Alternative Pain Management: Non-Pharmacological vs. Drug Approaches

Although it happens to be uncomfortable for most people, pain can be considered an instrumental human body alarm system. This is especially true given that it helps identify a wide range of stimuli likely to cause harm to our tissues. In clinical settings, various strategies are deployed in attempts to lessen the pain suffered by patients. The most common approach adopted by healthcare practitioners involves the use of FDA-approved pain-relieving medications. This is typically 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. The use of medicinal plants in pain management, for instance, has been practiced since time immemorial. Other approaches to pain management that have been used across various cultures include — but are not limited to — massage therapy, relaxation therapy, aromatherapy, yoga, chiropractic treatment, and acupuncture.

Pain is one of the most significant issues in the realm of healthcare, given that it can negatively impact treatment outcomes and adversely affect patient wellbeing. As Moore et al. (2019) point out, healthcare systems have engaged in consistent efforts to minimize patient discomfort by, among other things, seeking better ways to manage both acute and chronic pain. Pain among cancer patients, for instance, is an issue of great interest and concern among healthcare practitioners. According to the American Cancer Society (2019), many different factors affect the kind and intensity of pain experienced by cancer patients, including the stage and type of cancer as well as the treatment options embraced. If not properly managed, cancer-related pain can have a negative impact on patient wellbeing and recovery. 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 a 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 adhere is a serious problem which not only affects the patient but also the health care system" (p. 155).

It is also important 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 raised serious concerns about addiction to prescription opioids. As the American Society of Anesthesiologists (2021) points out, opioids have been found to be highly addictive, and the risk of addiction is particularly high when "opioids are used to manage chronic pain over a long period of time." Another concern relates to opioid side effects, which can in some instances be rather severe — ranging from the less severe, such as nausea and mental fog, to more serious consequences such as slowed breathing and, in some cases, overdose death. Available literature thus effectively demonstrates that some conventional pain management methods have their own significant limitations and pitfalls.

The relevance of exploring alternative pain management therapies cannot be overstated. This paper considers the efficacy of alternative pain management approaches and whether they can be incorporated as part of pain management practices in conventional healthcare settings.

There is no standard definition for alternative pain management. The phrase has been used in various contexts to refer to the many approaches that have been embraced in the past to manage pain apart from pharmacological approaches. For this reason, alternative pain management has been used synonymously with "non-pharmacological interventions," and that is the meaning assigned to the phrase throughout this paper.

According to Cho (2013), alternative pain management approaches have for a considerable period of time been dismissed by those in mainstream medicine. However, studies conducted in recent years demonstrate that these approaches to pain management do work. In the author's words, "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 of the literature indicates that the more commonly used alternative pain management strategies include:

a) Acupuncture; b) Exercise; c) Chiropractic manipulation; d) Vitamins and supplements; e) Relaxation therapy; f) Hypnosis; g) Music therapy.

Acupuncture has been proven effective in pain relief among patients with headaches or back pain (U.S. National Library of Medicine, 2021). Recent studies have also indicated that acupuncture may relieve pain caused by rheumatoid arthritis, osteoarthritis, musculoskeletal injuries, labor pain associated with childbirth, fibromyalgia, carpal tunnel syndrome, and cancer. With regard to hypnosis, the U.S. National Library of Medicine (2021) notes that it could be instrumental in lessening pain associated with tension headaches, irritable bowel syndrome, fibromyalgia, arthritis, and cancer.

According to Singh and Chaturvedi (2015), cancer pain is one of the most concerning issues in cancer treatment because it can have a largely negative impact on a patient's quality of life (QoL). Although much evidence has been gathered indicating that alternative pain management approaches may be effective in managing pain among cancer patients, the authors note that these approaches have yet to be fully embraced in mainstream settings. Some of the non-pharmacological approaches that have been extensively examined in relation to cancer pain management include acupuncture, massage therapy, reflexology, tai chi, hypnotherapy, and aromatherapy.

Bao et al. (2014) also hold that numerous methods have been found effective in managing cancer pain. However, some studies appear to yield conflicting results regarding the efficacy of various approaches. For instance, while Singh and Chaturvedi (2015) report that acupuncture is effective in managing cancer pain — specifically hot flushes among breast cancer patients — Bao et al. (2014) observe that the same method has been found to have no demonstrable benefit in cancer pain management. Similarly, the authors note that the efficacy of methods such as transcutaneous electric nerve stimulation and massage therapy cannot be definitively established, as results have been largely inconsistent. It therefore follows that not all alternative pain management approaches are effective; some have either been shown to be ineffective or outright risky. In the final analysis, Bao et al. (2014) conclude that some alternative pain management methods could indeed be effective in alleviating cancer-related pain, but that "future large and rigorous randomized controlled studies are needed to confirm the benefits of CAM on adult cancer pain" (p. 78).

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

Care is inseparable from the practice of nursing. 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 toward patients (Ozan and Okumus, 2017). Effective pain management is one of the most crucial components in creating a caring environment. One of the theory's key concepts — 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 of these factors would be rendered meaningless in the absence of effective pain management. The critical question, however, remains: are nurses sufficiently knowledgeable or skillful in matters revolving around alternative pain management therapy?

The model of caring described above guides the project's theoretical framework. In applying the theory, nurses can advance holistic care for patients — particularly in seeking to ensure that the role patients play in their own wellbeing, especially in pain management, is a proactive one. By embracing treatment interventions beyond conventional medicine, patients effectively become active participants in the treatment process. With regard to pain management, this means that patients can actively apply approaches and techniques such as acupuncture and mind-body therapies to maximize wellness and healing. Nurses ought therefore to seek ways of increasing their familiarity with alternative pain management therapy.

Watson held that two things contributed to good health: the absence of illness, and the presence of deliberate actions aimed at preventing illness (Ozan and Okumus, 2017). In this context, deliberate steps must be taken to promote better outcomes — potentially through the incorporation of alternative pain management therapy into the care equation. Nurses should be able not only to understand but also to feel comfortable engaging patients in conversations about alternative pain management. The focus is the advancement of holistic care, with Jean Watson's theory serving as a guide to practice.

The study explores alternative methods of pain management compared to pharmaceutical techniques. The research questions are:

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?

The best design for this study is an 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). Various alternatives can be used to manage pain, and there are corresponding statistical tests to determine whether non-conventional methods are effective. Some of the non-pharmacological approaches toward managing pain considered in this study include aromatherapy, relaxation therapy, and hypnosis.

To answer the research questions, a suitable sample must first be identified before data collection. The sample comprises cancer patients currently managing pain through both pharmacological methods and alternative therapy approaches. One group of patients receives alternative pain therapy, while another group accesses pharmacological interventions. Effectiveness is measured through pain intensity assessment using numerical pain rating tools such as verbal rating scales or the Visual Analog Scale (VAS) (Sykes, Bennet, and Yuan, 2008).

In addition, a survey is completed by the healthcare practitioner(s) managing the patients to provide additional insight into the pain management process. To ensure consistency, reliability, and validity, the Cronbach's alpha is used to assess scale reliability. According to DiClemente, Crosby, and Salazar (2020), "Cronbach's alpha is considered to be a measure of scale reliability" (p. 104), with an accepted value of 0.7 and above. Since the variable of interest is pain intensity, the data are quantitative and continuous — quantitative because they take numerical form, and continuous because intensity can take decimal values.

The best methods of data analysis are one-way ANOVA and the independent-sample t-test. ANOVA is used to determine whether there is a difference in intensity between the different approaches or methods.

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 method differs in mean pain intensity.

Hypothesis — Independent-Sample t-Test

Null Hypothesis (H0): There is no significant difference in pain intensity when using pharmacological methods versus alternative methods.

Alternative Hypothesis (H1): There is a significant difference in pain intensity when using pharmacological methods versus alternative therapeutic methods.

The research design is quantitative in nature. Descriptive statistics will address the demographic characteristics of sampled patients, including name, age, and residence. Inferential statistics will determine whether there is a significant difference in pain intensity between pharmacological and alternative methods, and whether the various alternative measures differ significantly from one another.

Random sampling is the chosen sampling method. According to Lavrakas (2008), "under random sampling, each member of the subset carries an equal opportunity of being chosen as a part of the sampling process" (p. 311). The sampling frame consists of a list of locally selected hospitals. The sample size is 25 patients who use alternative pain management methods. A survey with a questionnaire is distributed to the hospitals for patients to complete with the assistance of a health practitioner. The questionnaire gathers demographic information from respondents, and the data are analyzed using Excel.

Ethical requirements are observed throughout the study. Particular attention is paid to consciousness of multiple roles, ensuring that roles adopted in the research do not harm or adversely affect respondents. Informed consent is obtained through a consent form signed before questionnaires are completed. Respondents have the right to withdraw from the study at any point and for any reason. The privacy and confidentiality of respondents are protected, and information collected is used solely for the purposes of the present study. All external data and referenced works are duly acknowledged.