Bemaj Pharmacy

What is non-pharmacological pain management?

Abstract – Non-pharmacological pain therapy refers to interventions that do not involve the use of medications to treat pain. The goals of non-pharmacological interventions are to decrease fear, distress and anxiety, and to reduce pain and provide patients with a sense of control.

What is non-pharmacological treatment for pain nursing?

Nonpharmacologic interventions include distraction, relaxation, or imagery; superficial massage; breathing techniques; music therapy; spiritual practices; environmental modification (such as reducing lighting and noise); positioning and repositioning; heat or cold application; and transcutaneous electrical nerve

What are 3 different types of pain management?

Pain management strategies pain medicines. physical therapies (such as heat or cold packs, massage, hydrotherapy and exercise) psychological therapies (such as cognitive behavioural therapy, relaxation techniques and meditation)

What are examples of non opioid pain management?

Aspirin, Ibuprofen (Advil, Motrin), Naproxen (Aleve, Naprosyn) Relieve mild–moderate pain, and reduce swelling and inflammation. Risk of stomach problems increases for people who take NSAIDs regularly.

What are non-pharmacological approaches examples?

Conclusion – Non-pharmacological therapies including reassurance, lifestyle modification, psychotherapy, dietary management, medical food, acupuncture, and electrical stimulation/modulation can be useful options for the treatment of FD ( Table 5 ). Non-pharmacological therapies for FD are increasingly being sought by families and medical providers for treating dyspeptic symptoms.

• The non-invasive nature and potentially minimal side-effects of these non-addictive, non-pharmacological therapy are likely to benefit FD patients, especially those who have failed conventional therapies.
• The current evidence to warrant the routine use of non-pharmacological therapies in treating FD patients remains limited, though some FD patients do respond well to non-pharmacological management.

The timing to incorporate non-pharmacological therapy into the standard therapy and its position in the current treatment algorithm for FD patients remains to be settled. It is still unclear whether it should be used for refractory FD patients or used as an adjunct to the pharmacological therapy.

What are some non pharmacological interventions?

Those may include, but are not limited to, mental health assessment, therapy, skills building, parenting assistance or family therapy.

What are non-pharmacological pain management at end of life?

Treatment / Management – The management of pain at the end of life includes nonpharmacological measures, pharmacological measures, and psychosocial measures. Pharmacological Management of Pain The World Health Organization (WHO) devised a cancer pain ladder to guide caregivers in selecting pharmacological agents in managing pain.

• This is a stepwise process where the initial agents are nonopioids with escalation to incremental doses of opioids and adjuvant agents, ultimately leading to the abolishment of pain.
• While this is a good guide in managing pain, individual assessment of each patient should be performed to gauge the initial intensity of pain to avoid delay in therapy.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used initial pharmacological agents for pain. The mechanism of action of these drugs is based on the inhibition of the synthesis of prostaglandins. The cyclo-oxygenase enzyme COX-1 and COX-2 are inhibited by NSAIDs, with the COX-2 enzyme playing a key role in pain generated by inflammatory cells.

Some NSAIDs can also inhibit the lipoxygenase pathway, which is responsible for producing some algogenic (pain-producing) metabolites. NSAIDs also interfere with G-protein mediated signal transduction aiding in analgesia. Increasing evidence suggests that NSAIDs also have a central effect in the CNS mediated by endogenous opioid peptides or blockade of the release of serotonin.

Acetaminophen is used frequently in divided doses equaling a maximal dose of 4000mg every 24 hours. However, it is frequently associated with hepatotoxicity, and lower dosages may be needed in patients with hepatic disease. Ibuprofen is another NSAID that the FDA has approved for mild to moderate pain; however, it is associated with gastrointestinal bleeding, renal impairment rashes, and hypertension.

Etorolac is another NSAID that has a higher demonstrated potency than most other NSAIDs. However, in addition to gastrointestinal and renal side effects, it can cause an increased risk of cardiovascular thrombotic events and strokes. Selective COX-2 inhibitors like celecoxib can help manage pain associated with the musculoskeletal system and theoretically have a favorable side effect profile compared to other NSAIDs.

Celecoxib contains the sulfonamide group and can cause severe allergic reactions in patients with sulfa drug allergy. If any of these medications are being used for more than a week, a proton pump inhibitor should be added as gastric prophylaxis. Opioid analgesics are considered the gold standard of pain management at the end of life, providing the greatest analgesic relief.

Opioids act by interacting with the mu, delta, or the kappa opioid receptors by mimicking endogenous opioid peptides. These receptors are coupled to G1 proteins and act in an inhibitory capacity. They cause the closure of N-type voltage-gated calcium channels and open calcium-dependent inwardly-rectifying potassium channels.

This causes a reduction in neuronal hyperexcitability due to hyperpolarization. They also decrease the intracellular cAMP and thereby decrease the release of nociceptive neurotransmitters like substance P. The Mu receptors are key in mediating analgesia, euphoria, sedation, gastrointestinal dysmotility, and respiratory depression.

Mu receptors can cause respiratory depression by a decreased response to hypoxia and hypercarbia, resulting in decreased stimulus to breathe. However, respiratory depression is preceded by sedation, and the clinicians should perform a constant assessment of mentation to avoid respiratory depression. The pharmacokinetics of different opiates can be utilized in appropriate pain management at the end of life.

The time to peak analgesic effect is important in choosing the right medication. Several routes of administration are available for opioids, including oral, intravenous, subcutaneous, intramuscular, transmucosal, nasal, transdermal, and rectal. In general, the peak analgesic effect of oral opioids is close to 1 hour, whereas intravenous doses of opiates cause a peak effect around 10 minutes from the administration.

• Certain newer opiates using the trans-mucosal or intranasal mode of administration can have a faster onset of action and peak effect.
• The doses of opiates need individualization and should be titrated per the analgesic effect.
• Patients who need repeated doses of short-acting opiates may need longer-acting opiates scheduled round the clock.

The daily short-acting doses should be added up, and 50% to 75% of the dose should be converted to long-acting opiates. As needed, opiates should be prescribed to address breakthrough pain caused by interventions like turning, suctioning and changing of dressing, etc.

• The FDA approves morphine sulfate for acute or chronic pain with moderate to severe intensity.
• Morphine is metabolized in the liver and excreted by the kidneys.
• In patients with renal dysfunction, the active metabolites, namely 3-glucuronide and morphine-6-glucuronide, can accumulate, causing myoclonus and seizures.

Oxycodone similarly is another potent opiate that is approved for use in moderate to severe pain. It is available in the immediate release as well as extended-release formulations. Its metabolism is similar to morphine. Hydromorphone is another potent opiate analgesic available in the oral, subcutaneous, or sublingual preparation.

1. Fentanyl has gained popularity due to its several routes of administration and predictable analgesic effects.
2. Apart from being used as an infusion for sedation and analgesia in mechanically ventilated patients, it can be used as a transdermal patch in patients who cannot take medications orally.
3. Care is necessary when removing the used patch before placing a new patch to avoid an overdose.

Fentanyl is stored in the adipose tissue and takes 12 to 24 hours to wash out of the system once the patch is removed. Methadone is a long-acting pure mu-agonist with the advantages of having a long half-life and an inexpensive preparation available orally.

Unfortunately, methadone has a curvilinear pharmacokinetic curve leading to exponential effect in higher doses exposing to potentially life-threatening overdoses. It can also lead to QT interval prolongation and should be used cautiously in patients with underlying cardiac conditions. Tramadol has a dual-action at the mu-opioid receptor as well as a weak action as a serotonin-norepinephrine reuptake inhibitor.

Its use has been approved for moderate pain to moderately severe pain. The selection of an opiate agent should take into account the individual needs of the patient. The mechanically ventilated patient can get fentanyl or hydromorphone due to the fast action and easy titration.

Patients with renal and hepatic insufficiency should get IV Fentanyl with doses adjusted. Remifentanil can be used as well because its metabolism is not dependent on hepatic or renal function. It is metabolized by nonspecific plasma esterases located primarily within erythrocytes. Patients who require frequent neurological checks can also benefit from remifentanil due to its ultra-short duration of action.

Patients with hemodynamic instability or bronchospasm should not receive morphine sulfate as it causes histamine release. Meperidine should be avoided in patients with renal and hepatic failure because of severe neurotoxicity from the accumulation of an active metabolite.

• Codeine is another medication with limited use at the end of life with a high incidence of constipation.
• Approximately 10% of the population lacks the enzyme necessary to convert codeine (a prodrug) to morphine, leading to insufficient analgesia.
• Patient-controlled analgesia (PCA) via an infusion pump is a modality that can be utilized when the daily dosages required are high, or the patient is unable to tolerate oral analgesia.

