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When determining the best strategy for controlling pain, both pharmacological and nonpharmacological methods are considered at Baptist Health Systems’ South Miami Hospital. The nonpharmacological modalities are used in conjunction with medications. "Those nonphar-macological methods that are established and evidence-based can always help in terms of supplementing pharmacological methods," says Kathryn Worley, BSN, MSW, manager of counseling services at South Miami Hospital.
The nurse at the bedside uses simple interventions. These may be relaxation techniques such as dimming the lights, providing a buffer for any noise that would be disturbing, or guiding the patient in deep breathing. Bedside nurses also use distraction techniques such as music or a movie.
Trained therapists conduct the interventions that require expertise, such as guided imagery or meditation, and are available with a physician’s order. Primarily, clinical social workers at the institution are the staff trained in postgraduate meditation and relaxation techniques.
The institution also has four expressive therapies offered on an outpatient basis but also available with a physician’s order to acute patients. These include art therapy, music therapy, poetry and journaling therapy, and dance and movement therapy. Therapists who have obtained a credential in that particular modality teach these techniques for pain control. "These expressive therapies are offered in regular groups for the outpatient population, so we really emphasize that the main help from these kinds of therapies comes by doing them on an ongoing, long-term basis," says Worley.
South Miami Hospital has a behavioral medicine department that mainly focuses on pain management interventions for the patients on the units. A second department, which is new, is collaborative medicine. It concentrates on mindfulness stress reduction, which is meditation on a very regular basis and has been shown to be effective with chronic pain, says Worley.
With any nonpharmacological pain methods, education is important, whether the patient is required to participate in the intervention or not. The patient needs to understand the process, trust the practitioner, and believe that the therapy will help reduce pain in order for it to work well, says Worley. "We help the patient understand with the data, why it might be effective," she explains.
After evidence is given, if the patient does not believe the therapy will work, it doesn’t necessarily mean that the modality should be forgotten. A practitioner might be able to offer other credible references that may persuade the person to give it a chance. However, if patients are resistant, their wishes should never be ignored, says Worley.
It’s important to provide education for both staff and patients through credible research from credible organizations. Some nonpharmacological pain management interventions are evidence-based, some have been proven time and again to be ineffective, and some have not been confirmed one way or the other. "There is no solid research yet on magnet therapy and some people find it very successful in their individual use so we would not discourage them," says Worley. (To learn how patients and family members are educated about the use of herbal remedies while under medical care, see article, below.)
As with any pain control method whether pharmacological or nonpharmacological, its appropriateness for a patient must be determined by a proper assessment. Ask if the patient has experienced similar pain in the past and, if so, what has worked, advises Worley. Also determine what the patient will consider. The second question to pursue is the type of pain the person is having because some nonpharmacological interventions work better on certain types of pain than others. For example, massage, another modality offered at South Miami Hospital, is very good for back pain, says Worley.
The type of nonpharmacological intervention does depend on the patient’s health problem as well as physical limitations. Sometimes, a modality can be altered to fit the patient’s need. For example, while people with pulmonary disease often have difficulty laying in a prone position for a massage, they can be positioned in a chair for one and it seems to ease their anxiety and pain.
"Every situation is very individual and requires that assessment to evaluate what might be best for them," says Worley. (To learn how to use nonpharmacological pain management techniques with children, see pediatric insert in this issue.)
Currently, South Miami Hospital is considering the implementation of a pre-op class in guided imagery and meditation for scheduled surgery patients. It would be a one-and-a-half- to two-hour group class for people considering surgery. There would be some basic training in meditation and relaxation techniques that the patient could incorporate after surgery.
While a patient can be guided in meditation and relaxation exercises without any teaching, it is better for patients to learn the skills so that they might make use of them on their own. "It is empowering," says Worley.
For more information about incorporating nonpharmacological pain control methods into management strategies, contact: