Pain management is an essential piece of the care provided in long-term and post-acute care (LTPAC) settings. Many residents experience acute or chronic pain due to a variety of conditions, such as postsurgical recovery, arthritis, and neuropathy. Pain traditionally was managed with pharmacological interventions, including narcotics and nonsteroidal anti-inflammatory drugs. But reliance on these medications comes with risks like dependency, adverse drug reactions, and complications associated with polypharmacy.
Thus, non-pharmacological interventions have emerged as a necessary component of a comprehensive pain management plan. These interventions focus on reducing pain without the risks associated with medications. Implementing evidence-based non-pharmacological approaches can significantly improve residents’ quality of life, both physical and emotional, and their functioning.
Four Pain Management Challenges
Managing pain in older adults in LTPAC facilities presents several challenges. (1) The high prevalence of chronic pain experienced by residents, if left untreated, can lead to decreased mobility, depression, and social isolation. (2) Barriers to pain assessment: cognitive impairment, especially in residents with dementia, can make it difficult for individuals to articulate their pain levels, leading to either undertreatment or overtreatment. (3) When residents take multiple medications for chronic conditions, polypharmacy may increase the likelihood of drug interactions, side effects, and even hospitalizations. (4) The opioid crisis has heightened awareness about the risks of overprescribing pain medications, leading to regulatory measures that may limit access to needed pain relief.
Given the challenges just described, facilities must implement a multimodal pain management approach. It should consider non-pharmacological interventions as both a first line and complementary strategy.
Benefits of Non-pharmacological Pain Interventions
Alternative interventions help lower the use of narcotics and other pain medications, reducing the risk of dependency and adverse effects. By addressing pain through holistic methods, healthcare providers can improve physical function, emotional well-being, and engagement in daily activities for residents.
Chronic pain, often the physical manifestation of anxiety and depression, can lead to decreased motivation. Thus, addressing the psychological aspects behind pain becomes necessary. Non-pharmacological approaches, such as mindfulness and therapy, can address these emotional elements. Yet another benefit is that they support individualized care. Tailoring interventions to residents’ preferences and needs leads to a more successful resident-centered approach to pain management.
Types of Non-pharmacological Pain Interventions
- Physical Interventions
- Heat and cold therapy: Applying heat packs can relieve stiffness; cold therapy can reduce inflammation and swelling.
- Massage therapy: Gentle techniques reduce muscle tension, improve circulation, and encourage relaxation.
- Positioning and support: Adjusting position with pillows for support and helps prevent pressure injuries.
- Transcutaneous electrical nerve stimulation (TENS): Low-voltage electrical impulses can disrupt pain signals.
2. Cognitive and Behavioral Interventions
- Guided imagery and relaxation techniques: Visualizing a calm scene can distract from pain and enhance comfort.
- Distraction techniques: Providing a preferred activity such as a game, puzzle, conversation, or TV can divert attention from pain.
- Mindfulness and meditation: Techniques such as deep breathing and guided meditation help residents focus on relaxation and reduce pain-related stress.
- Structured cognitive behavioral therapy: This approach helps individuals change negative thought patterns associated with chronic pain.
3. Sensory Interventions
- Aromatherapy: Essential oils such as lavender and peppermint applied topically or inhaled have calming and pain-relieving properties.
- Music therapy: Listening to or playing music has been shown to reduce pain perception and enhance mood.
- Pet therapy: Interaction with animals can lower stress levels, increase endorphins, and provide emotional comfort.
- Therapeutic touch/Reiki: These light touch or energy-based techniques can reduce pain.
4. Activity-Based and Rehabilitative Interventions
- Physical therapy and stretching: Regular movement and strengthening exercises help maintain joint function, reduce stiffness, and improve mobility.
- Yoga and Tai Chi: Combining movement with mindfulness encourages relaxation and pain relief.
- Aquatic therapy: Using water buoyancy to reduce joint stress can help residents with arthritis or mobility issues.
5. Environmental and Lifestyle Modification Interventions
- Adaptive equipment and ergonomic adjustments: Providing residents with supportive seating, cushions, and adjustable beds can help alleviate discomfort.
- Sleep hygiene improvements: Encouraging better sleep habits can reduce fatigue-related pain.
- Social engagement: Staying socially active can improve mental well-being and distract residents from pain.
Implementation Strategies
To integrate non-pharmacological pain interventions in a comprehensive pain management program, the facility needs a structured approach:
- Follow federal and state regulations along with current policy and procedure: Obtain physician orders prior to implementation where necessary.
- Incorporate alternative interventions into individualized care plans: Assess residents’ pain levels and preferences to tailor non-pharmacological interventions to specific needs.
- Educate staff: Provide training on recognizing nonverbal pain cues, using the resident’s care plan, implementing alternative therapies effectively, and how to complete proper documentation.
- Monitor and adjust interventions: Evaluate pain levels regularly and adjust strategies based on resident feedback and outcomes.
- Encourage interdisciplinary collaboration: Work closely with physical therapists, occupational therapists, social workers, and activity coordinators to deliver a holistic approach.
Pain management in LTPAC settings requires a comprehensive resident-centered approach that goes beyond traditional pharmacological methods. The interventions described here offer a safer and often more effective way to manage pain while improving quality of life. By regularly integrating these techniques into routine care, facilities can reduce reliance on medications, enhance resident comfort, and promote holistic well-being.
As healthcare continues to shift toward resident-centered, holistic, and integrative care models, non-pharmacological pain interventions will remain vital in shaping the future of pain management. Facility leaders, clinicians, and care staff must prioritize these evidence-based approaches to ensure better outcomes for residents. AAPACN has developed the tool “Pain Relief Without Pills: A Guide to Non-pharmacological Interventions,” a resource that reviews each type of intervention and its mechanism of action, along with an example for use. The tool also includes an audit to ensure compliance and identify areas for improvement.
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