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Mini Review Volume 9 Issue 3
Outcomes of Non-Pharmacological Nursing Interventions’ on Patients with Chronic Pain
Catarina Barbosa,1 Dulce Gonçalves,2 Isabel Pão-Alvo,2 Maria Aurea Tobio,3 Teresa Gonelha,4 Ana Ramos,5
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César Fonseca6
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1Hospital Cuf Descobertas, Lisboa, Portugal
2Centro Hospitalar de Lisboa Ocidental, Hospital São Francisco Xavier, Lisboa Portugal
3Hospital Professor Doutor Fernando da Fonseca, EPE, Lisboa, Portugal
4Centro Hospital de Setúbal, Hospital São Bernardo, Setúbal, Portugal
5Centro Hospitalar Médio Tejo, EPE, Abrantes, Portugal
6Universidade de Évora, Évora, Portugal
Correspondence: Ana Ramos, Centro Hospitalar Médio Tejo, EPE, Abrantes, Portugal
Received: November 01, 2017 | Published: December 20, 2017
Citation: Barbosa C, Gonçalves D, Pão-Alvo I, Tobio MA, Gonelha T et al. (2017) Outcomes of Non-Pharmacological Nursing Interventions’ on Patients with Chronic Pain. J Anesth Crit Care Open Access 9(3): 00344. DOI: 10.15406/jaccoa.2017.09.00344
Abstract
Considering the high number of people who experience chronic pain, with need of differentiated care, it is relevant to identify non-pharmacological nursing interventions in pain control and health gains. The objective of this paper is to identify nursing intervention and outcomes of non-pharmacological measures in chronic pain. The results of the analysis of literature allow us to synthesize some efficient interventions as: (1) auricular point acupressure; (2) hearing stimulation; (3) manipulation of the cervical and thoracic spine; (4) therapeutic massage (5) physical activity; (6) incentive the use of woolen underwear; (7) therapeutic dialogue and (8) behavioral interventions. Significant improvements in pain control as found, like increased functional capacity, improved quality of life, control of psychological maladjustment, and increased health literacy. This nursing interventions are recommended in the hospital environment and in primary health care.
Keywords: nursing care, interventions non-pharmacological, chronic pain, outcomes
Chronic pain is a subjective, complex, and multidimensional experience and it constitutes the type of pain that creates bigger consequences on the persons, with a significant impact in quality of life and on the society.1 According to Pain Proposal,2 a project developed to evaluate chronic pain’s impact on Europe, chronic pain affects approximately 36% of the Portuguese population with over 18 years old. It creates suffering in around 3 million individuals and has a negative influence on health, well-being, daily life activities and professional performance, which accounts to elevated costs of the country’s nation health system and national economy. Furthermore, this project assessed the economic effect of chronic pain in the individuals that are on labor inactivity due to chronic pain for at least 14 days per year, which resulted in costs around 290 million euros/ per year, supported by social security.
The individual suffering caused by pain predispose to the isolation, negative feelings and neglect of their own needs, due to the low self-esteem and altered body image perception, that compromising their relationship with the others. Caring for the patient with pain is a gratifying challenge for the nurse, who holds specialized knowledge about different therapeutic interventions, manly on the non-pharmacological ones. These non-pharmacological interventions must be chosen according to the patient’s preferences as well as the goals of the treatment and in agreement with the more recent scientific evidence.3 So is important analyze previous studies with non-pharmacological nursing intervention to understand their impact in well-being and quality of life of the patients with chronic pain, as the health gains for the economic system.
Kiyak’s4 conducted a randomized controlled study, which evaluates the benefit of wearing wool underwear in adults suffering from chronic low-back pain. These research verifies that wool has a bigger capacity of hear-retaining, when compared to regular fiber, and improving muscular tension, reducing the pain intensity and improving the general functionality. The treatment group reported that they consumed less analgesics, less anti-inflammatory drugs and less muscle-relaxant drugs when compared to the control group. Panpanit et al.5 study verified that Education Programmer that include pain and symptom management strategies as well a healthy lifestyle behaviors and problem-resolution strategies have a positive result on individual’s functionality and self-management. The American Pain Society recommends patient education as a fundamental first step to pain control preceding to any type of pharmacological intervention. The multidisciplinary chronic pain management program presented by Dysvik et al.6 has demonstrated that the use of Behavioral Cognitive Therapy on chronic pain help to increase their quality of life, as well as their functional capacity.
According to Yeh et al.,7 auricular acupressure had notorious results changing pain intensity on individuals suffering from low-back chronic pain. It verified a 30% reduction of pain intensity immediately after the first session and a continuous improvement until 44% reduction by the end of the treatment. A study developed by Lara-Palomo et al.8 exposed the effectiveness of the combined procedure of the massage and electrotherapy in individuals suffering from low-back chronic pain of a non-mechanic etiology. The rating scales were applied before the treatment and immediately after the last treatment and concluded that it resulted in improvements on functional capacity, pain management and quality of life.
