1. 1 Nondrug Pain Management Adapted from:The PERT Program 2004 Pain & Palliative Care Research Department Swedish Medical Center, Seattle, Washington Geriatric Aide Curriculum NC Division of Health Service Regulation Module 20

2. 2 Nondrug Pain Management Nondrug Pain Management Objectives 1. Describe the reasons for using different types of therapies to relieve pain symptoms 2. Describe special considerations and precautions for using specific nondrug therapies 3. Demonstrate the use and teaching of several nondrug techniques

3. 3 General Measures to Help Cope with Pain Good body alignment Bed linens tight and wrinkle-free Not lying on drainage tubing Elimination needs Warmth and chilling

4. 4 General Measures to Help Cope with Pain (continued) Talk softly and gently No jarring movements of bed or chair Handle the person gently Calm, quiet, darkened setting Stay in room for a meal

5. 5 Two Categories of Nondrug Interventions for Pain Physical Psychological

6. 6 Examples of Nondrug Interventions for Pain Massage Cold Heat Vibration Positioning Exercise Physical

7. 7 Examples of Nondrug Interventions for Pain Psychological Distraction Relaxation Music Comfort Foods Imagery Controlled Breathing

8. 8 Combination Therapy For chronic pain, pain medications are still the mainstay for pain relief Nondrug techniques alone have proven effective for some people The use of both drug and nondrug techniques (combination therapy) might be necessary to achieve optimal pain control

9. 9 Advantages to Nondrug Interventions for Pain Low cost Less potential for side effects Decrease emotional response to pain Provide resident with sense of control or involvement

10. 10 Disadvantages to Nondrug Interventions for Pain Outcomes are variable May be time-consuming Some require advanced training Misunderstandings may affect willingness to try the techniques

11. 11 Six Common Misunderstandings About Nondrug Interventions for Pain Misunderstanding #1 Most nondrug methods reduce the intensity of pain for most people. Correction Pain reduction is not a guaranteed outcome of many techniques. However, coping abilities may improve making the pain more bearable.

12. 12 Misunderstanding #2 Nondrug measures should be used instead of pain medication or to lengthen the time between doses of pain meds. Correction Anti-drug attitudes or fear of addiction can cause people to avoid the use of medication. Nondrug approaches should not be used as a substitute for appropriate pain management. Six Common Misunderstandings About Nondrug Interventions for Pain

13. 13 Misunderstanding #3 Nondrug techniques for pain management work by increasing endorphin levels, the body’s natural sedation. Therefore, they lessen the risk of addiction. Correction Addiction is a minimal risk when a person is in pain and at the end of life. Addiction should not be an excuse for avoiding pain meds. Six Common Misunderstandings About Nondrug Interventions for Pain

14. 14 Misunderstanding #4 Cutaneous (skin) techniques must be used over the site of pain. Correction Techniques such as cold and heat can be effective on the opposite side of the pain being experienced, or even at a totally different site. Six Common Misunderstandings About Nondrug Interventions for Pain

15. 15 Misunderstanding #5 If people can be distracted from their pain, the pain isn’t “real” or it’s not as bad as they are saying. Correction People who use distraction techniques regularly may be able to make their pain more bearable and regain a sense of control when using distraction. This doesn’t mean that they aren’t really experiencing pain. Six Common Misunderstandings About Nondrug Interventions for Pain

16. 16 Misunderstanding #6 The effectiveness of nondrug approaches to pain management is well established through research. Correction Some therapies have scientifically proven effectiveness, while others are less well studied. The same holds true for more traditional approaches to pain. Six Common Misunderstandings About Nondrug Interventions for Pain

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18. 18 Complementary and Alternative Medicine (CAM) Includes a broad range of healing philosophies, approaches, and therapies that are not presently considered part of conventional medicine. ~NCCAM (National Center for Complementary and Alternative Medicine)

19. 19 Complementary and Alternative Medicine (CAM) “Complementary” therapies – used in addition to conventional treatments “Alternative” therapies – used instead of conventional treatment ~NCCAM (National Center for Complementary and Alternative Medicine)

20. 20 CAM Therapy Examples Acupressure Acupuncture Aromatherapy Herbal therapy Homeopathy Hypnosis Magnet Therapy Naturopathy Therapeutic Touch

