Non-Pharmacological Interventions for Pain Management
Patients undergo a large number of painful procedures during their ICU stay. Experiencing pain has long-term consequences on physical and psychological recovery. Whereas pain management in the ICU is mostly based on pharmacological interventions, non-pharmacological approaches are commonly used in the treatment of patients with chronic pain. Non-pharmacological strategies are inexpensive, easy to provide and safe. They have recently been introduced in ICUs, but there are very few studies to evaluate their effectiveness.
The recent published study "Patients and ICU nurses’ perspectives of non-pharmacological interventions for pain management" aimed to describe the perspectives of patients, family members and nurses about the usefulness, relevance and feasibility of non-pharmacological interventions for pain management in the ICU.
To obtain a straight description of the perspectives of patients, families and nurses about non-pharmacological interventions for pain management, 45-min focus group interviews were conducted using a semi-structured discussion guide. Patients and families of patients treated in ICUs for solid organ transplantation were recruited to participate. Other focus group interviews were conducted with ICU nurses. During focus group discussions, participants were shown a list of potential non-pharmacological interventions for pain management that were suggested by ICU patients and their nurses in previous case studies. For each intervention, questions were asked to assess whether i) participants had been exposed to this intervention in the ICU, ii) participants thought the intervention was or could be useful and feasible, iii) they could think of and define other potentially suitable interventions. To be considered in the final analysis, non-pharmacological interventions had to be discussed in at least half of the focus groups interviews. These interventions were further classified as useful (testimonies of effectiveness in pain relief), relevant (potentially useful) or feasible.
Four patients, two family members and 32 nurses participated in the focus group interviews. They discussed 33 non-pharmacological interventions, among which four were found to be useful, relevant and feasible in at least half of the focus groups. The top interventions included music therapy and distraction (cognitive-behavioural category), simple massage (physical category) and family presence facilitation (emotional support category). Patients/family members and nurses showed different interests towards some interventions. Patients emphasised active listening/reality orientation, while nurses discussed mostly about teaching or positioning.
This study explores a field which is poorly evaluated in the ICU. The effectively utilised methodology allowed investigators to gather descriptions of a large set (33) of non-pharmacologic interventions (NPI) considered by patients and caregivers. Discussion of the interventions were mostly qualitative, as the methodology used did not allow a proper evaluation of efficacy of the interventions in pain relief. In particular, the study did not allow the targeting of specific interventions based on the type and severity of pain or on ICU procedures performed. The focus-group interviews did not highlight specific methods to use the various non-pharmacological interventions.
Interestingly, patients and relatives seem to favor different interventions to those of caregivers. Some NPI commonly used did not generate much interest to either group. Additional issues in study design further limit the interest of the study. Patient sample size was small, and the discussion of non-pharmacological interventions by relatives may not be as relevant as the patients’ opinion. In addition, it would be interesting to extend this analysis to patients with a larger set of admission diagnosis.
This study identifies four interventions – music therapy, distraction, simple massage and family presence facilitation – that seem to be useful, relevant and feasible methods for pain relief.
What is now needed is a comprehensive definition of the indications and practical modalities for each of these four interventions. This is a pre-requisite for prospective interventional studies aiming to assess the effectiveness of these interventions on ICU patients.
This review was prepared and submitted by Anne-Sophie Debue (Cochin Hospital; Paris, France) on behalf of the N&AHP committee.
Céline Gélinas et al. Patients and ICU nurses’ perspectives of non-pharmacological interventions for pain management. Nursing in Critical Care Volume 18, Issue 6, pages 307–318, November 2013