Non-pharmacological pain management Flashcards
Types of non-pharmacological pain management
- Physical therapy- exercise
- Psychological therapies
- Complementary & alternative therapies
- Education
- Joint protection
- Occupational therapy
- Weight control
- Surgery
What is the aim of physical therapy?
Aim- to help overcome ‘fear avoidance’, where patients associate activity w/ an increase in pain & therefore do progressively less activity, w/ resultant deconditioning.
Therefore important to pace physical activity so that patients do not cycle from over-activity, w/ a flare in pain, to fatigue & deconditioning.
- Done by establishing patients baseline level of activity & tailoring exercise programme
Exercise very important in management of chronic pain
Examples of physical therapies and the benefits for each?
Aerobic fitness training
- improves well-being
- Benefits common comorbidity e.g. obesity, diabetes, hypertension
- Encourages restorative sleep
- produce long-term reduction in pain & disability.
- E.g. walking, running, yoga, pilates, household activities, swimming
Strengthening exercises for muscles
- reduces pain & disability
- improves muscle strength
- Improves proprioception, coordination & balance associated w/ chronic arthritis.
Weight- bearing exercises
- can result in modest increases in bone density & slow bone loss- very important osteoporosis!
What are the aims of psychological therapies?
Aim- to increase coping skills & improve quality of life when facing the challenges of living w/ chronic pain.
Examples of psychological therapies and aims of each?
Cognitive-behavioural therapy (CBT)
- About changing the narrative or thoughts in a patient’s head.
- Aim- reduce negative thoughts & beliefs, & develop positive coping strategies
- Assesses a person’s beliefs on the impact, cause, cure & prospects of their pain.
- A problem-focused approach is used
- Keeping records of thoughts - helps to identify unhelpful patterns of thinking and to learn to challenge unhelpful thoughts.
Mindfulness Based Stress Reduction (MBSR)
- Teaches that pain & suffering are part of life so we can learn how to deal w/ them & go on living.
- Focuses on increasing awareness of moment to moment experiences i.e. being present.
- e.g. mindfulness, meditation, yoga
Acceptance & Commitment Therapy (ACT)
- About understanding & reaching a place of acceptance in relation your pain.
- Goal is to refocus their energies on what they can achieve despite pain - psychological flexibility.
- Involves mindfulness - teaches psychological skills.
Examples of complementary/ alternative medicine? Issues with it?
- E.g. herbal medicines, vitamins & homeopathy
- Little evidence of efficacy
- May interact w/ conventional drugs causing adverse side effects
Advantages of patient education?
- Patients must be informed about their condition, treatment & prognosis- improves health outcome
- reduces pain & disability
- improve self-efficacy - reduce the health-care costs of MSK conditions
- leads to improved adherence to treatments
Joint protection- what causes joint pain? How to protect the joint from pain?
- Excessive loading & repetitive use of compromised joint can worsen symptoms in patients w/ arthritis
Reduced by limiting contact sport & by pacing activities by dividing physical tasks into shorter segments w/ breaks in between
Adaptations to tools e.g. shock-absorbing footwear which can reduce impact-loading & use of walking stick on contralateral side to painful hip or knee
What is the role of occupational therapy in the management of chronic pain?
Aids & appliances provide independence for patients w/ respect to activities of daily living.
- E.g. raised toilet seat, raised chair height, extended handles on taps, a shower instead of a bath
Local heat, ice packs, wax baths - induce muscle relaxation.
Hydrotherapy- it is warm, induces muscle relaxation & allows movement w/out the restraints of gravity or normal load bearing.
What role does weight have in Chronic pain? How to address this?
Obesity aggravates pain through increased mechanical strain
- Also risk factor for joint damage in patients w/ OA
Excessive weight loss can be counterproductive - adults w/ BMI of < 20 kg/m^2 are at increased risk of fractures
This should be explained to obese patients & strategies offered on how to lose & maintain an appropriate weight
- advised to maintain BMI w/in 20–25 g/m^2 range.
What is the aim of surgery? What do you need to consider?
Aim- provide pain relief & improve function & quality of life
Need to consider patients consequences & wishes- e.g. for severely compromised patients, pain relief & functional independence are more important than surgery, which may result in patient loosing independence & mobility (even if successful).
Examples of surgical procedures?
Soft tissue release & tenosynovectomy - can reduce inflammatory symptoms, improve function & prevent tendon damage
Synovectomy- does not prevent disease progression but used for pain relief when drugs, physical therapy & intra-articular injections have been insufficient
Osteotomy- cutting bone to alter joint mechanics & load transmission
Excision arthroplasty- removing part or all of the joint
Joint replacement- insertion of prosthesis in place of the excised joint
Arthrodesis- joint fusion
Surgical fixation of fractures is frequently required in patients w/ osteoporosis.
