Pain control and nonpharmacologic interventions

Nurses' Attitudes Toward Holistic and Complementary Medicine in Pain Management

BACKGROUND

The effects of nurses' attitudes toward complementary and alternative medicine (CAM) in pain management in terms of safety and quality of life are important. Nurses turn to a CAM approach to deal with pain problems.

AIM

This study aimed to investigate nurses' attitudes toward CAM and to determine their sociodemographic and pain-related characteristics.

DESIGN

This study is a cross-sectional descriptive study.

METHODS

This study was carried out with 150 nurses between March 31 and April 30, 2023. Data were collected with the "Data Collection Form," "Pain Numerical Rating Scale," and "Attitudes toward Holistic and Complementary Medicine Scale" developed by the researchers.

RESULTS

The mean age of the nurses who participated in the study was 33.24 ± 8.69. It was determined that 55.3% of the nurses frequently used pharmacological and CAM treatments together in their pain management, and 71.3% of them used these treatments for less than 1 week. It was found that 65.3% of the nurses used massage, 60% used spa/hot-cold applications, 54.0% used acupuncture, 42.6% used art/color/music/dance therapy, and 12.6% used prayer or meditation in pain management.

CONCLUSIONS

It was determined that nurses used pharmacological and CAM methods together in pain management. Nurses can be offered CAM therapy options in addition to pharmacological treatments to manage their pain, and information can be given.

The impact of cold application on pain and comfort during the process of diabetic foot care

BACKGROUND AND AIM

Given the significance of pain management in the context of diabetic foot ulcer (DFU) care, particularly in terms of ensuring patient adherence to treatment regimens, this study was undertaken to ascertain the impact of cold washing on pain and comfort levels during diabetic foot care.

METHODS

A single-blind randomized controlled trial was conducted in the chronic wound care clinic of a teaching and research hospital in the southeastern region of Turkey. The sample consisted of 68 patients, with 34 assigned to the cold application group and 34 assigned to the control group. Pain and comfort levels were recorded at baseline, and during and after the application of a 0.9% NaCl solution (cold or warm) during DFU care.

RESULTS

A comparison of the Cold Application group with the control group revealed a statistically significant reduction in post-intervention pain scores (p = 0.000) and a statistically significant increase in comfort scores (p = 0.000) over time.

CONCLUSION

It can be posited that cold washing represents an efficacious intervention in the management of pain and discomfort associated with diabetic foot care.

A Qualitative Exploration of Rural Older Adults' Experiences With Pain From Chronic Illnesses and Its Treatment

Pain is one of the most common concerns among chronically ill older adults. However, access to pain management is not equitable among certain populations, including rural residents. This qualitative study explored rural older adults' experiences with pain and its treatment. Eighteen participants were recruited from rural counties of Alabama, who were age 60+, cognitively intact, community-dwelling, had one or more chronic/serious illnesses, and experienced pain. Open-ended questions were asked in individual interviews, and inductive, thematic analysis was used for data analysis. Findings revealed the impact of pain (physical limitations, psychological distress, and coping strategies), the impact of COVID-19 (physical/mental health and pain management), challenges in pain management in rural areas (lack of provider and healthcare resources, transportation-related issues, mistrust, and limited insurance coverage) and suggestions to address these challenges. Program and policy-level interventions are crucial in improving the resources and education/training needed for effective pain management for rural older adults.

Teaching Strategies for Nonpharmacological Pain Management to Nursing Students

BACKGROUND

Pain management is an essential concept to be integrated throughout undergraduate nursing curricula. Many studies have identified a lack of knowledge in pain assessment and management among nurses. Educators have significant roles in preparing students with pain knowledge and application of alternative nonpharmacological pain management techniques.

AIM

The purpose of this research study was to explore the impact of instruction on nonpharmacological pain management techniques in both didactic and simulated laboratory settings on nursing students' application of these techniques in clinical settings.

DESIGN

A mixed-method descriptive study, with a survey that included closed and open-ended questions.

PARTICIPANTS

The sample included 144 first-semester senior prelicensure baccalaureate nursing students.

METHOD

Investigators developed two research questionnaires. All students were given nonpharmacological pain management instruction didactically and practiced in the simulation lab and a hospital-based obstetrical practicum under faculty supervision. The students completed research questionnaires at the semester's conclusion and again prior to graduation.

RESULTS

Students reported that they implemented taught nonpharmacological pain management techniques in the clinical setting under faculty supervision. A review of the follow-up questionnaire indicates that graduating seniors did implement the nonpharmacological pain management techniques in other clinical settings and plan to utilize them in their future nursing practice.

CONCLUSIONS

Teaching nonpharmacological pain management techniques didactically, in a simulation lab and a supervised clinical setting contributes to students' ability to apply these techniques. The findings of this study have implications for nursing education and students' future clinical practice to foster their utilization of nonpharmacological pain management techniques across all settings.

