Non Pharmacological Approaches vs Pharmacological Methods

ALTERNATIVE PAIN MANAGEMENT THERAPY

Alternative Pain Management Therapy: Non-Pharmacological Approaches vs. Pharmacological Methods

Introduction

Although it happens to be uncomfortable for most people, pain could be considered an instrumental human body alarm system. This is more so the case given that it comes in handy in the identification of a wide range of stimuli likely to occasion harm to our tissues. In clinical settings, various strategies are deployed in an attempt to lessen the pain suffered by patients. The most common approach adopted by healthcare practitioners involves the utilization of pain-relieving medications that are FDA-approved. This is usually the case in efforts to manage both acute and chronic pain.

It would, however, be prudent to note that alternative pain management approaches have been used in diverse settings for ages. As a matter of fact, the utilization of medicinal plants in pain management has been practiced since time immemorial. Other approaches to pain management that have been used in various cultures are inclusive of, but they are not limited to; massage therapy, relaxation therapy, aromatherapy, yoga, chiropractic treatment, as well as acupuncture.

Background and Significance

Pain happens to be one of the most significant issues in the realm of healthcare. This is more so the case given that pain could have a negative impact on treatment outcomes and adversely impact patient wellbeing. As a matter of fact, as Moore et al. (2019) points out, healthcare systems have been engaged in consistent efforts to minimize patient discomfort by, amongst other things, seeking better ways to manage both acute and chronic pain. Pain among cancer patients, for instance, happens to be an issue of great interest and concern amongst healthcare practitioners. According to the American Cancer Society (2019), there are many different factors that affect the kind and intensity of pain experienced by cancer patients. The said factors are inclusive of, but they are not limited to, the stage and type of cancer, as well as the cancer treatment options embraced. If not properly managed, pain attributable to cancer could have a negative impact on patient wellbeing and recovery. This is more so the case given that as the American Cancer Society (2019) further observes, “pain can even make some people stop treatment if it’s not managed.” It therefore follows that there is need to explore alternatives to pain management that could promote adherence to treatment. Jimmy and Jose (2011), are categorical that “adherence to therapies is a primary determinant of treatment success… failure to adherence is a serious problem which not only affects the patient but also the health care system” (p. 155)

It would also be prudent to note that over the last several decades, America has seen an unprecedented increase in the number of persons using opioids for the management of pain, particularly chronic pain (American Society of Anesthesiologists, 2021). This has resulted in concerns about addiction to prescription opioids. As the American Society of Anesthesiologists (2021) points out, opioids have been found to be highly addictive. Indeed, as the said society further observes, the risk for addiction has been found to be particularly high in those instances whereby “opioids are used to manage chronic pain over a long period of time” (American Society of Anesthesiologists, 2021). Yet another concern about opioids is related to their side effects – which could in some instances be rather severe. The said side effects could range from the less severe ones such as nausea and mental fog, to more severe side effects such as slowed breathing and in some instances overdose death. Thus, available literature effectively demonstrates that some conventional pain management methods have their own limitations and pitfalls.

It is important to note that to a large extent, the relevance of exploring alternative pain management therapies cannot be overstated. In so doing, I would be considering the efficacy of alternative pain management approaches and whether they can be roped in as part and parcel of pain management practices in conventional healthcare settings.

Literature Review

There is no standard definition for alternative pain management. This is to say that there is no assigned or generally adopted definition of ‘alternative pain management’ as a phrase. However, the phrase has in various contexts been used in reference to the various other approaches that have been embraced in the past in efforts to manage pain, apart from pharmacological approaches. For this reason, alternative pain management has been used synonymously with ‘non-pharmacological interventions.’ This is the meaning that will be assigned to the phrase in this text.

