● Decreased interest in activities, social gatherings, or old routines Opioids for chronic noncancer pain in adults An estimated 100 million adults in the United States are affected by chronic pain and are commonly diagnosed with chronic low back pain, joint pain/arthritis, or headaches (Smith & Hillner, 2019). Chronic pain often has no cure; treatment will not provide complete resolution. Treatment interventions for chronic pain should focus on long-term management of Integrative nursing Integrative nursing, as defined by Kreitzer and Koithan (2019), is a “way of being-knowing-doing that advances the health and wellbeing of persons, families, and communities through caring/healing relationships. Integrative nurses use evidence to inform traditional and emerging interventions that support whole person/whole system healing” (p. 4). Integrative medicine and integrative nursing are the same. In the past, these therapies were called complementary because they were adjuncts to the prescribed treatment regimen. Some called these therapies nonsense. The opioid epidemic has pressured providers with the option to prescribe more controlled substances or offer alternatives. Literature shows that integrative therapies positively affect patients’ perception of pain. DeBar et al. (2022) found that primary care–based cognitive behavioral therapy intervention (CBT) using frontline clinicians produced modest but sustained reductions in measures of pain and pain-related disability compared with usual care. Yoga and low back pain demonstrated a similar positive finding. A systematic review published in 2022 found that yoga revealed robust short- and long-term effects on pain, disability, physical function, and mental health compared with nonexercise controls (Anheyer et al., 2022). In their book Integrative Nursing , Kreitzer and Koithan (2019) offer a tiered approach to pain management. Nurses have offered these therapies to their patients for years. The different tiers and integrative therapy approaches are shown in Table 8.
physical, psychological, and social symptoms to improve pain management and quality of life and decrease suffering. Thus, a multidisciplinary, multimodality approach is the most effective method for managing adults’ chronic noncancer pain (Halpape et al., 2022).
Table 8. Tiered Integrative Approaches to Pain Management* Tiered Intervention Integrative Approaches Examples
Hot/cold therapy Relaxation response Guided imagery
Tier 1
Aromatherapy Yoga Hydrotherapy
Tier 2
Cognitive-behavioral (pain management) therapy Mindfulness-based stress reduction meditation Massage Acupressure Homeopathy Chiropractic NSAIDs Transcutaneous electrical nerve stimulation
Tier 3
Tier 4
Tier 5 Pharmacological therapies Surgical procedures Nerve blocks *Adapted from Integrative Nursing (Kreitzer & Koithan, 2019). Self-Assessment Quiz Question #6 Are integrative nursing therapies and complementary therapies the same?
a. Yes. b. No.
Clinical case example Ana is a 50-year-old female with chronic arthritis pain in her hands and knees. She states that the pain has worsened in the past two months, and previously tried therapies do not alleviate the pain. She went for a refill of morphine but was turned back to the pain specialist since the script was expired. So, Ana is asking the nurse practitioner for another prescription. Given the information provided, which tier aligns with Ana’s symptoms? Provide one short-term and one long-term intervention using the integrative approach examples.
Suggest one immediate intervention for the patient and provide a brief rationale.
Immediate interventions for Ana would include • Therapeutic listening, presence, therapeutic use of self • Touch • Heat/cold therapy Because of the recent change in pain and increase in the past two months, gather some diagnostics—check a rheumatoid For long-term therapies, Ana’s focus could be on some movement therapies, including • Yoga • Hydrotherapy • Tai chi These therapies might help with the circulation of joints. They might help with deep breathing exercises and a sense of appreciation for self. factor, sed rate (ESR), and c-reactive protein (CRP).
Suggest one long-term intervention for the patient and provide a brief rationale.
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