Pain Management - Non Pharmacological

Question 1

Who can help in non pharmacological methods of pain relief

Answer 1

Physio, PT
Clinical psychologist
Osteopath, chiropractors, acupuncturist, complementary therapists

Question 2

Distraction techniques

Answer 2

Mild, moderate pain

-descending pathways inhibit pain messages

Question 3

Guided imagery

Answer 3

Imagination used to guide thoughts, can help improve relationship with pain

Can be done in a group or individual setting

Question 4

Listening to music

Answer 4

Distraction
Decrease muscle tension
Promote relaxation, sleep, endogenous opioids

Question 5

Physical activity, exercise

Answer 5

Can be aerobic, strength-based, balance, flexibility
Modifiable if movement is restricted

Release of endorphins => relaxation
Increase muscular support for arthritic joints
Weight loss, better sleep, mood, CV function

Can be supported by physio, self motivation

Question 6

TENS

Answer 6

Small battery operated device => low intensity electrical impulses

High frequency - Ab fibres stimulated and competes with Ad/C fibres => inhibition
-tingling, pins and needle like
Low frequency - stimulates production of endogenous opioids
-pulsing, tapping with contractions

Used in labour, neuropathic pain
-not suitable for all patients

CI

• undiagnosed painful condition
• pacemaker
• epilepsy
• first 6 months of pregnancy
• broken/inflammed skin
• directly on tumour site
• allergic reaction to electrodes

Not to be placed on

• head, carotid sinus
• areas of altered sensation
• transdermal patches

Evidence for effectiveness if mixed

Question 7

CBT

Answer 7

Process that helps people to
-question their current beliefs
-reframe them
so their emotional response is not as distressing, does not worsen pain

Fear avoidance - work on proving your past unhelpful beliefs wrong

Can be done individually, guided by a therapist or in a group

Question 8

ACT

Answer 8

Acceptance and Commitment Therapy - encourages people to identify values that are important to them in their life

Encourages psychological flexibility, acceptance of chronic pain whilst separating pain from their suffering

Question 9

Psychological therapies

Answer 9

Mood disorders can exacerbate pain and vice verse

-important to keep mental wellbeing in mind whilst working with patients

Question 10

Patient resources

Answer 10

Professional organisations
Pain charities or initiatives
Charities for specific painful conditions

Question 11

Self management for persistent/chronic pain

Answer 11

Promotion of self management whenever possible

Pain Management Programmes run by MDT can help address many domains that contribute to chronic pain