PCA pumps have a button that allows for a breakthrough dose when pressed by the patient. The pumps can be programmed to allow doses separated by a safety interval. The dose delivered on pressing the button is typically 50 % of the hourly dose. Monitoring for sedation in patients on a PCA pump is important to avoid respiratory depression.

1. In patients with inability, debility, or cognitive decline, the PCA can be replaced with a Nurse controlled analgesia pump (NCA) where the nurse administers breakthrough doses prior to interventions or on observing objective signs of pain in the patient.
2. Nonopiate medications can be used as an adjunct to opiates or NSAIDs for pain management.

Antiepileptic medications like gabapentin and pregabalin can be used for pain from neuropathy and bony metastasis. Both these medications require dose adjustments for renal impairment. Corticosteroids can be used in late disease as an adjunct and can aid in improving appetite and mood.

1. However, severe interactions and adverse side effect profiles warrant a risk vs.
2. Benefit discussion with the patient.
3. Non-Pharmacological Management of Pain The nonpharmacological measures for the management of pain include measures aimed at avoiding pain triggers and psychosocial assistance in managing the end of life.

Proper head positioning and neck support can avoid spasms of the neck, artificial tears and lubricants can help avoid painful keratitis. The use of gel foam pads on the skin-appliance interface can help avoid ulceration, for example, nasal bridge gel pads for noninvasive ventilation.

• Oral care and proper hydration can avoid painful ulcerations and dental decay.
• Frequent repositioning and offloading the dependent areas of the body can help avoid decubitus ulcers.
• In case of skin breaks, non-bulky, non-stinging chemical dressings can be used to avoid pain.
• Counseling for getting affairs in order and devising robust goals of care while the patient can still make decisions can help alleviate anxiety and improve interpersonal relations.

Daily sponging and grooming, as tolerated, leads to better hygiene and preserves the patient’s dignity and sense of self-worth. Spiritual counseling and pastoral visits can help counter non–acceptance of impending death and help alleviate suffering. Alternative medicinal therapies like acupuncture and Reiki can be offered to support pharmacological measures in managing pain.

What are non-pharmacological and pharmacological treatment approaches?

STUDENT NT DECODER: –

Pharmacological Management : management of symptoms through the use of medication. Non-Pharmacological Management : management of symptoms without the use of medication such as in this example of OA with exercise, weight loss and acupuncture.

What are the 4 A’s of pain management?

MONITORING – On the basis of risk assessment, patients can be stratified by their level of risk, and therapy can be structured appropriately to minimize risk and guide monitoring.6, 13 Patients at minimal risk can receive minimal structure, whereas those at greater risk can receive more structure, such as more frequent visits, fewer pills per prescription, specialist-level care (eg, an addiction specialist or psychotherapist), and UDTs.

An opioid treatment agreement, discussed and signed by the patient before opioid therapy begins, outlines the risks and benefits, explains what is expected of the patient, educates the patient about drug storage, and helps the patient distinguish between acceptable and unacceptable drug-taking behaviors.16, 30 Refusal to sign such an agreement may indicate misuse or abuse issues but may arise from concerns or psychological issues unrelated to substance abuse or misuse.

Patients must be made aware of the responsibility of safeguarding these medications against diversion by friends, family, or visitors who may have access to medications left out or in unlocked locations. Multiple studies have shown that 50% or more of prescription opioids diverted for nonmedical use are obtained from friends and family.31, 32 The physician can benefit from consulting endorsed guidelines for using opioids to treat chronic pain, available from various state medical boards and the Federation of State Medical Boards.7, 30 A recent survey showed that these techniques led to resolution of aberrant behaviors in more than 40% of problematic patients when administered by a multidisciplinary team comanaged by a pharmacist and a nurse practitioner.33 As comanagers, pharmacists and nurse practitioners can play a critical role by directly educating and monitoring patient compliance with opioid-based treatment regimens.

• When using opioids to treat chronic pain, physicians should be observant of aberrant drug-taking behavior, which can prompt them to suspect deeper problems with abuse or diversion of opioids.
• Ongoing assessment of the 4 A’s of pain treatment is helpful.
• The 4 A’s—analgesia, activities of daily living, adverse events, and aberrant drug-taking behaviors—can structure assessment and serve as a means by which to record patient response to therapy.

