritive sucking. Counselling parents to continue breastfeeding or guiding them to use skin-to-skin care or music was rarely reported as used to alleviate infants' pain.

CONCLUSIONS

Educational interventions for nurses are needed to improve pain assessment and management practices in the NICUs. In addition, there is a need for national guidelines in order to ensure the equal treatment to all neonates.

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.

Experiences of Iranian Nurses on the Facilitators of Pain Management in Children: A Qualitative Study

Background. Despite decades of research and the availability of effective analgesic approaches, many children continue to experience moderate-to-severe pain after hospitalization. Greater research efforts are needed to identify the factors that facilitate effective pain management. The aim of this study was to explore the perceptions of Iranian nurses on facilitators of pain management in children. Materials and Methods. This qualitative study collected the data profoundly through unstructured interviews with 19 nurses in Amirkola Children's Hospital in Babol and Children's Medical Center in Tehran, during 2013-2014. Purposeful sampling and analysis of the data were conducted using conventional qualitative content analysis. Results. Four themes were extracted through data analysis: mother and child participation in diagnosis and pain relief, the timely presence of medical staff and parents, proper communication, and training and supportive role of nurses. Conclusion. Mother and child participation in the report and diagnosis of pain and nonpharmacological interventions for pain by the mother, the timely presence of medical team at the patient's bedside, and proper interaction along with the training and supportive role of a nurse enhanced the optimal pain management in hospitalized children.

Experienced nurses' use of non-pharmacological approaches comprise more than relief from pain

This study investigated the use of, and reasoning by, experienced nurses regarding non-pharmacological pain approaches to care for children in hospitals, with the aim of increasing our understanding, and hence optimizing, these approaches. Three focus-group interviews with 14 experienced nurses, were conducted in 2009. Our findings emphasized the role of non-pharmacological methods in building and maintaining cooperation with the child and in caring for the child by individualizing the use of non-pharmacological methods.

Influences shaping nurses' use of distraction for children's procedural pain

PURPOSE

This study explored pediatric nurses' choices to use distraction for managing painful procedures.

DESIGN AND METHODS

Using interpretive description approaches, interviews with pediatric nurses provided descriptions of choices to manage procedural pain.

RESULTS

Nurses' distress influenced distraction use to mitigate the suffering of children and themselves. Newer nurses described task mastery as influencing distraction choices. Nurses' accounts of performing painful procedures on children mirrored children's descriptions of pain from the literature.

PRACTICE IMPLICATIONS

Nurses' distress and competency performing painful procedures on children influenced practice. Future qualitative studies could extend understanding of pain management choices by pediatric nurses and the impact on undermanaged pain.

Nurses' experiences of caring for children in pain

AIM

To describe nurses' experiences when caring for children in pain.

BACKGROUND

Earlier studies have shown that nurses are key actors in pain management and that there is a need to focus on the nurses' own experiences of caring for children in pain.

METHOD

Semi-structured interviews were conducted with 21 nurses at one paediatric clinic. The data were analysed by means of content analysis.

RESULTS

The interviews suggested that when a child's pain followed an expected pattern and they complied with treatment, the nurses trusted their knowledge and felt comfortable. On the other hand, in unpredictable situations the nurses felt fearful, powerless, abandoned and distrustful.

CONCLUSION

The nurses were comfortable in predictable situations, but if a situation was unpredictable, they felt they had lost control over it. IMPLICATIONS FOR PAIN MANAGEMENT: To reduce feelings of abandonment, work shifts should be organized so that more experienced nurses can work side by side with those who are less experienced. Pain assessment tools and guidelines for pain management should be introduced into the daily work, and systematic reflection should be used for nurses' professional development.

