{Author Name [first-name middle-name-initials last-name]}
{Institution Affiliation [name of Author’s institute]}
Introduction
Pain is an unpleasant sensory and an emotional experience which is associated with the potential damage of tissues (Gregory & Haigh, 2008). There are various factors that contribute to the pain psychology such as psychological and environmental. Acute pain is associated with the actual tissue damage which is associated with the surgical incidence and tissue damage. When the pain is experienced for a longer period due to unknown reasons or any underlying problem, it’s called chronic pain which illustrates the pain of Mr. John Smith due to osteoarthritis (Leaper, Whitaker & Leaper, 2010). Unattended pain impacts the patient’s health and hospital stay. The aim of pain assessment is to identify the pain level of the patient so that the pain can be relieved. Recent medical advances found the side-effects of pharmacologic interventions such as the use of opioids, NSAIDs and adjuvant medications (Dworkin et al., 2007). The paper presents certain important aspects of non-pharmacologic interventions that facilitate faster recovery and fewer chances of side-effects (Hochberg et al., 2012; Carpenito-Moyet, 2006).
Why pain assessment is necessary and how?
In the case of Mr. John Smith, he has been experiencing a chronic pain for many years, due to osteoarthritis and currently he has been admitted to the hospital for the hip replacement surgery which may cause acute pain. For Mr. Smith pain evaluation is a fundamental requisite for accurate pain management and enhanced intervention outcomes as he is an older patient and pain will impact his life at a higher level. There are various pain assessment tools such as Wong-Baker FACES Pain Rating Scale, 0–10 Numeric Pain Rating Scale, Visual Analog Scale, neuropathy pain scale and Verbal Pain Intensity Scale. Numeric Pain Rating Scale and Visual Analog Scale (VAS) are two most popular pain assessment scales that help in understanding the patient’s severity level of pain. VAS is presented through a straight line which depicts two extreme points at the ends that are “no pain” and “worst pain.” In VAS tool the patient draws a line to indicate his pain and distance of this point from the origin point will determine the pain intensity. It is found very sensitive and accurate that presents the real difference of the pain. Though, scoring between just two distant points is time-consuming for patient and vulnerable to errors (Haefeli & Elfering, 2006). The numeral rating scale demonstrates pain on the scale from 0 to 10 where 0 indicates no pain, 1-3 illustrate mild, 4-6 stands for the moderate and 7-10 stand for severe pain. The main advantage of this tool is high consistency, accurate measurement of present or past pain episodes and more suitable for chronic pain. The only disadvantage of this tool is a lot of adjectives on the scale that may confuse the patient. In this case, I will prefer using the numeral rating scale. For this application, a direct observation is needed which will be supported by the Patient’s self-reporting.
The most abundant problem associated with osteoarthritis is the pain. Pain contributes to multiple physiological complications, functional limitations and impacts the quality of patient’s life. In the aforementioned case, Mr. Smith has been suffering chronic pain that has impacted his lower extremity the most. Various evidence based researches have shown that osteoarthritis pain in lower extremities is one the primary reason behind physical inability among older adults worldwide. There are two types of pain identified in osteoarthritis cases, intermittent and constant. Intermittent pains are more severe as they are unpredictable and impose higher impacts on the patient (Neogi, 2013). Mr. Smith also faces intermittent pain which normally occurs in the morning due to the long period of lying or sitting down during the night time. Same body posture for a longer time makes his pain worse, and it exacerbates in his hips and spreads towards the lumbar and cervical spine. Background pain or constant pain does not impact that much. The pain enforces negative effects on mood, sleep as well as partaking in recreational and social activities. The quality of pain in Osteoarthritis also varies like its impacts and severity. Evidence suggest that one third osteoarthritis patients claim a burning, tingling pain in hip and knee along with numbness and needles like symptoms that is also reported by Mr. Smith. Evidence-based studies on etiology of Osteoarthritis suggest the involvement of neuropathic nerves in this pain. Though not any specific lesions have been detected yet, radiographs also cannot provide significant insight into the structural pathology of pain. Pain, gelling and stiffness in osteoarthritis is well-associated with pain severity with an extent of functional limitation (Neogi, 2013).
Non-pharmacological approaches that can be given to the patient are massage therapy, exercises, radiotherapy, heat therapy, Spinal cord stimulation (SCS), etc. A theory of pain known as “gate control theory” suggests that pain stimuli travel through different neurological gates while trying to reach the brain. Thus, on the basis of this theory rubbing and massaging at the painful site will impact these gates and interfere with the pain stimuli. Effective non-pharmacological recommendations and intervention modalities for the pain management of osteoarthritis are provided by numerous health organizations such as European League against Rheumatism (EULAR) (Fernandes et al., 2013), Osteoarthritis Research Society International (OARSI) (Zhang et al., 2007) and American College of Rheumatology (ACR). They provided (Hochberg et al., 2012).
Non-pharmacological interventions are based on biomechanical observations including insoles, orthoses, diet, exercise and patient education where every healthcare professional including nurses, general practitioner, physiotherapists, rheumatologists, occupational therapists, orthopedic surgeons, dietician, psychologist, clinical epidemiologist and patient representatives can be a part of it. Based on evidence-based nursing practice specific exercises and insoles should be designed for the patient (Rannou & Poiraudeau, 2010: Hochberg et al., 2012).
