Non-pharmacological alternatives to conventional pain management medications

Alternatives to Pain Medication

Given the growing concerns over opioid addictions in recent years and the potential for tolerance, clinicians continue to search for efficacious alternatives to convention pain medications (Moore & Anderson, 2016). Fortunately, a number of alternatives to conventional pan medication are readily available, including cannabis, yoga, hypnosis, mind-body meditation, therapeutic touch, herbal remedies, acupuncture, biofeedback, massage therapy, homeopathic practices (Tan & Craine, 2007) and aromatherapy (Esposito & Bystrek, 2014). To learn more about these alternatives, this paper provides an initial reference list of ten relevant peer-reviewed and scholarly sources concerning pain medication alternatives, followed by a description of clinical guidelines and an implementation plan for these alternatives. A discussion concerning the manner in which the implementation of the intervention should be tested is followed by an assessment of potential barriers and strategies intended to gain cooperation from individuals who will be implementing the change. Finally, a timeline with criteria for evaluating the outcomes concludes this paper.

Initial reference list of ten resources

Ault, A. (2006, January). Chronic pain, addiction behavior are different: Giving shorter-acting opioids to those already taking long-acting formulations might create tolerance. Clinical Psychiatry News, 34(1), 54.

Briggs, J. (2015, Spring). Americans' active quest for health through complementary and integrative medicine. Generations, 39(1), 56-59.

Crow, E. & Jeannot, E. (2015, January-June). Effectiveness of Iyengar yoga in treating spinal (back and neck) pain: A systematic review. International Journal of Yoga, 8(1), 3.

Denneson, L. M. & Corson, K. (2011, September). Complementary and alternative medicine use among veterans with chronic noncancer pain. Journal of Rehabilitation Research & Development, 48(9), 1119-1123.

Esposito, E. R. & Bystrek, M. V. (2014, May). An elective course in aromatherapy science. American Journal of Pharmaceutical Education, 78(4), 37-41.

Haldavnekar, R & Tekur, P. (2014, July-December). Effect of yogic colon cleansing (Laghu Sankhaprakshalana Kriya) on pain, spinal flexibility, disability and state anxiety in chronic low back pain. International Journal of Yoga, 7(2), 111.

Levin, R. F. & Feldman, H. R. (2006). Teaching evidence-based practice in nursing: A guide for academic and clinical settings. New York: Springer Publishing Company.

Moore, B. A. & Anderson, D. (2016, Janury). Stepped care model for pain management and quality of pain care in long-term opioid therapy. Journal of Rehabilitation Research & Development, 53(1), 137-141.

Tan, G. & Craine, M. H. (2007, March-April). Efficacy of selected complementary and alternative medicine interventions for chronic pain. Journal of Rehabilitation Research & Development, 44(2), 195-201.

Waldman, H. B. & Compton, K. (2013, August). Complementary and alternative medicine for children with healthcare special needs. The Exceptional Parent, 43(8), 37-41.

Develop Clinical Guidelines and Implementation Plan, by initiating development of a guideline or protocol based on literature search

According to the U.S. National Center for Complementary and Integrative Health, "Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (Clinical practice guidelines, 2016, para. 2). The U.S. Agency for Healthcare Research and Quality also advises that, "Pain Management means the assessment of pain and, if appropriate, treatment. Treatment of pain may include the use of medications or application of other modalities and medical devices" (Pain management guidelines, 2016, para. 2). The clinical guidelines set forth in Table 1 below are recommended for assessing pain management requirements and the suitability of alternatives to conventional pain medications.

Table 1

Pain management assessment to determine appropriateness of pain medication alternatives

Guideline

Description

Pain classification

• Somatic Pain: Result of activation of nociceptors (sensory receptors) sensitive to noxious stimuli in cutaneous or deep tissues. Experienced locally and described as constant, aching and gnawing. The most common type in cancer patients.

• Visceral Pain: Mediated by nociceptors. Described as deep, aching and colicky. Is poorly localized and often is referred to cutaneous sites, which may be tender. In cancer patients, results from stretching of viscera by tumor growth.

Identify optimal alternative Interventions

Acupuncture, reflexology, aroma therapy, music therapy, dance therapy, yoga, hypnosis, relaxation and imagery, distraction and reframing, psychotherapy, peer support group, spiritual, chiropractic, magnet therapy, bio-feedback, meditation, relaxation techniques.

Post-intervention Pain Assessment

Pain Assessment findings shall be documented in the medical record. This shall include, but not be limited to, the date, pain rating, treatment plan, and response.

Patient Education

• Explain causes of the pain, assessment methods, treatment options and goals, use of analgesics, and self-help techniques.

• Regularly reinforce educational content.

• Provide specific education before special treatments and/or procedures.

Source: Adapted from Pain Management Guidelines, 2016

In addition, the Iowa Model of Evidence-Based Practice to Promote Quality Care provides useful guidance concerning the implementation of evidence-based practices (Levin & Feldman, 2006).

Timeline with criteria for evaluating the outcomes

Depending on the severity and type of pain that is involved, all patients receiving alternative pain interventions should be periodically evaluated to determine the effectiveness of the intervention based on the following criteria:

• Pain severity, character, frequency, pattern, location, duration

• Interventions to promote comfort

• Quality of life (Pain Management Guidelines, 2016).