Knowledge and attitudes regarding pain management of pediatric nurses in Turkey

Nurses play an important role in managing children's pain. The nurse's accurate assessment, appropriate intervention, and evaluation of pain relief measures are necessary for positive patient outcomes. The aim of this study was to determine the level of knowledge and attitudes of pediatric nurses regarding the child's pain. The Pediatric Nurses' Knowledge and Attitude Survey (PNKAS) was used to evaluate the nurses' knowledge and attitudes. The PNKAS consists of 40 questions. In this study, 29.9% of nurses had a diploma and 40.6% associate's, 25.0% bachelor's, and 4.5% master's degree, and respondents had an everage 6.1 years pediatric nursing experience. The total mean score on the PNKAS scale was 38.2%. The highest score was 65%, and the lowest score 15%. The findings of the survey show that pediatric nurses in Turkey have insufficient knowledge regarding pain management and could benefit from additional education on that issue.

Comfort First: an evaluation of a procedural pain management programme for children with cancer

BACKGROUND

The Comfort First Program (CFP) provides children and their caregivers with early procedural pain management intervention to reduce procedural pain and distress. This study evaluated whether the CFP was meeting its goals and effectively implementing the Royal Australasian College of Physicians paediatric pain management guidelines.

METHODS

The study was conducted as a single-site cross-sectional audit. One hundred and thirty-five patients (mean age 7.7 years) receiving treatment at the Royal Children's Hospital, Melbourne, Children's Cancer Centre Day Oncology Unit were observed. Procedural aspects related to the treatment room, carer and staff behaviour, child distress and use of pharmacologic and nonpharmacologic interventions were recorded using an audit tool developed for the study.

RESULTS

The procedure room was regularly quiet and prepared before the child entered. Median procedure duration was 8 min. Median procedure wait time was 54 min. At least one carer was typically present during procedures. Comfort First (CF) clinicians were more likely to be present in procedures with a significantly distressed child. Carers, nurses and CF clinicians generally displayed comfort-promoting behaviour. Topical anaesthetic was regularly utilised. Nonpharmacologic supports were frequently used, particularly distraction. Patients under 8 years of age were significantly more likely to receive nonpharmacologic supports and have a carer and CF clinician present. Age was a significant predictor of distress, with higher distress rates in younger children.

CONCLUSIONS

The CFP was found to be effectively implementing procedural pain guidelines. Regular audit is recommended to ensure adherence to pain management standards.

The use of nonpharmacological methods for children's postoperative pain relief: Singapore nurses' perspectives

PURPOSE

The purpose of this study was to examine nurses' use of nonpharmacological methods for school-age children's postoperative pain relief.

DESIGN AND METHODS

A survey was conducted in 2008 with a convenience sample of 134 registered nurses from 7 pediatric wards in Singapore.

RESULTS

Nurses who were younger, had less education, lower designation, less working experience, and no children of their own used nonpharmacological methods less frequently.

PRACTICE IMPLICATIONS

Nurses need training and education on nonpharmacological pain relief methods, particularly on methods that have been shown to be effective in prior research but that were less often used by nurses in this study: massage, thermal regulation, imagery, and positive reinforcement.

Mothers' View on Late Postoperative Pain Management by the Nursing Team in Children After Cardiac Surgery

Postoperative pain management in children is a complex, multidimensional and subjective phenomenon. It represents a challenge for children, parents and health professionals. This study aimed to understand how mothers assess their children's pain management by the nursing team in the late postoperative phase of cardiac surgery. Empirical data collection was carried out through semistructured interviews with 17 mothers who accompanied their children. Data were subject to qualitative analysis, revealing that, for the mothers, taking good care results from the confidence they vest in the nursing team and from the observation of the medication interventions this team performs. Not taking good care of their children is a consequence of lack of information or inadequate communication between the team and the mothers. The results of this study permit identifying aspects that strengthen and weaken nursing care for these clients, contributing to the improvement of the delivered care.