Pain Management Strategies After Orthopaedic Trauma: A Mixed-Methods Study with a View to Optimizing Practices

PURPOSE

To examine 1) pain management strategies within the care trajectory of orthopaedic trauma patients and patients' perception of their effectiveness, 2) adverse effects (AEs) associated with pharmacological treatments, particularly opioids and cannabis, and 3) patients' perceptions of strategies that should be applied after an orthopaedic trauma and support that they should obtain from health professionals for their use.

PATIENTS AND METHODS

This study was conducted with orthopaedic trauma patients in a level 1 trauma center. A convergent mixed-methods design was used. Data on pain experience, pain management strategies used and AEs were collected with self-administered questionnaires at hospital discharge (T1) and at 3 months after injury (T2). Patients' preferences about the pain management strategies used, the required support and AEs were further examined through semi-structured individual interviews at the same time measures. Descriptive statistics and thematic analyses were performed.

RESULTS

Seventy-one patients were recruited and 30 individual interviews were undertaken. Pharmacological pain management strategies used at T1 and T2 were mainly opioids (95.8%; 20.8%) and acetaminophen (91.5%; 37.5%). The most frequently applied non-pharmacological strategies were sleep (95.6%) and physical positioning (89.7%) at T1 and massage (46.3%) and relaxation (32.5%) at T2. Findings from quantitative and qualitative analyses highlighted that non-pharmacological strategies, such as comfort, massage, distraction, and physical therapy, were perceived as the most effective by participants. Most common AEs related to opioids were dry mouth (78.8%) and fatigue (66.1%) at T1 and insomnia (30.0%) and fatigue (20.0%) at T2. Dry mouth (28.6%) and drowsiness (14.3%) were the most reported AEs by patients using recreational cannabis. An important need for information at hospital discharge and for a personalized follow-up was identified by participants during interviews.

CONCLUSION

Despite its AEs, we found that opioids are still the leading pain management strategy after an orthopaedic trauma and that more efforts are needed to implement non-pharmacological strategies. Cannabis was taken for recreational purposes but patients also used it for pain relief. Support from health professionals is needed to promote the adequate use of these strategies.

Laughter therapy: A humor-induced hormonal intervention to reduce stress and anxiety

Prolonged pharmacological interventions have detrimental health consequences by developing drug tolerance or drug resistance, in addition to adverse drug events. The ongoing COVID-19 pandemic-related stress has adversely affected the emotional and mental health aspects around the globe. Consequently, depression is growing during the COVID-19 pandemic. Besides specific pharmacological interventions, which if prolonged have detrimental health consequences, non-pharmacological interventions are needed to minimize the emotional burden related to the COVID-19 pandemic. Laughter therapy is a universal non-pharmacologic approach to reduce stress and anxiety. Therapeutic laughter is a non-invasive, cost-effective, and easily implementable intervention that can be used during this pandemic as a useful supplementary therapy to reduce the mental health burden. Laughter therapy can physiologically lessen the pro-stress factors and increase the mood-elevating anti-stress factors to reduce anxiety and depression. In this ongoing stressful period of the COVID-19 pandemic, keeping necessary social distancing, it is important to create a cheerful environment that will facilitate laughter among the family, neighbor, and community to cope with the stresses of the COVID-19 pandemic.

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Prolonged pharmacological interventions have detrimental health consequences.

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Laughter therapy is a universal non-pharmacologic approach to reduce stress and anxiety.

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Therapeutic laughter is a non-invasive, cost-effective, and easily implementable intervention.

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Laughter therapy can be used during COVID-19 pandemic as a useful supplementary therapy to reduce the mental health burden.

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.

Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery

This Consensus Statement provides recommendations on the prescription of pain medication at discharge from hospital for opioid-naïve adult patients who undergo elective surgery. It encourages health care providers (surgeons, anesthesiologists, nurses/nurse practitioners, pain teams, pharmacists, allied health professionals, and trainees) to (1) use nonopioid therapies and reduce the prescription of opioids so that fewer opioid pills are available for diversion and (2) educate patients and their families/caregivers about pain management options after surgery to optimize quality of care for postoperative pain. These recommendations apply to opioid-naïve adult patients who undergo elective surgery. This consensus statement is intended for use by health care providers involved in the management and care of surgical patients. A modified Delphi process was used to reach consensus on the recommendations. First, the authors conducted a scoping review of the literature to determine current best practices and existing guidelines. From the available literature and expertise of the authors, a draft list of recommendations was created. Second, the authors asked key stakeholders to review and provide feedback on several drafts of the document and attend an in-person consensus meeting. The modified Delphi stakeholder group included surgeons, anesthesiologists, residents, fellows, nurses, pharmacists, and patients. After multiple iterations, the document was deemed complete. The recommendations are not graded because they are mostly based on consensus rather than evidence.