Excerpt: Pain Assessment and Management in Aging Mimi Hanks-Bell, MN, RN, APN; Kathleen Halvey MN, RN, APN; Judith A. Paice, PhD, RN Nonpharmacologic Management of Pain Non-pharmacologic treatments (NPTs) include various physical and emotional therapies for both acute and persistent pain. NPTs are most effective when paired with analgesic medications and function as adjuvant pain treatment. Selection of the appropriate NPT depends on the individual and the family, the type of pain being experienced, and preexisting medical problems. Research of the use NPTs has been sparse and results are inconclusive, therefore, claims of dramatic pain relief from any NPT must be viewed with caution. The older adult may be susceptible to unfounded claims about new NPT products; the nurse can educate seniors about the validity of such claims. Physical NPTs include the use of physical movement, heat, cold, massage, acupuncture or acupressure, and transcutaneous electrical nerve stimulation (TENS). Physical movement such as sports, dance, or Tai Chi decreases pain from chronic pain syndromes such as osteoarthritis, fibromyalgia, or peripheral vascular disease (Bunch, 2004). Activity improves joint function and flexibility, increases muscle strength for improved alignment and reduced muscle spasms, and promotes collateral circulation, minimizing symptoms of claudication. The application of heat or cold can be helpful as well. Care must be taken to avoid skin damage or burns in this susceptible population. Cold is appropriate for acute injuries, especially during the first 48 hours post injury. Cold therapy is also appropriate to decrease bleeding or hematoma formation, edema, and chronic back pain. Heat works well for relief of muscle aches and abdominal cramping. Massage offers many therapeutic effects that reduce pain, including release of muscle tension, improved circulation, increased joint mobility, and decreased anxiety. Many small studies have been published about the efficacy of acupuncture and acupressure and the reduction of pain. However, results remain inconclusive due to poor study design (Pan, Morrison, Ness, Fugh-Berman, & Leipzig , 2000). Cognitive NPTs, such as guided imagery and relaxation, can be effective but require the ability to learn new skills and the motivation to practice these techniques (Kerns, Otis, & Marcus, 2001). Once learned, guided imagery and active relaxation can be practiced individually or with the aid of a coach and are most effective in reducing pain by relieving anxiety and reducing muscle tension (Kwekkeboom, Kneip, & Pearson, 2003). Distraction also helps reduce the sensation of pain. Some watch television, play cards, work with their hands, listen to music, or interact with friends, families, or pets. Attending to personal fears or concerns of family, finances, or spirituality can also help to decrease pain levels (Weiss, Emanuel, Fairclough, & Emanuel, 2001). Online J Issues Nurs 9(3), 2004. 12/04 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.