Music Therapy to Reduce Pain and Anxiety in Children With Cancer Undergoing Lumbar Puncture: A Randomized Clinical Trial

A nonpharmacological method can be an alternative or complement to analgesics.The aim of this study was to evaluate if music medicine influences pain and anxiety in children undergoing lumbar punctures. A randomized clinical trial was used in 40 children (aged 7-12 years) with leukemia, followed by interviews in 20 of these participants. The participants were randomly assigned to a music group (n = 20) or control group (n = 20). The primary outcome was pain scores and the secondary was heart rate, blood pressure, respiratory rate, and oxygen saturation measured before, during, and after the procedure. Anxiety scores were measured before and after the procedure. Interviews with open-ended questions were conducted in conjunction with the completed procedures. The results showed lower pain scores and heart and respiratory rates in the music group during and after the lumbar puncture. The anxiety scores were lower in the music group both before and after the procedure. The findings from the interviews confirmed the quantity results through descriptions of a positive experience by the children, including less pain and fear.

Fatores que interferem no reconhecimento por adultos da expressão facial de dor no recém-nascido

OBJETIVO:Avaliar quais fatores relacionados ao observador adulto interferem no reconhecimento da expressão facial de dor do recém-nascido a termo. MÉTODOS: Foram entrevistados 405 indivíduos (191 profissionais da área da saúde da criança e 214 pais/mães de recém-nascidos), pesquisando-se características pessoais, profissionais e socioeconômicas. Ao término da entrevista, cada indivíduo observou três séries de fotos de três bebês diferentes, cada série com oito fotos da face de cada neonato em oito tempos diferentes (T1, T3, T6 e T8: repouso; T2: estímulo luminoso; T4 e T5: fricção do calcâneo; T7: punção) e respondeu à seguinte pergunta: em qual foto desta prancha o senhor acha que o bebê está sentindo dor? Os 405 entrevistados foram analisados de acordo com número de acertos para as três séries de fotos por regressão linear múltipla. RESULTADOS: Constatou-se um menor número de acertos para os entrevistados sem parceiro fixo, com maior número de filhos, renda per capita elevada, atuação profissional na área da saúde e escolaridade inferior a 16 anos ou com atuação profissional em outras áreas que não a da saúde e escolaridade superior a 16 anos. Ou seja, os entrevistados detentores dessas características tiveram maior dificuldade para reconhecer a expressão facial de dor do recém-nascido. CONCLUSÕES: Diante da heterogeneidade dos fatores que interferem no reconhecimento da expressão facial de dor no recém-nascido por observadores adultos aqui encontrada, faz-se necessária a utilização rotineira de instrumentos objetivos para a avaliação sistemática da dor no período neonatal.

School-based drama interventions in health promotion for children and adolescents: systematic review

AIM

The paper is a report of a review of the literature on the effects of school-based drama interventions in health promotion for school-aged children and adolescents.

BACKGROUND

Drama, theatre and role-playing methods are commonly used in health promotion programmes, but evidence of their effectiveness is limited. The educational drama approach and social cognitive theory is share the assumption that learning is based on self-reflection and interaction between environment and person. However, educational drama also emphasizes learning through the dialectics between actual and fictional contexts.

DATA SOURCES

A search was carried out using 10 databases and hand searching for the period January 1990 to October 2006.

METHODS

A Cochrane systematic review was conducted.

RESULTS

Nine studies met the criteria for inclusion. Their topics included health behaviour (five studies), mental health (two) and social health (two). Actor-performed drama or theatre play followed by group activities was the intervention in five studies, and classroom drama in four studies. Four of the studies were randomized controlled trials and five were non-randomized controlled studies. Four reports gave the theory on which the intervention was based, and in eight studies at least some positive effects or changes were reported, mostly concerning knowledge and attitudes related to health behaviour. The diversity of designs and instruments limited comparisons.

CONCLUSION

There is a need for well-designed and theory-based studies that address drama interventions in health promotion for children and families. The challenge is to find or develop a theory, which combines educational, drama and health theories with valid and reliable measurements to examine the effects of the intervention.

[Notes of post-operative pain in children: a retrospective analyses of hospitals from Londrina, PR, Brazil]

All surgical procedures involve tissue lesions, manipulation of structures and organs, causing pain which can be minimized during the process. The objective of this study is to characterize, retrospectively, the process of managing post-operative pain based on 300 medical records of 280 children, who underwent surgery in 2004, in 3 hospitals located in Londrina, PR, Brazil. The study revealed that only a few nurses document post-operative pain, and that the majority of the records were made by nursing aides or technicians. The results have shown the need for research on pediatric pain management and the factors affecting them.