The Pain Assessment and Documentation Tool is useful for evaluating outcomes in those 4 domains.34 Documentation of all aspects of patient care, from the initial examination to later visits, reduces the risk of regulatory sanction and is an important part of risk management.6, 35 However, not all instances of aberrant drug-taking behavior are related to abuse or addiction on the part of the patient.

For example, a patient taking more medication than indicated may be doing so to obtain adequate analgesia, indicating that he or she has become tolerant to the medication ( Table 4 ). Diversion of prescription opioids may be unintentional on the part of the patient, such as a case in which an adolescent who uses drugs recreationally takes prescription opioids from a parent or grandparent’s medicine cabinet ( Table 4 ).

Certainly, frank abuse and criminal diversion of opioid medications may also occur.

Why is non pharmacological pain management important?

Previous research has suggested that using nonpharmacologic therapies to manage chronic pain may be effective not only in decreasing pain and improving function but also in reducing longer-term adverse effects such as substance use disorders and suicide attempts.

What is the safest non-opioid analgesic?

Acetaminophen – Mechanism of Action Acetaminophen inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever primarily in the CNS. Indications for Use Acetaminophen is used to treat mild pain and fever; however, it does not have anti-inflammatory properties.

Nursing Considerations Across the Lifespan Acetaminophen is safe for all ages and can be administered using various routes. Geriatric populations should not exceed 3000 mg in 24 hours, and chronic alcoholics should not exceed 2000 mg in 24 hours due to the risk for hepatoxicity. Adverse/Side Effects Adverse effects include skin reddening, blisters, rash, and hepatotoxicity.

Severe liver damage may occur if a patient:

takes more than 4,000 mg of acetaminophen in 24 hours (3200 mg for geriatric adults, 2000 mg for chronic alcoholics) takes with other drugs containing acetaminophen consumes 3 or more alcoholic drinks every day while using this product.

Some medications are combined with acetaminophen and are prescribed “as needed,” so the nurse must calculate the cumulative dose of acetaminophen over the previous 24-hour period. For example, Percocet 5/325 contains a combination of oxycodone 5 mg and acetaminophen 325 mg and could be ordered 1-2 tablets every 4-6 hours as needed for pain.

• If 2 tablets are truly administered every 4 hours over a 24-hour period, this would add up to 3900 mg of acetaminophen, which would exceed the recommended guidelines for a geriatric patient and could cause liver damage.
• If overdose occurs, the antidote is acetylcysteine.
• Patient Teaching & Education Medications should be taken as directed and the dosing schedule should be adhered to appropriately.

Patients should not take the medication for greater than 10 days. Additionally, patients should avoid taking alcohol while using these medications. If a rash occurs, this should be reported to the healthcare provider and the medication should be promptly stopped.

Use of medications may interfere with blood glucose monitoring. If a fever lasts longer than three days or exceeds 39.5 C, this should be reported to the healthcare provider. Now let’s take a closer look at the medication grid on acetaminophen in Table 10.6a., ‘,footnote]Centers for Disease Control and Prevention.

(2019, August 28). Opioid overdose, CDC guideline for prescribing opioids for chronic pain. https://www.cdc.gov/drugoverdose/prescribing/guideline.html Medication grids are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.

1. Basic information related to each class of medication is outlined below.
2. Detailed information on a specific medication can be found for free at Daily Med at https://dailymed.nlm.nih.gov/dailymed/index.cfm,
3. On the home page, enter the drug name in the search bar to read more about the medication.
4. Prototype/generic medications listed in the grids below are also hyperlinked directly to a Daily Med page.

Table 10.6a Acetaminophen Medication Grid

Class/ Subclass	Prototype- generic	Administration Considerations	Therapeutic Effects	Adverse/Side Effects
Nonopioid analgesic Antipyretic	acetaminophen	Can be given orally, rectally, and IV Assess pain prior to and after administration Administer with a full glass of water Maximum dose over 24-hour period: -4000 mg for adults, -3200 mg for geriatric patients -2000 mg for patients with chronic alcoholism	Relief of mild pain and fever	Skin reddening Blisters Rash Hepatic failure (liver damage)

Your patient is admitted to the hospital with acute liver failure due to acetaminophen toxicity. Your patient reveals that they have had a cold for several days and have been taking over-the-counter cold medications and acetaminophen for a headache. They also mention that every night after work they drink a “few” beers.

Are there non-opioid painkillers?

