Nursing and Inter-professional management

• Nondrug Therapy
  • Massage
  • Exercise
  • TENS or PENS
    • Transcutaneous/ percutaneous electrical nerve stimulation (TENS/PENS) involves the delivery of an electric current through electrodes applied to the skin surface over the painful region, at trigger points, or over a peripheral nerve
  • Acupuncture
    • Traditional Chinese medicine
  • Heat or cold therapy
  • Cognitive therapies
    • Hypnosis and Distraction
    • Relaxation strategies

Nursing and Inter-professional management

• Effective communication

• • Patient’s report of pain is believed, is not perceived as “complaining”
  • The nurse communicates concern and affirms her commitment to the patient

• Common concerns

Tolerance

• • • Occurs with chronic exposure to a variety of drugs
    • Very high opioid doses can result in opioid-induced hyperalgesia (OIH) rather than pain relief, thus increase in the dose can lead to higher pain levels.

• 1. • • Need for increased dose to maintain same degree of pain control
       • Rotate drug if tolerance develops, as increasing dose could result in opioid-induced hyperalgesia (OIH)

Physical dependence

• • • It is manifested by a withdrawal syndrome when the drug is abruptly decreased.

• 1. • • To avoid withdrawal, drug should be tapered

Pseudo-addiction

• • • Inadequate treatment of pain where the patient exhibit behaviors commonly associated with addiction and commonly labelled as “drug seeking” resulting in mistrust between them and caregivers.

Addiction

• • • Neurobiological condition with drive to obtain and take substances for other than prescribed therapeutic value

• 1. • • Tolerance and physical dependence are not indicators of addiction