Med-Surg · chapter 7 · Pain Assessment and Management
Nonpharmacological Pain Management
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Documentation and evaluation
Like all treatments, nonpharmacological interventions should be documented in the plan of care and their effectiveness evaluated in terms of their ability to meet the patient’s goals for pain relief.
Rest and clustered care
To provide the opportunity for rest, consider clustering care (planning to include care tasks in as few visits as possible) to reduce unnecessary interruptions. Rest is important whether the pain is caused by illness or injury, as it allows the body to focus on healing.
Compression assessment
When using a compression bandage, the nurse must carefully assess the area to ensure proper blood flow to the extremity.
Heat therapy effects
Heat decreases pain by increasing blood flow through vasodilation, which promotes relaxation and alleviates muscle stiffness or chronic pain. Heat may be applied for five to twenty minutes at a time.
Cold therapy effects
Cold decreases pain by reducing the blood flow through vasoconstriction; it also numbs nerve sensations. Cold should be applied for no longer than twenty minutes at a time.
Skin protection
Heat and ice should never be directly applied to the skin. The nurse should routinely examine the site to assess for potential skin burns.
RICE timing
RICE is most effective when implemented immediately following an injury, and for the twenty-four to forty-eight hours that follow, to decreased inflammation, pain, and risk for further injury.
Cognitive behavioral therapy
Another approach to mind-body therapy is through cognitive behavioral therapy (CBT) in which individuals are taught how to manage and cope with pain more effectively by changing their negative thought pattern, identifying and reducing stressors that exacerbate pain perception, and focusing on adapting to pain in situations when pain cannot be eliminated.
Natural products regulation
All these remedies may add small amounts of necessary nutrients to the body, though they are not regulated by the Food and Drug Administration (FDA) for safety and effectiveness.
Massage precautions
Due to the risk of injury if not performed correctly, massage should only be performed by trained individuals. It should be used with caution in patients on blood thinners or with wounds, fractures, blood clots, infection, or weakened bones.
Acupuncture uses and cautions
Acupuncture is commonly used to relieve chronic pain resulting from arthritis; back, neck, knee, and muscle pain; headaches and migraines; menstrual cramps; sports injuries; and nerve discomfort. It is not recommended for those with pacemakers, those taking blood thinners, or those who are pregnant.
TENS uses and cautions
TENS therapy has been shown to relieve pain associated with osteoarthritis, fibromyalgia, labor pains, and diabetes-related neuropathy (Njogu et al., 2021; Wu et al., 2022). TENS therapy should not be used for those with an implantable device; those who have cancer, epilepsy, deep vein thrombosis, or hemorrhaging; or those who are pregnant.
Individualized pain plan
When formulating a pain management plan, it is important to meet the needs of the individual patient. For some, nonpharmacological therapies alone may manage the pain.
Nurse role
The nurse’s role in nonpharmacological pain treatment is to generate ideas about which therapies may be beneficial to the patient, implement the interventions, and then assess the effectiveness of the interventions.
Terms to know
- complementary therapy
- A therapy that is used in combination with pharmacological pain management is called a complementary therapy, whereas one used in place of pharmacological pain management is called an alternative therapy.
- alternative therapy
- A therapy that is used in combination with pharmacological pain management is called a complementary therapy, whereas one used in place of pharmacological pain management is called an alternative therapy.
- thermotherapy
- A treatment called thermotherapy is the application of heat or cold to alter the cutaneous, intra-articular, and core temperatures of soft tissues.
- RICE
- A combination referred to as RICE, stands for rest, ice, compression, and elevation.
- aromatherapy
- The inhalation or dermal application of essential oils— aromatherapy —is another strategy that can be used for nonpharmacological pain management.
- chiropractic therapy
- The practice that manipulates the spine, joints, and skeletal system is chiropractic therapy.
- reflexology
- The type of massage applied to specific pressure points aligned with the body in the hands and feet is called reflexology.
- transcutaneous electrical nerve stimulation (TENS) therapy
- Another type of nonpharmacological pain management is transcutaneous electrical nerve stimulation (TENS) therapy, which delivers low-voltage electrical current to reduce pain.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
At 1830, you provide music and dim the lights for a patient whose pain-relief goal is to rest comfortably. At 1900, the patient says, "I feel calmer, but I am still too uncomfortable to rest." Which documentation best evaluates the intervention?
- Music and dimmed lighting provided; patient reports feeling calmer but remains too uncomfortable to rest. Goal of comfortable rest not met.
- Music and dimmed lighting provided for comfort; patient tolerated both interventions.
- Music and dimmed lighting provided; pain-relief goal met because the patient reports feeling calmer.
- Patient reports feeling calmer after music and dimmed lighting; continue the current comfort plan.
Answer: Music and dimmed lighting provided; patient reports feeling calmer but remains too uncomfortable to rest. Goal of comfortable rest not met.
The correct entry documents the intervention and response, then evaluates that response against the patient's stated goal. Feeling calmer or tolerating an intervention does not establish goal attainment, and simply continuing the plan leaves the patient's remaining discomfort undocumented.
At 1430, a patient reports that guided imagery has not achieved the pain-relief goal documented in the care plan. You document this response. Which next steps are supported by the section? Select all that apply.
- Consider additional therapies to add to the treatment plan.
- Carry forward the initial response as the response to any added therapy.
- Reassess after any added therapy and document the reassessment.
- Document the response to an added therapy only if it differs from the initial response.
- Document the added therapy when completed and reassess only if the patient requests more relief.
Answer: Consider additional therapies to add to the treatment plan., Reassess after any added therapy and document the reassessment.
When the patient's pain goal remains unmet, the section supports considering additional therapies, followed by reassessment and documentation. The initial response cannot substitute for assessing the added therapy, and reassessment and documentation are not limited to patient requests or changed findings.
At 1010, you finish a ten-minute heat application for chronic lower back pain. Your draft note includes the application times, use of a barrier between the heat source and skin, and the patient's report of reduced stiffness. Which additional assessment should you perform and document to address the heat-related injury risk identified in the section?
- Determine whether the patient has reached the pain-relief goal in the care plan.
- Ask whether the patient would prefer heat for future pain episodes.
- Examine the application site for evidence of skin burns.
- Assess whether the patient is now comfortable enough to rest.
Answer: Examine the application site for evidence of skin burns.
The section calls for routine examination of the treatment site for potential skin burns; documenting barrier use and symptom improvement does not replace that examination. Preferences, goal attainment, and ability to rest help evaluate treatment but do not assess the local skin injury risk from heat.
Where every quote comes from
Section 7.4 Nonpharmacological Pain Management of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.