What are some alternatives to opioids? – There are many non-opioid pain medications that are available over the counter or by prescription, such as ibuprofen (Motrin), acetaminophen (Tylenol), aspirin (Bayer), and steroids, and some patients find that these are all they need. Other people find relief with nondrug therapies that can be used alone or in combination with medications. These include:

Physical therapy – A physical therapist or physician who specializes in physical medicine and rehabilitation may be able to create an exercise program that helps you improve your ability to function and decreases your pain. Whirlpools, ultrasound, and deep-muscle massage may also help. Acupuncture – You may find relief from acupuncture, in which very thin needles are inserted at different places in your skin to interrupt pain signals. Surgery – When other treatments aren’t effective, surgery can be performed to correct abnormalities in your body that may be responsible for your pain. Injections or nerve blocks – If you are having a muscle spasm or nerve pain, injections with local anesthetics or other medications can help short-circuit your pain.

Many patients also find relief from massages and other relaxation techniques, as well as biofeedback, where you learn to control involuntary functions such as your heart rate.

What are non-pharmacological pain management at end of life?

Treatment / Management – The management of pain at the end of life includes nonpharmacological measures, pharmacological measures, and psychosocial measures. Pharmacological Management of Pain The World Health Organization (WHO) devised a cancer pain ladder to guide caregivers in selecting pharmacological agents in managing pain.

This is a stepwise process where the initial agents are nonopioids with escalation to incremental doses of opioids and adjuvant agents, ultimately leading to the abolishment of pain. While this is a good guide in managing pain, individual assessment of each patient should be performed to gauge the initial intensity of pain to avoid delay in therapy.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used initial pharmacological agents for pain. The mechanism of action of these drugs is based on the inhibition of the synthesis of prostaglandins. The cyclo-oxygenase enzyme COX-1 and COX-2 are inhibited by NSAIDs, with the COX-2 enzyme playing a key role in pain generated by inflammatory cells.

• Some NSAIDs can also inhibit the lipoxygenase pathway, which is responsible for producing some algogenic (pain-producing) metabolites.
• NSAIDs also interfere with G-protein mediated signal transduction aiding in analgesia.
• Increasing evidence suggests that NSAIDs also have a central effect in the CNS mediated by endogenous opioid peptides or blockade of the release of serotonin.

Acetaminophen is used frequently in divided doses equaling a maximal dose of 4000mg every 24 hours. However, it is frequently associated with hepatotoxicity, and lower dosages may be needed in patients with hepatic disease. Ibuprofen is another NSAID that the FDA has approved for mild to moderate pain; however, it is associated with gastrointestinal bleeding, renal impairment rashes, and hypertension.

Etorolac is another NSAID that has a higher demonstrated potency than most other NSAIDs. However, in addition to gastrointestinal and renal side effects, it can cause an increased risk of cardiovascular thrombotic events and strokes. Selective COX-2 inhibitors like celecoxib can help manage pain associated with the musculoskeletal system and theoretically have a favorable side effect profile compared to other NSAIDs.

Celecoxib contains the sulfonamide group and can cause severe allergic reactions in patients with sulfa drug allergy. If any of these medications are being used for more than a week, a proton pump inhibitor should be added as gastric prophylaxis. Opioid analgesics are considered the gold standard of pain management at the end of life, providing the greatest analgesic relief.

Opioids act by interacting with the mu, delta, or the kappa opioid receptors by mimicking endogenous opioid peptides. These receptors are coupled to G1 proteins and act in an inhibitory capacity. They cause the closure of N-type voltage-gated calcium channels and open calcium-dependent inwardly-rectifying potassium channels.

This causes a reduction in neuronal hyperexcitability due to hyperpolarization. They also decrease the intracellular cAMP and thereby decrease the release of nociceptive neurotransmitters like substance P. The Mu receptors are key in mediating analgesia, euphoria, sedation, gastrointestinal dysmotility, and respiratory depression.

1. Mu receptors can cause respiratory depression by a decreased response to hypoxia and hypercarbia, resulting in decreased stimulus to breathe.
2. However, respiratory depression is preceded by sedation, and the clinicians should perform a constant assessment of mentation to avoid respiratory depression.
3. The pharmacokinetics of different opiates can be utilized in appropriate pain management at the end of life.

The time to peak analgesic effect is important in choosing the right medication. Several routes of administration are available for opioids, including oral, intravenous, subcutaneous, intramuscular, transmucosal, nasal, transdermal, and rectal. In general, the peak analgesic effect of oral opioids is close to 1 hour, whereas intravenous doses of opiates cause a peak effect around 10 minutes from the administration.