A randomized study of Saavedra-Hernández et al.9 compared the use of cervical spine manipulations in mechanic cervical chronic pain, against the use of more complex manipulations in the cervical, cervico-thoracic and thoracic spine. This study permit concluded that complex manipulations increase the functional capacity, while the pain reducing is similar in both types of manipulations. Furthermore, in both types of manipulation an increase of the cervical movement’s range of motion was verified (Table 1).
|
Interventions |
Outcomes |
|
|
Pain Management
Functional State |
1 - Multidiscilplinary Chronic Pain Management Programme6 |
|
|
2 - Electro-massage with interferential current8 |
2 - Decreased pain perception6 |
|
|
3 - Auditory and Visual stimulation10 |
||
|
4 - Use of woollen undergarments4 |
||
|
5 - Auricular Acupressure7 |
||
|
6- Follow-up Programmes6 |
6 - Better sleep pattern10 |
|
|
Coping Strategies |
1 - Group-Therapy Sessions5 |
|
|
2 - Problem-solving strategies5 |
2 - Therapeutic Adherence promotion5 |
|
|
3 - Behavioural Cognitive Therapeutic6 |
3- Distress reduction5 |
|
|
4 - Therapeutical Dialogue6 |
||
|
Quality of Life |
1 - Group-Sessions Family Participation5 |
1 - Family workload relief 5 |
|
2 - Pain treatment information5 |
3 - Nursing care satisfaction5 |
|
|
3 - Pratictioners’ Evaluation5 |
4 - Cost-Effective relation (reduction in pharmacological drugs’ usage)4,10 |
|
|
Literacy |
1 - Health Education (healthy lifestyles)5 |
1 – Rational utilization of health services5 |
Table 1 Non-pharmacological intervention to control chronic pain and outcomes.
The non-pharmacological nursing interventions have been developed from a vision that integrates the individual’s bio-psychosocial level, empowerment and making patient the main responsible for this process of rehabilitation. It is commonly agreed, that the non-pharmacological interventions only by themselves do not replace the pharmacological ones, but the combination of both brings a wide range of benefits to the treatment of chronic pain. In the functional state of the individual, literature points relevant positive changes in sleep patterns. The nurses promotes adaptive strategies, treatment-adherence and self-control. The pain self-management is empowered by the health literacy, which help to acquire knowledge on how to deal, manage and taking control of his own health conditions. The pain control is an outcome that had influence on the physical, emotional and social status.
Acknowledgments
None.
Conflicts of interest
The authors declare no conflicts of interest.
References
- Direção Geral de Saúde (DGS). Plano Estratégico Nacional de Prevenção e Controlo da Dor (PENPCDor). DGS, Lisboa, Portugal. 2013.
- The Pain Proposal Steering Committee. Pain Proposal:improving the current and future management of chronic pain. A European consensus report. 2010.
- Ordem dos Enfermeiros (OE). Dor – Guia Orientador de Boa Prática. OE, Lisboa, Portugal. 2008.
- Kiyak E. The impact of wool in the patients with chronic non–specific low back pain. Coll Antropoll. 2012);36(2):623–626.
- Panpanit L, Carolan–Olah M, McCann T. A qualitative study of older adults seeking appropriate treatment to self–manage their chronic pain in rural North–East Thailand. BMC Geriatr. 2015;15166.
- Dysvik E, Kvaløy JT, Natvig GK. The effectiveness of an improved multidisciplinary pain management programme:a 6– and 12–month follow–up study. J Adv Nurs. 2011;68(5):1061–1072.
- Yeh C, Kwai–Ping Suen L, et al. Day–to–Day Changes of Auricular Point Acupressure to Manage Chronic Low Back Pain: A 29–day Randomized Controlled Study. Pain Med. 2015;16(10):1857–1869.
- Lara–Palomo I, Aguilar–Ferrándiz M, Matarán–Peñarrocha G, et al. Short–term effects of interferential current electro–massage in adults with chronic non–specific low back pain:a randomized controlled trial. Clin Rehabil. 2015;27(5):439–449.
- Saavedra–Hernández M, Arroyo–Morales M, Cantarero–Villanueva I, et al. Short–term effects of spinal thrust joint manipulation in patients with chronic neck pain:a randomized clinical trial. Clin Rehabil. 2013;27(6):504–512.
- Tang H, Vitiello M, Perlis M, et al. A pilot study of audio–visual stimulation as a self–care treatment for insomnia in adults with insomnia and chronic pain. Appl Psychophysiol Biofeedback. 2014;39(3–4):219–225.
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