Forget the pillbox: Teach nurses alternative pain Rxs

Inservice ‘fair’ shows ways to ease suffering

It’s the rare nurse who doesn’t know some home remedy for treating pain, whether it’s applying a hot rice bag or playing a little relaxation music. But Western medicine traditionally has overlooked many alternative methods, so if a patient asks the nurse about homeopathy or therapeutic touch, the nurse might not have an answer.

A Wisconsin home care agency gave staff nurses and other employees a chance to learn about a wide variety of alternative pain treatments. This way nurses would be able to use certain techniques if they felt it was appropriate, or they would at least know what was happening if a patient started to use some unusual device.

"Our goal was for people to understand there are many things you can do that are not drugs to relieve pain," says Pat Trapp, RN, staff educator of Hillside Home Care Hospice in Beaver Dam, WI. Trapp came up with more than a dozen different types of pain treatment that she wanted to teach to the staff.

Demonstrating different techniques

But how do you fit all that into an inservice?

She found the perfect solution by turning the inservice into a week-long fair with 15 different stations. Nurses and other staff could visit the stations at their leisure, and since all the booths except the one with scheduled demonstrations of hand massage were not staffed, staff could visit them at any time.

The agency’s pain management stations were set up to demonstrate the following techniques:

Distraction and comfort foods.

"We had tea there and asked the question, ‘What is your comfort food?’" Trapp says. "What makes you feel better when you’re sick?" The booth displayed a sign which listed a variety of comfort foods, such as Oreo cookies, chicken soup, saltines with milk, milk bread, and others.

Distractions are methods that allow a person in pain to focus on something besides that pain, Trapp explains. For example, watching a bird eating from a feeder on the window sill can be a distraction, as well as watching television and reading books.

Ultrasound.

An ultrasound machine was set up with a sign that explained how it is used. "Ultrasound is ordered by a physician, and you might have it for lower back pain," Trapp says. "It’s a machine that bounces sound waves off the body, and it can provide pain relief."

Rice bags.

General merchandise stores in Wisconsin now sell rice bags in heart shapes that can be heated in a microwave and used like a heating pad, Trapp says.

Any rice bag will work, so long as it is kept dry and heated for two to three minutes in the microwave, she adds. "It molds itself to the body, and you can put it across the abdomen for cramping or on the head for a headache. It’s a comfort measure and makes people feel better."

Acupressure.

Acupressure is a technique administered by an acupressure practitioner who massages certain areas of the body to relieve pain in other areas. The practitioner uses his or her knowledge about a geography of points and meridians on the body to guide the application of finger pressure, instead of inserting needles, which is done in a similar fashion through acupuncture. The purpose is to facilitate the flow of energy or chi through the meridians.1

This is the type of treatment that a patient might choose to undergo independent of home care treatment, Trapp says. "Not everything shown at the stations is something you would be able to perform yourself, but you’d know more about it and understand it," she adds.

Use of reflexology

In addition, this station had a poster on reflexology, which is the manual stimulation of reflex points on the feet, ears, and hands. It’s similar to acupressure and has been practiced in China for thousands of years. The pressure on these points is supposed to relieve stress and improve blood supply and restore balance to the body. Reflexology was introduced in the United States in the early 1900s by William Fitzgerald, who called it "zone therapy."1

Diseases with chronic pain.

This station provided information and explanations about chronic pain as it relates to arthritis, cancer, and low back problems.

Relaxation techniques.

This booth provided two different relaxation tapes. One tape explained progressive relaxation, in which a person is guided through a peaceful scene, such as a beach or mountain setting, until he or she feels relaxed. And the other demonstrated the tighten-and-release technique, where someone focuses on a certain area, tightens it, and then relaxes it.

Some people have trouble with deep breathing and relaxing while listening to guided imagery that sends them to a sunny beach or cabin in the woods, as are used in progressive relaxation techniques, Trapp says. People who are very tense might not respond if told to relax because they don’t know how, she adds. For these people, the tighten-and-release technique might work best because this helps the participant recognize the difference between how the body feels when its tightened and how it feels when its released.

Fluidotherapy.

This technique originated from occupational therapists, who sometimes use a machine that contains heated cellulose made from ground corn. The patient puts his hand inside the machine’s glove or cuff, and the warm cellulose blows around the arthritic hand for 15 to 20 minutes.

Cancer pain.

Different drugs are available to treat cancer pain, and these were listed in the booth. Also staff were shown a stair-step ladder used for pain control. "This station also [presented information] about physical and psychosocial interventions," Trapp says.

Use of antidepressants.

This display explained how antidepressants can increase the potency of certain drugs, particularly in treating pain that is common in cancer cases.

Cold and heat therapies.

Staff were given examples of home-grown methods of providing heat and cold therapies. For example, a bag of frozen peas can be used in place of an ice bag because peas will mold to the body better than ice, Trapp says. "We also had a recipe for how you can make slush by freezing a mixture of alcohol and ice. So if you’re an orthopedic patient and are supposed to put an ice pack on the knees for 20 minutes after doing exercises, then you can use this."

The station also gave some cautionary information, such as the dangers of heating pads and how patients might fall asleep on them and burn themselves.

Music therapy.

The agency consults with a music therapist, who has created tapes of soothing, comforting music that may be played for patients. This station included different samples of therapeutic music on cassette tapes and listed some research on how it could be used. "The hospice has a Walkman that we lend out to patients so they can listen to relaxation tapes or music tapes during the night," Trapp says.

TENS unit.

The transcutaneous electrical nerve stimulation (TENS) device, which uses electrodes and electric stimulation to fool the pain center, may be administered by physician’s order, Trapp says. Patients may apply it themselves, and it’s used sometimes for low back pain.

The unit is about the size of a pack of cigarettes, and patients can wear it on their belts. Physical therapy departments typically have these units. "We had one available in the station so that people could put it on if they wanted," Trapp says.

Paraffin bath.

Patients may use this wax bath at home or in an outpatient setting, under a physician’s order. The station demonstrated how the treatment could be created from a recipe at home in a Crock-Pot.

"They dip their hands in melted paraffin at a [prescribed] temperature to avoid burns, and it’s like a hot wax glove for your arthritic hand," Trapp explains. "It feels very relaxing, and it traps a lot of the heat."

Aromatherapy.

The station listed information about how certain people believe that different scents may help people with physical problems. For example, lavender is often said to help with pain, Trapp says. The scent is concentrated, and the patient may put a few drops in water and breathe it in during a massage or relaxing bath. A list of 30 different scents was posted, including information about what they are supposed to help, whether it was for abdominal discomfort, stress, or a variety of other problems.

"We were not necessarily recommending it, and there is no proof that it has efficacy, but some people think it helps," Trapp says. "The other reason we chose to include this one is because sometimes we have nonresponsive patients or patients with dementia, and smell is one sense you can stimulate, so maybe they could reach them with this."

Hand massage.

A nurse demonstrated hand massages for five sessions a day. Nurses may use massage oil and rub a patient’s hand to give the person a little additional comfort, Trapp says.

Reference

1. Collinge W. The American Holistic Health Association Complete Guide to Alternative Medicine. New York: Warner Books; 1996.