Certain newer opiates using the trans-mucosal or intranasal mode of administration can have a faster onset of action and peak effect. The doses of opiates need individualization and should be titrated per the analgesic effect. Patients who need repeated doses of short-acting opiates may need longer-acting opiates scheduled round the clock.

The daily short-acting doses should be added up, and 50% to 75% of the dose should be converted to long-acting opiates. As needed, opiates should be prescribed to address breakthrough pain caused by interventions like turning, suctioning and changing of dressing, etc.

The FDA approves morphine sulfate for acute or chronic pain with moderate to severe intensity. Morphine is metabolized in the liver and excreted by the kidneys. In patients with renal dysfunction, the active metabolites, namely 3-glucuronide and morphine-6-glucuronide, can accumulate, causing myoclonus and seizures.

Oxycodone similarly is another potent opiate that is approved for use in moderate to severe pain. It is available in the immediate release as well as extended-release formulations. Its metabolism is similar to morphine. Hydromorphone is another potent opiate analgesic available in the oral, subcutaneous, or sublingual preparation.

• Fentanyl has gained popularity due to its several routes of administration and predictable analgesic effects.
• Apart from being used as an infusion for sedation and analgesia in mechanically ventilated patients, it can be used as a transdermal patch in patients who cannot take medications orally.
• Care is necessary when removing the used patch before placing a new patch to avoid an overdose.

Fentanyl is stored in the adipose tissue and takes 12 to 24 hours to wash out of the system once the patch is removed. Methadone is a long-acting pure mu-agonist with the advantages of having a long half-life and an inexpensive preparation available orally.

Unfortunately, methadone has a curvilinear pharmacokinetic curve leading to exponential effect in higher doses exposing to potentially life-threatening overdoses. It can also lead to QT interval prolongation and should be used cautiously in patients with underlying cardiac conditions. Tramadol has a dual-action at the mu-opioid receptor as well as a weak action as a serotonin-norepinephrine reuptake inhibitor.

Its use has been approved for moderate pain to moderately severe pain. The selection of an opiate agent should take into account the individual needs of the patient. The mechanically ventilated patient can get fentanyl or hydromorphone due to the fast action and easy titration.

Patients with renal and hepatic insufficiency should get IV Fentanyl with doses adjusted. Remifentanil can be used as well because its metabolism is not dependent on hepatic or renal function. It is metabolized by nonspecific plasma esterases located primarily within erythrocytes. Patients who require frequent neurological checks can also benefit from remifentanil due to its ultra-short duration of action.

Patients with hemodynamic instability or bronchospasm should not receive morphine sulfate as it causes histamine release. Meperidine should be avoided in patients with renal and hepatic failure because of severe neurotoxicity from the accumulation of an active metabolite.

Codeine is another medication with limited use at the end of life with a high incidence of constipation. Approximately 10% of the population lacks the enzyme necessary to convert codeine (a prodrug) to morphine, leading to insufficient analgesia. Patient-controlled analgesia (PCA) via an infusion pump is a modality that can be utilized when the daily dosages required are high, or the patient is unable to tolerate oral analgesia.

PCA pumps have a button that allows for a breakthrough dose when pressed by the patient. The pumps can be programmed to allow doses separated by a safety interval. The dose delivered on pressing the button is typically 50 % of the hourly dose. Monitoring for sedation in patients on a PCA pump is important to avoid respiratory depression.

In patients with inability, debility, or cognitive decline, the PCA can be replaced with a Nurse controlled analgesia pump (NCA) where the nurse administers breakthrough doses prior to interventions or on observing objective signs of pain in the patient. Nonopiate medications can be used as an adjunct to opiates or NSAIDs for pain management.

Antiepileptic medications like gabapentin and pregabalin can be used for pain from neuropathy and bony metastasis. Both these medications require dose adjustments for renal impairment. Corticosteroids can be used in late disease as an adjunct and can aid in improving appetite and mood.

1. However, severe interactions and adverse side effect profiles warrant a risk vs.
2. Benefit discussion with the patient.
3. Non-Pharmacological Management of Pain The nonpharmacological measures for the management of pain include measures aimed at avoiding pain triggers and psychosocial assistance in managing the end of life.

