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


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


      • 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.


      • Neurobiological condition with drive to obtain and take substances for other than prescribed therapeutic value
        • Tolerance and physical dependence are not indicators of addiction