Perianesthesia Nurses’ Pain Management After Tonsillectomy and Adenoidectomy: Pediatric Patient Outcomes

Tonsillectomy and adenoidectomy (T and A) is a common, painful surgical procedure. The purpose of this descriptive-comparative study was to evaluate the effects of postanesthesia analgesic treatments on self-reported pain intensity, incidence of nausea and vomiting, and amount of oral fluid intake among pediatric patients after T and A. A total of 92 patients, 3 to 18 years old, received one of five analgesic treatments during their postoperative recovery: (1) intravenous fentanyl alone, (2) intravenous fentanyl in combination with an oral analgesic, (3) intravenous morphine alone, (4) intravenous morphine in combination with an oral analgesic, or (5) oral analgesics alone. Although significant differences were found in mg/kg morphine equivalents among the five analgesic groups (P < .0001), there were no differences in pain scores, incidence of nausea and vomiting, or amount of oral intake among the groups. Overall 29% of patients had nausea and vomiting, but all ingested oral fluids before discharge home. Nurses gave significantly more mg/kg morphine equivalents to patients who reported any pain while in the PACU (Phase I recovery) than patients who reported no pain (P = .046). All patient groups reported low pain scores upon discharge from Phase I and Phase II recovery. Nurses, however, reported difficulty obtaining pain-intensity scores for many patients, especially in Phase I. These findings suggest that despite variations in analgesics and the amount of analgesics administered, patients received adequate pain control. The findings also support the need for pain medication titration and validate that the amount required to relieve pain differs from child to child.

Manejo da dor pós-operatória na Enfermagem Pediátrica: em busca de subsídios para aprimorar o cuidado

O objetivo deste artigo é realizar uma revisão da literatura sobre o manejo da dor pelos profissionais de enfermagem no pós-operatório infantil, no período de 1993 a 2005. A revisão possibilitou identificar três temáticas: fatores que influenciam o manejo da dor da criança pelos enfermeiros, intervenções para o alívio da dor da criança e avaliação e resposta dos enfermeiros à experiência de dor da criança. O manejo da dor infantil é um ato complexo que engloba elementos das dimensões referentes à própria criança, aos profissionais de saúde e aos seus familiares. A carência de estudos nesta área revela a necessidade de se realizarem pesquisas, para que se possa (re)pensar o cuidado de enfermagem pediátrica.

Playing in the park: what school-age children tell us about imagery

The purpose of this exploratory study was to describe children's use of imagery before and after ambulatory surgery (AS). The study sample was a subset of 75 children (7-12 years) who were randomly assigned to the treatment group (n = 38) from five AS settings in a larger study on the effectiveness of imagery after surgery. They listened to an audiotape of imagery before surgery, after surgery, and after discharge from AS. Imagery use was evaluated with the Imagery Assessment Questionnaire and a home diary. Imagery tapes were used significantly more times at home after surgery than before surgery. There were no significant changes in the children's Imagery Assessment Questionnaire scores at any time point. Children most often imagined going to the park when they used the tape.

Pain experiences and non-pharmacological strategies for pain management after tonsillectomy: a qualitative interview study of children and parents

Tonsillectomy is one of the most common paediatric surgical procedures. This study aimed to investigate children's experience of pain and the nonpharmacological strategies that they used to manage pain after tonsillectomy. A further aim was to investigate parental views on these same phenomena. Six children (aged seven to 18 years) and their parents (four mothers and two fathers) were interviewed separately on the day after tonsillectomy. The data were analysed using a qualitative approach. Pain experiences were divided into the categories of physiological pain and psychological pain. Children rated their 'worst pain' during the past 24 hours between 6 and 10 (visual analogue scale, 0-10). The non-pharmacological strategies used most frequently to manage pain were thermal regulation (physical method) and distraction (cognitive-behavioural method) according to the framework used. Specific non-pharmacological strategies for pain management relative to different surgical procedures need to be considered.