According to Cho (2013), alternative pain management approaches have for a considerable period of time been scoffed at by those in mainstream medicine. However, according to the author, studies done in the recent past demonstrate that indeed, the said approaches to the management of pain do work. In the words of the author, “the phrase 'alternative pain treatments' doesn't mean much now… the line between them and mainstream treatment has been blurred” (Cho, 2013, p. 119). A comprehensive review or literature indicates that some of the more commonly used alternative pain management strategies are inclusive of;

a) Acupuncture

b) Exercise,

c) Chiropractic manipulation

d) Vitamins and supplements

e) Relaxation therapy

f) Hypnosis,

g) Music therapy, etc.

Acupuncture has, for instance, been proven effective in pain relief amongst patients having headaches or suffering from back pain (U.S. National Library of Medicine, 2021). Further, as the U.S. National Library of Medicine (2021) further points out, recent studies have also indicated that acupuncture could come in handy in efforts to relieve pain caused by, or emanating from; rheumatoid arthritis, osteoarthritis, injuries to the musculoskeletal system, labor associated with childbirth, fibromyalgia, carpal tunnel syndrome, and cancer. On the other hand, when it comes to hypnosis the U.S. National Library of Medicine (2021) points out that it could be instrumental in efforts to lessen pain in the case of; tension headache, irritable bowel syndrome, fibromyalgia, arthritis, as well as cancer.

According to Singh and Chaturvedi (2015), cancer pain happens to be one of the most concerning issues in the treatment of the said disease. This, according to the authors, is more so the case owing to the fact that it could have a largely negative impact on a cancer patient’s quality of life (QoL). The authors are categorical that although much evidence has in recent times been gathered indicating that alternative pain management approaches could possibly be effective in the management of pain among cancer patients, the said approaches are yet to be fully embraced or deployed in mainstream settings. The authors point out that some of the non-pharmacological approaches that have been extensively examined in relation to their effectiveness in pain management among cancer patients are; acupuncture, massage therapy, reflexology, taichi, and hypnotherapy, and aromatherapy.

Bao et al. (2014) are also of the opinion that there are numerous methods that have been found effective in the management of cancer pain. However, it is important to note that some studies appear to have conflicting results/findings in as far as the efficacy of the various approaches is concerned. For instance, while Singh and Chaturvedi (2015) point out that acupuncture happens to be effective in the management of cancer pain (i.e. in relation to hot flushes among breast cancer patients), Bao et al. (2014) observe that the very same method has been found to have no benefit in cancer pain management. On the other hand, the authors point out that the efficacy of methods such as transcutaneous electric nerve stimulation and massage therapy cannot be ascertained as results have largely been inconsistent. It therefore follows that not all alternative pain management approaches are effective. Indeed, some have either been shown to be ineffective or outright risky. This is the very same point of view that Bao et al. (2014) advance. In the final analysis, the authors make a finding to the effect that some alternative pain management methods could indeed be effective in the alleviation of cancer-related pain. However, in the words of the authors, “future large and rigor randomized controlled studies are needed to confirm the benefits of CAM on adult cancer pain” (Bao et al., 2014, p. 78).

Aims of the Study

The overall aim of the present study is to determine how effective alternative main management methods are in comparison to pharmacological pain management approaches particularly amongst cancer patients. Establishing the efficacy of the said non-pharmacological approaches would be instrumental in efforts to further promote not only the comfort, but also the wellbeing of hospitalized patients.

Theoretical Model

Care happens to be inseparable to the practice of nursing. Indeed, in the words of Panjnikihar, Stiglic, and Vrbnjak (2017), “caring is the core concept in nursing” (p. 79). Jean Watson’s caring theory largely concerns itself with the expression of care by nurses towards patients (Ozan and Okumus, 2017). How exactly is this particular theory linked with alternative pain management therapy? Effective pain management happens to be one of the most crucial components in the creation of a caring environment. As a matter of fact, one of the theory’s key concepts, i.e. the human being concept, perceives the human being as “a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted” (Wei and Watson, 2019, p. 18). All these factors would be rendered useless in the absence of effective pain management. The all important question, however, remains; are nurses sufficiently knowledgeable or skillful in matters revolving around alternative pain management therapy.

The model of caring highlighted above would guide the project’s theoretical framework. It is important to note that in applying the theory, nurses can be able to advance care that is deemed holistic to patients. This is more so the case in seeking to ensure that the role that patients play in their wellbeing, especially in as far as pain management is concerned, is proactive. In embracing other treatment interventions other than conventional medicine, patients effectively become active participants in the treatment process. With regard to the management of pain, this means that patients can actively apply approaches and techniques such as acupuncture and mind-body therapies to maximize wellness as well as healing. Nurses ought to, therefore, seek ways of increasing their familiarity on alternative pain management therapy.

Watson was convinced that there were two things that contributed to good health; illness absence, and presence of undertakings meant to result in the absence of illness (Ozan and Okumus, 2017). In this realm, therefore, there would be need to ensure that deliberate steps are taken to promote better outcomes. This could be accomplished via the incorporation of alternate pain management therapy into the care equation. Nurses ought to be able to not only comprehend, but also feel comfortable engaging patients in conversations revolving around alternative pain management therapy. The focus in this case would be the advancement of holistic care – in which case Jean Watson’s theory would be instrumental in efforts to direct practice.

Formulation of the study question

The study explores the alternative methods of payment vis-à-vis pharmaceutical techniques. The study or research questions seek to give answers to the purpose of the research or study. In this scenario, the study's goal is to determine or ascertain the efficacy of alternative pain management methods. Suitable research questions would be:

1. Are alternative pain management approaches effective as compared to pharmacological methods?

2. Do the various alternative approaches to pain management have the same efficacy rate?

Method/Design and Statistical Analysis

Research Design

The best design for this study would be experimental design. As Herzog, Francis, and Clarke (2019) point out, “experimental design refers to how participants are allocated to the different groups in an experiment” (p. 77). To a large extent, there are various alternatives that can be used to manage pain, as there are statistical tests to determine whether the nonconventional methods are effective. It would be prudent to note that some of the non-convectional approaches towards managing pain are inclusive of aromatherapy, relaxation, hypnosis, etc. These are some of the approaches that will be taken into consideration on this front.

To seek answers to the above research questions, we need to determine a suitable sample before data is collected. Based on the study topic, the best sample will comprise cancer patients currently managing pain through pharmacological methods and alternative therapy approaches. A group of patients will have the alternative pain therapy administered, while the other groups will access pharmacological interventions. Effectiveness will be measured via the assessment of pain intensity using any of the various numerical pain ratings. Examples in this case could be inclusive of verbal rating scales, visual analog scale (VAS), etc. (Sykes, Bennet, and Yuan, 2008).

In addition, a survey will be filled by the health practitioner(s) managing the patients. This will shed more light into the process of pain management. To show consistency, reliability, and validity, tools will be used. The Cronbach's alpha could be used to determine the consistency of the study. According to DiClemente, Crosby, and Salazar (2020), “Cronbach’s alpha is considered to be a measure of scale reliability” (p. 104). The accepted value of Cronbach's alpha is 0.7 and above. Since the variable of interest is pain intensity, the type of data is quantitative and continuous. The type of data is quantitative since it takes numerical form. The data type is continuous since intensity can take up decimal places.

Hypothesis

The best method of data analysis is one-way ANOVA or the independent sample t-test. ANOVA can be used to determine whether there is a difference in intensity between the different approaches/methods. The hypothesis of the One-way ANOVA is shown below.

Hypothesis-One way ANOVA

Null Hypothesis (H0): there is no significant difference in pain intensity between the different pain management methods.

Alternative hypothesis (H1): At least one of the intensity differs in mean.

The independent-sample t-test can also be used in the study. The independent sample mean can be used to determine whether there is a significant difference in the alternative measures and pharmacological measures.