Download Nonpharmacologic Interventions in Pain Management

Nonpharmacologic Interventions in
Pain Management
Dan Wermeling,
Pharm.D.
Professor
225 COP
Objectives
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Describe and apply physical approaches to
pain treatment
Describe psychological approaches used in
pain treatment
Describe alternative and complementary
medicine approaches to pain treatment
Attributes of Nonpharmacologic Pain
Treatment
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Augment action of analgesic medications
Stabilize mood, reduce anxiety
Increase sense of self-control
Strengthen coping abilities
Improve sleep
Relax muscles
Enhance quality of life
Sleep Hygiene – Non-restorative
sleep makes pain and mood worse
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Keep regular schedule
Exercise regularly away from sleep time
Caffeine and alcohol management
Manage bedroom activities for sleep only
Eat last meal > 3 hours prior to sleep
Physical Approaches to Pain
Management
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General Goals
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Pain reduction
Restoration of function
Complement pharmacologic treatment
Potentially decrease need for medications
Cold Temperature
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Used acutely after physical injury
Cold produces local anesthesia & slows
nerve conduction
Vasoconstriction, decreases inflammation
Decreases swelling
Examples
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Cold compress or ice pack
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Plastic bag & crushed ice
Gel products
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Reusable materials
Rectangular packs or conforms to area of body injury,
i.e., knee, shoulder, etc.
Chemical cold – chemical reaction within
container creates cold sensation, or chemical
sprays – ether like evaporation.
Usage
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Place over injured area
Or, use rotational massage
Sensations from burning, to mild ache, to
numbing
Avoid frostbite. Don’t over do. Look for
white patchiness forming on skin to stop
therapy. 20-30 minutes of each hour.
Examples of Cold Products
Heat Therapy
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Use after initial swelling is reduced
Produces local analgesia
Dilates blood vessels
Promotes flexibility
Relaxes muscles and decrease spasms
Usage similar to ice packs
Don’t over do. Can burn the skin
Heat Products
Physical Therapy
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Rest and immobilization
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Exercises
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Regain strength and range of motion
Stretching
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Promote injury healing
Improve flexibility
Massage
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Promote muscle relaxation and reduce pain
Aromatherapy
TENS
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Transcutaneous Electrical Nerve Stimulation
A device applies a prescribed electrical
impulse of low current across the skin
Mechanism is defined within the gate theory
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Sends additional signals down nerve conduit
Inhibition at the spinal level
Promotes endogenous pain control (endorph)
Restore afferent nerve input
Muscle relaxation through tiring
TENS
TENS Uses
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Low back pain
Neurogenic pain
Musculoskeletal pain
Post-surgical pain
Patients adjust amplitude and frequency to
optimize pain relief
Relatively safe
TENS Contraindications
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Use of other electrical devices, implanted
pumps, pacemaker, etc.
Pregnancy
Sensory impaired area
Near the throat, anterior neck
Spinal Cord Stimulator
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Technology similar to
TENS and Implanted
Pump
Pulse generator
Gate Control Theory of
Pain Principle
Jerry Lewis (actor)
Used for refractory
pain, CRS, ischemia,
failed back
Psychological Approaches
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Cognitive
Coping Strategy
Relaxation with Imagery
Biofeedback
Hypnosis
Contingency Management
Psychotherapy
Music
Laughter
Cognitive
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Goals are to alter the perceptions of pain
Increase sense of control
Decrease maladaptive behaviors
Strategies
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Distraction – divert attention away from pain
to a neutral or positive thought
Relaxation and Imagery
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Attention is directed toward relaxing various
muscle groups
Imagine back toward a positive experience
Coping – affirming positive outlook, like “ I
can beat this”.
Strategies
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Hypnosis – achieving an intense internal
state of relaxation, almost trance like, at the
suggestion to alter sensations, behavior,
feelings or thoughts
Problem solving – labeling a problem and
creating solutions
Acupuncture
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“rebalance body life force”
Widely used
Little data supporting efficacy
Alternative and Complementary
Approaches to Pain Management
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Definitions
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Alternative Medicine – used by themselves in
place of traditional care
Complementary – used in conjunction with
traditional care
Most common source is patients using
“dietary supplements”
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Arthritis, headaches, cancer uses
Why do patients use these products?
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Dissatisfaction with contemporary medicine
More consistent with health beliefs
Effective treatment for headache, back ache,
anxiety, emotional problems, etc.
Consistent with prevention and wellness
beliefs
Concerns About These Therapies
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Potential side effects and drug interactions
Variability in products potency and form
No standardization
Adulteration and contamination, nonGMP
Active ingredient is unknown or a
combination of unknowns
Misidentification
Costs are not insured
Concerns
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Questions about claims made
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Alter the structure and/or function of the human
body, was, now disallowed
Now they may not imply disease treatment or
prevention
Health maintenance claims allowed, like, “helps
you maintain healthy bladder function”
Consult FDA/NIH websites for specific
information for consumer information
Product Selection Quality Control
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Has product been evaluated in clinical
studies and what were the results?
Do the analyze raw materials and operate
under GMP
Does the company analyze product to make
sure it matches label
What are the bioavailability/dissolution
standards?
What are product contraindications?
Examples and Comments
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Glucosamine – derived from shells. Has GI
side effects. Can interact with diabetes and
certain cancer treatments due to mechanism
of action. May be efficacious in OA.
Chondroitin – large glycoprotein in normal
cartilage. Too large for oral absorption.
Breakdown products have GI SE and edema.
No drug interactions reported.
Examples
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Devils Claw – root to treat joint pain. Acts as
anti-inflammatory. Is oxytocin-like. Interacts
with many medications, BP, cardiac, and is
additive anti-coagulant with warfarin. – Cats
Claw is similar
Example
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Evening Primrose Oil – contains certain plant
alkaloids
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Used in many pain treatments for diabetic
neuropathy, PMS, mastitis, MS
Metabolite blocks leukotriene metabolism
Increased bleeding when used with other
anticoagulant materials
Seizures when combined with general anesthesia
Conclusions
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There are many physical and psychological
approaches available to supplement
traditional pharmacotherapy
These approaches are complementary in
difficult cases and can make a difference
Complementary and alternative approaches
are used, but must be researched before
implementation since they can have serious
side effects.