21. 21 Observations of Resident Prior to Starting Therapy Understanding of options Attitude and comfort Family interest and availability Need for education Ability to participate

22. 22 Nondrug Interventions Massage Cold Heat Positioning Distraction Relaxation Music Comfort Foods

23. 23 Massage Decreases pain by soothing the skin and relaxing tense muscles

24. 24 Massage Examples Brief touch such as rubbing someone’s shoulder A warm foot soak and rub Massaging a hand with warm lotion

25. 25 Reduces pain by: –numbing nerve endings –reducing muscle spasms –decreasing inflammation Also decreases the desire to scratch areas that itch!

26. 26 Cold Examples An ice pack to the neck and upper shoulders, after BenGay™ applied Ice massage to the knee with a Dixie Cup™ (water frozen in Dixie Cup™) Ice cloth to the hip opposite the one that hurts

27. 27 Relieves pain by reducing inflammation and soreness. Also decreases sensitivity to pain and increases blood flow to the skin.

28. 28 Warm washcloth to head Hot water bottle to abdomen Jacuzzi™ bath

29. 29 Positioning/Movement Positioning eases pain by placing the body into postures that maintain or promote normal function of the muscles. Movement helps maintain or restore ease of function in joints, bones, nerves, and ligaments.

30. 30 Positioning/Movement Examples Use of full-length body pillow Pillow between knees when lying on either side Pretend write the alphabet by using the feet – switch feet every 6 or 8 letters

31. 31 Distraction Used to focus attention on something other than pain. By decreasing concentration on pain, it becomes more bearable.

32. 32 Distraction Example-Pictures Bring out file of pictures Have resident look at a picture and describe it in any way they choose: –Talking about the picture –Pretending they are in the picture –Telling a story about the picture

33. 33 Distraction Example-Pictures Choose a new picture as soon as resident interest decreases in the current one

34. 34 Relaxation Described as freedom from physical and mental tension Helps reduce stress that causes muscle tension which, in turn, increases pain.

35. 35 Relaxation Example Go to a quiet room Breathe in deeply; exhale slowly Think of a calm setting or peaceful place that you’ve enjoyed visiting Try to think only of your breathing and your place of relaxation

36. 36 Music Decreases pain by: –reducing anxiety –prompting recall of pleasant memories –interrupting the stress response

37. 37 Music Examples Listen to calming music for relaxation Mark time to music (tap or nod head) for distraction Select a song with familiar words and sing it aloud or silently. Sing faster when pain increases, slower when it decreases.

38. 38 Comfort Foods Assists in decreasing pain by: –providing distraction –evoking comforting memories –promoting relaxation and physical calm

39. 39 Examples of Comfort Food 7-up™ Chicken soup Hot chocolate Popsicles Potato chips Ice cream Hot tea

40. 40 Using Nondrug Therapies in Daily Care: Building a Toolkit

41. 41 You can add a cassette or CD player or a radio with a set of headphones.

42. 42 Comfort foods can be a part of the toolkit.

43. 43 Think about cards, pictures, games or drawing materials.

44. 44 It’s nice to store the items together in a plastic bin or tote.

45. 45 Role of the Nurse Aide in Nondrug Pain Management Activities not requiring an order: Distraction Music Positioning Backrub/shoulder massage Reading Prayer/Meditation Comfort foods

46. 46 Role of the Nurse Aide in Nondrug Treatments Activities that require an order or are clearly part of a care plan: –Application of heat or cold –Use of menthol-based product –Massage of lower extremities

47. 47 Case Study #1 After receiving a backrub, a resident remarks how appreciative she is and how much it helps relieve her backache. You go into the next room where the resident also states his back “really hurts.” You offer a backrub, which he gruffly declines saying, “touching it makes it hurt even more.”

48. 48 Case Study #1 What do you think is going on with the resident who said “No” to the backrub? What should you do?

49. 49 Case Study #2 You check on a resident who asks you to please fill a basin in his room with “really hot water” in order to soak his painful feet. –Should you do what he asks? –What questions will help you determine your course of action?

50. 50 Case Study #3 A resident in your area states her hip is very sore. She says she remembers ice is good for bone pain. –What do you need to know about her to know if this technique is appropriate for her pain?

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