Recommended non-pharmacological strategies for hip Osteoarthritis include land-based exercise, losing weight, participation in self-management programs, use of thermal agents and walking agents that help in relieving pain (Airaksinen et al., 2006). Complementary strategies are also a good option that such as Tai Chi, Yoga (Hashefi, 2013; Abou-Setta et al., 2011).
While applying the non-pharmacological therapies, it is necessary to evaluate the psychosocial factors by patient's side. If the patient is ready and comfortable, such therapies will provide positive psychological effects regarding pharmacological agent's response (Poulten et al., 2001). Additional cognitive behavioral and energy based intervention may be included (Poulten et al., 2001).
Conclusion
An evidence-based research has demonstrated that the demand and acceptance for non-pharmacological interventions for pain management are rising universally. Literature is crammed up with such evidence where every individual and organization associated with healthcare is involved willingly in such interventions. These approaches will help in defining the pain management strategies and the future of pain management in the cases of osteoarthritis, especially among older patients. The current evidence will also facilitate education and knowledge to learning nurses and other health care specialists in dealing with the pain.
This essay has critically evaluated the non-pharmacological interventions and focused on the importance and necessity of such interventions in treating pain. It helped in clarifying that why it should be preferred as a nursing care plan.
References
Abou-Setta, A. M., Beaupre, L. A., Rashiq, S., Dryden, D. M., Hamm, M. P., Sadowski, C. A.,
& Mousavi, S. S. (2011). Comparative effectiveness of pain management interventions
for hip fracture: a systematic review. Annals of internal medicine, 155(4), 234-245.
Airaksinen, O., Brox, J. I., Cedraschi, C., Hildebrandt, J., Klaber-Moffett, J., Kovacs, F., &
Zanoli, G. (2006). Chapter 4 European guidelines for the management of chronic
nonspecific low back pain. European spine journal,15, s192-s300.
Carpenito-Moyet, L. J. (Ed.). (2006). Nursing diagnosis: Application to clinical practice.
Lippincott Williams & Wilkins.
Dworkin, R. H., O’connor, A. B., Backonja, M., Farrar, J. T., Finnerup, N. B., Jensen, T. S., &
Portenoy, R. K. (2007). Pharmacologic management of neuropathic pain: evidence-based
recommendations. Pain, 132(3), 237-251.
Fernandes, L., Hagen, K. B., Bijlsma, J. W., Andreassen, O., Christensen, P., Conaghan, P. G.,
& Lohmander, L. S. (2013). EULAR recommendations for the non-pharmacological core
management of hip and knee osteoarthritis. Annals of the rheumatic diseases, 72(7),
1125-1135.
Gregory, J., & Haigh, C. (2008). Multi-disciplinary interpretations of pain in older patients on
medical units. Nurse education in practice, 8(4), 249-257.
Haefeli, M., & Elfering, A. (2006). Pain assessment. European Spine Journal, 15(1),
S17-S24.
Hashefi, M. (2013). Nonpharmacologic, complementary, and alternative interventions for
managing chronic pain in older adults. Clinical Geriatrics, 21(3)
Hochberg, M. C., Altman, R. D., April, K. T., Benkhalti, M., Guyatt, G., McGowan, J., &
Tugwell, P. (2012). American College of Rheumatology 2012 recommendations for the
use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip,
and knee. Arthritis care & research, 64(4), 465-474.
Leaper, D., Whitaker, I., & Leaper, D. (2010). Post-operative complications. Oxford: Oxford
Michael, J. W., Schlüter-Brust, K. U., & Eysel, P. (2010). The epidemiology, etiology, diagnosis,
and treatment of osteoarthritis of the knee. Dtsch Arztebl Int, 107(9), 152-62.
Neogi, T. (2013). The epidemiology and impact of pain in osteoarthritis. Osteoarthritis and
Cartilage, 21(9), 1145-1153.
Poulton, V., Hobman, A., Berggren, L., Nash, P., Helmrich, S., & Yates, P. (2001). Factors
influencing nurses' decisions to use non-pharmacological therapies to manage patients'
pain. Australian Journal of Advanced Nursing, 19(1), 27.
Rannou, F., & Poiraudeau, S. (2010). Non-pharmacological approaches for the treatment of
osteoarthritis. Best practice & research Clinical rheumatology, 24(1), 93-106.
Ramsay, M. A. (2000). Acute postoperative pain management. Proceedings (Baylor University.
Medical Center), 13(3), 244.
Rosenstiel, A. K., & Keefe, F. J. (1983). The use of coping strategies in chronic low back pain
patients: relationship to patient characteristics and current adjustment. Pain, 17(1), 33-44.
Zhang, W., Moskowitz, R. W., Nuki, G., Abramson, S., Altman, R. D., Arden, N., &
Dougados, M. (2007). OARSI recommendations for the management of hip and knee
osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic
review of current research evidence. Osteoarthritis and cartilage, 15(9), 981-1000.