Proper head positioning and neck support can avoid spasms of the neck, artificial tears and lubricants can help avoid painful keratitis. The use of gel foam pads on the skin-appliance interface can help avoid ulceration, for example, nasal bridge gel pads for noninvasive ventilation.

• Oral care and proper hydration can avoid painful ulcerations and dental decay.
• Frequent repositioning and offloading the dependent areas of the body can help avoid decubitus ulcers.
• In case of skin breaks, non-bulky, non-stinging chemical dressings can be used to avoid pain.
• Counseling for getting affairs in order and devising robust goals of care while the patient can still make decisions can help alleviate anxiety and improve interpersonal relations.

Daily sponging and grooming, as tolerated, leads to better hygiene and preserves the patient’s dignity and sense of self-worth. Spiritual counseling and pastoral visits can help counter non–acceptance of impending death and help alleviate suffering. Alternative medicinal therapies like acupuncture and Reiki can be offered to support pharmacological measures in managing pain.

What are 4 common non-pharmacological non surgical treatments or therapies that may be considered when managing a client’s pain?

Manage the pain – Follow your hospital policies and procedures and pathways for pain management. Consider pharmacological and non-pharmacological approaches: A pharmacological approach requires an understanding of the mode of action, common side effects and common drug interactions.

Consider pre-emptive analgesia prior to any medical procedure (IV cannulation, dressing change), or rehabilitation procedure (physiotherapy exercises) likely to cause significant pain. Consider patient-controlled analgesia post-operatively. Chronic pain is best managed with around-the-clock analgesia. Medications should be given, even if the person doesn’t have pain at the time the medication is due. Monitor regularly for any side effects following pain treatment (such as nausea, vomiting, sedation, constipation or dizziness) Address opiophobia:

Many older people with pain respond well to opioid therapy, particularly if nociceptive pain. Opioids should not be denied because of fears of addiction. It is reasonable for a person with severe pain to seek and/or be offered analgesia. Addiction, also known as psychological dependency, is manifested by opioid-seeking behaviours for reasons other than pain relief. Psychological dependency should be differentiated from physical dependency. Physical dependency occurs after a person has been on certain medications for some time, including opioid analgesics, and is manifested as withdrawal symptoms if the drug is suddenly stopped. Chronic opioid therapy should therefore not be abruptly stopped. Opiophobia by health care staff may contribute to persistent unrelieved pain.

Simple analgesia, such as regular paracetamol, is well tolerated and can provide a background level of analgesia. If the person’s pain is not well controlled the addition of opioids provided regularly and/or as required can be an effective strategy to manage a person’s pain. Some medications that are not typically used for pain may also be helpful for its management. Examples of these include tricyclic or SNRI antidepressants and gabapentinoids. These may improve the quality of opioid analgesia and limit the development of opioid tolerance.

Non-pharmacological approaches include psychological approaches (cognitive behavioural therapy, relaxation, education), physical therapies (physiotherapy, occupational therapy, superficial heat and cold, TENS, gentle exercise, hydrotherapy), and complementary and alternative therapies (acupuncture, massage, other supplements).

Encourage the older person to move regularly around the ward if they are capable and it is appropriate.

Refer the patient for an inpatient management assessment or to an outpatient multidisciplinary pain clinic on discharge if their pain persists after pharmacological and non-pharmacological therapies.

What are the non-pharmacological approaches used?

Conclusion – Non-pharmacological therapies including reassurance, lifestyle modification, psychotherapy, dietary management, medical food, acupuncture, and electrical stimulation/modulation can be useful options for the treatment of FD ( Table 5 ). Non-pharmacological therapies for FD are increasingly being sought by families and medical providers for treating dyspeptic symptoms.

• The non-invasive nature and potentially minimal side-effects of these non-addictive, non-pharmacological therapy are likely to benefit FD patients, especially those who have failed conventional therapies.
• The current evidence to warrant the routine use of non-pharmacological therapies in treating FD patients remains limited, though some FD patients do respond well to non-pharmacological management.

The timing to incorporate non-pharmacological therapy into the standard therapy and its position in the current treatment algorithm for FD patients remains to be settled. It is still unclear whether it should be used for refractory FD patients or used as an adjunct to the pharmacological therapy.

Why is non-pharmacological pain management important?

Previous research has suggested that using nonpharmacologic therapies to manage chronic pain may be effective not only in decreasing pain and improving function but also in reducing longer-term adverse effects such as substance use disorders and suicide attempts.