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Nursing intervention for adult patients experiencing chronic pain.

Recommendations

* Listening to music is an effective short term nursing intervention for reducing chronic pain caused by osteoarthritis in persons aged 65 years or more. (Grade B)

* Listening to music is a nursing intervention that helps in a short term to reduce articular pain, depression and disability, and to increase capacity (empowerment). This improvement is bigger if the patient chooses the type of music preferred by him compared to standard music. (Grade B)

* A cognitive-behavioural treatment program is a nursing intervention that may reduce non malignant chronic pain. (Grade B)

* A psycho-education program may reduce the severity of osteoarticular pain with unknown cause, depression, disability, dependence, self-efficacy, participation in activities, role behavior and satisfaction with life. (Grade B)

* Sensorial stimulation such as the Snoezelen's technique, may be a useful nursing intervention for reducing pain intensity for chronic pain, irrespective of its origin. (Grade B)

* Magnetic therapy may be a useful nursing intervention for reducing chronic headache. (Grade B)

* Guided imagery may be an effective therapy for the management of tension chronic headache in addition to conventional pharmacological treatment (Grade B)

* Exercise programs may be effective at improving physical function of patients with chronic musculoskeletal pain, however care must be taken in fragile patient populations to avoid causing pain. (Grade B)

Information Source

This Best Practice information sheet has been derived from a systematic review published in 2010 in the JBI Library of Systematic Reviews. The full text of the systematic review report (2) is available from the Joanna Briggs Institute

(www..joannabriggs.org)

Background

Chronic pain is a widely spread and devastating problem, as pain increases morbidity and mortality increases in patients that suffer from it. Chronic pain also represents the third most frequent health problem, following cardiovascular diseases and cancer. (2) In the last fifty years, the issue of pain and its treatment has reached global recognition and, as a consequence of such interest, its study and development have been considered from the approach of several disciplines, with the aim of making progress in the scientific and humanitarian understanding and consequently optimize therapeutic approaches. Chronic pain is a multifactorial suffering, thus therapies should include the three following aspects: psychological, physical and pharmacological. (2) At present, non pharmacological interventions for the control of pain arouse more and more interest. Complementary interventions for the management of pain include relaxation, education and information techniques. (2) Non pharmacological interventions for pain treatment include exercise programs, massage, cognitive-behavioural therapy, music listening, as well as hypnosis or entertainment. (2)

Objectives

The purpose of this Best Practice Information Sheet is to present the best available evidence on nursing interventions for adult patients experiencing chronic pain.

Types of Intervention

The systematic review considered studies that assess the effectiveness of non-pharmacological nursing interventions for chronic pain. Therefore, the studies that clearly reported that the interventions focused on relieving/reducing chronic pain were exclusively performed by nurses or they participated together with other members of the multi-professional team, were considered for inclusion.

Quality of the research

Eight studies were included in the systematic review, of which 7 were randomized controlled trials and one a quasi-randomized controlled trial (RCTs).

Results

Sensorial stimulation

The Snoezelen's technique is based on multi-sensorial stimulation for sharpening the primary senses of view, hearing, touch, taste and smell, through the use of illumination effects, tactile surfaces, meditative music and relaxant essential oils perfume. One RCT compared the use of the Snoezelen's intervention (sensorial stimulation) as a potential strategy for relaxation and distraction, with the traditional relaxation approach used in a Pain Clinic, for chronic pain, irrespective of its origin. The Snoezelen intervention showed significant differences as a potential strategy for improving recreation or leisure time, the participative process being a potential explanation of success.

Music Therapy

Music therapy is the use of music and/or its musical elements with the aim of developing skills and/or restoring the individual's functions. One RCT examined the effectiveness of using music as a nursing intervention for relieving pain caused by osteoarthritis in elderly people living in the community. The results indicate that those who had listened to music had significantly reduced pain. Results show that the experimental group experienced a decrease, both in the perception as well as in the intensity of pain, throughout the whole period of the study, while the control group maintained relatively the same level of pain. The study found that listening to music is an effective nursing intervention for the reduction of chronic pain perceived in populations with osteoarthritis that are older than 65 years and living in the community.

One RCT evaluated the effect of music as a nursing intervention for coping with articular pain, depression, helplessness feelings and disability, in populations with heterogeneity of pathologies (osteoarthritis, slipped disk, rheumatoid arthritis, fibromyalgia) aged from 21 to 65 years old. Music listening was effective for relieving chronic pain, which may be helpful. Besides, it improves: depression, disability and capacity (empowerment). No significant differences were found between when the music was chosen by the patient or by the researcher. For all these reasons, there is good evidence to suggest music is an effective nursing intervention in adult people with chronic pain, helping to reduce pain, depression and disability, and increasing capacity (empowerment).

Cognitive-Behavioural Program

Cognitive therapy or cognitive-behavioural therapy is a psychotherapeutic intervention focused on the cognitive reconstruction, the promotion of a collaborative therapeutic alliance and behavioural and emotional methods associated through a structured framework.

One study investigated the effect of a cognitive-behavioural program in patients of the external consultations of a "Multidisciplinary Pain Treatment Centre, that necessarily includes a nurse in the work group" (Group MPT), compared to patients in treatment with their general practitioner, after having been initially assessed by a pain specialist (Group GP), and with a control group (Group CG) made up by patients that had been waiting for six months for the specialised treatment. The treatment using a nursing approach (Group MPT) significantly reduced pain intensity (non-malignant chronic pain), increased quality of life and increased sleep quality, compared with Group GP and Group CG.

Psycho-education program

One RCT examined the effectiveness of a Chronic Pain Self-Management Program (CPSMP), based on the theoretical framework of Braden's Self-Help Model, as support to patients with osteoarticular pain with unknown cause. The effectiveness of (CPSMP) on pain severity, quality of life and depression was examined at six weeks and should be considered as an intervention complementary to traditional therapy. Pain severity was reduced and quality of life measures improved in the intervention group. There is good evidence to support the effectiveness of a Chronic Pain Self-Management Program (CPSMP).

Physical Exercise Program

One RCT examined the effect of exercise on musculoskeletal chronic pain in persons living in Nursing Houses (NH), with urinary incontinence, and not wearing an urinary catheter. Exercise improved physical function but it was not effective for pain management among residents with incontinence and in some participants even increased pain symptoms, thus it is suggested to use preventive analgesia or to modify exercise techniques for this fragile patient population.

Guided Imagery

A quasi-randomised controlled trial of guided Imagery (GI) examined effectiveness on relieving tension chronic headache, with or without migraine, in addition to conventional pharmacological therapy. The patients in the GI intervention group reported reductions in pain frequency, severity of the headache and disability caused by the headache. The number of headaches reported by patients in the intervention group were significantly lower compared to the control. The patients of the intervention group reported a significant improvement compared to the control group in three domains of the SF-36: body pain, vitality, and mental health.

The study concluded that guided imagery was an effective therapy for chronic tension headache management with or without migraine, as an addition to conventional pharmacological treatment. Guided Imagery showed significant benefits for chronic headache, and is also low cost (considering that the materials used are a tape and a tape-player) and very accessible intervention, as the patient can use the intervention at home. The technique relies on the patients motivation, and the required frequency for maintaining the intervention's effectiveness is unknown.

Magnetic Field Therapy

One RCT study showed that the magnetic field therapy can relieve headaches, but they did not establish effectiveness as compared to other therapies.

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Acknowledgments

This Best Practice information sheet was developed by The Joanna Briggs Institute.

Definitions

For the purposes of this information sheet the following definitions were used (2):

Nursing interventions: Any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance client outcomes. Nursing interventions include all interventions performed by nurses, both direct and indirect care, targeted at individuals, families and communities, whether treatments are initiated by nurses, doctors or other professionals.

Physical exercise: is defined as the physical activity presenting a specific biomechanical structure and directed to the achievement of an objective that can be recreational, of health or sportive

Guided imagery: is a relaxation technique based on the visualisation of pleasant images and the awareness of the own body.

Magnetic field therapy: is a non invasive therapy that uses the magnetic energy produced by the movement of electrical and electronic load material

Psycho-education: refers to the education or information offered to patients with the aim of understanding and being able to manage their disease. It provides a strengthening of the patient's strengths, resources and skills for coping with the disease, and contributes to his own health and wellbeing.

Grades of Recommendation

These Grades of Recommendation have been based on the JBI-developed 2006 Grades of Effectiveness (1)

Grade A Strong support that merits application

Grade B Moderate support that warrants consideration of application

Grade C Not supported

References

(1.) The Joanna Briggs Institute. Levels of evidence and Grades of Recommendations. http://www.joannabriggs.edu.au/About%20Us/JBI%20Approach

(2.) Castillo-Bueno MD, Moreno-Pina JP, Martinez-Puente MV, Artiles-Suarez MM, Company-Sancho MC, Garcia-Andres MC, Sanchez-Villar I, Hernandez-Perez R. Effectiveness of nursing intervention for adult patients experiencing chronic pain: a systematic review. JBI Library of Systematic Reviews 2010; 8 (28):1112-1168.

(3.) Pearson A, Wiechula R, Court A, Lockwood C. The JBI model of evidence-based healthcare. Int J of Evid Based Healthc 2005; 3(8):207-215.

Evidence-based Practices evidence, context, client preference judgement

This Best Practice information sheet presents the best available evidence on this topic. Implications for practice are made with an expectation that health professionals will utilise this evidence with consideration of their context, their client's preference and their clinical judgement. (3)
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Publication:Best Practice
Date:Jul 1, 2011
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