and social factors, thereby limiting the potential effectiveness of the narcotic. Although NSAIDs such as aspirin and ibuprofen are not typically used for severe pain, NSAIDs have been employed to treat mild to moderate pain – both acute and chronic (McCarberg & Gibofsky, 2012). They should be given with food to minimize gastrointestinal complications such as ulceration of the gastric mucosa. Other negative effects of NSAID use include adverse events in the cardiovascular system and the kidneys (McCarberg & Gibofsky, 2012). Because NSAIDs can interfere with nociceptive input during the pre- and perioperative periods, resulting in diminished perception of postoperative pain (Dionne, 2000), pain control may be best achieved through the administration of NSAIDs during the preoperative phase. This strategy minimizes central nervous system sensitization by interfering with the expected cascade of inflammatory mediators that are released when tissue is injured. More recently, Penprase, Brunetto, Dahmani, Forthoffer, and Kapoor (2015) systematically reviewed the literature and found that gabapentin and COX-2 inhibitors were more effective preemptive analgesics for postoperative pain. Use of a long-acting local anesthetic to sustain pain control through the critical first hours post-surgery is also an effective practice. Finally, a well-defined pharmaceutical regimen over the anticipated normal cycle of postoperative pain can diminish central sensitization. Healthcare practitioners can support clients in their pain management strategies by inquiring if they have remembered to take their medication prior to the treatment session, creating strategies or embedding cues into daily routines to support adherence to medication usage, and educating clients about possible altered response during days when they are not taking their prescribed medication. Complementary and alternative treatments The National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH) funds research on complementary and integrative health interventions. The Center defines complementary as “non-mainstream practice that is used together with conventional medicine,” and alternative as “non-mainstream practice that is used in place of conventional medicine” (NCCIH, 2018). The term integrative medicine involves bringing conventional and complementary approaches together in a coordinated manner. This approach to health and wellness has grown across the United States. Currently, complementary health approaches refer to practices and products that are of nonmainstream origin. Integrative health is the incorporation of the complementary approaches into mainstream health (NCCIH, 2018). Using the National Health Interview Survey 2012 data, 29.6% of adults in the United States reported using at least one form of complementary approaches in the previous 12 months (Yan et al., 2015). When looking at the sociodemographic characteristics of the complementary approach users, Yan et al. (2015) reported that they were more likely to be non-Hispanic White females, living with a spouse or partner in the Western or Midwestern regions of the United States. They were likely to have a least baccalaureate degree with higher personal earnings and greater family spending on health care. The authors also report the top 10 health conditions included back pain, neck pain, joint pain or stiffness, arthritis, muscle or bone pain, cholesterol, anxiety, headaches, stress, and other nonspecified conditions (Yan et al., 2015). Women report that their motivation for using complementary approaches is to improve health and well-being, where men report that they wish to improve athletic or sports performance (Yan et al., 2015). According to NCCIH (2018), natural products, deep breathing, movement techniques (yoga, tai chi, qi gong), chiropractic or osteopathic manipulation, meditation, massage, special diets, homeopathy, and progressive relaxation are the 10 most common complementary health approaches used.
Combination therapy, which targets a variety of pathways and mechanisms, can be an effective approach (Gilron, Jensen, & Dickenson, 2013). Prior to the introduction of NSAIDs, a combination of aspirin or acetaminophen with an opioid such as codeine had been the drug of choice to control moderate to severe pain. NSAIDs used in conjunction with acetaminophen can provide pain relief that is more effective and consistent over the period of the administered dose. Use of this combination also avoids the deleterious side effects associated with opioid drugs. Clients should always be referred to their physician and pharmacist with questions about potential drug interactions. Other medications, such as anticonvulsants, tricyclic antidepressants, and steroids, may also modify the peripheral pain stimulus. Antispasmodics, antiarthritis drugs, and muscle relaxants are given for skeletal and smooth muscle relaxation, which can help decrease the reaction to pain. However, because many clients with chronic pain have comorbid psychiatric and somatic diagnoses, complications with medication management can arise. According to Cicero and Ellis (2017), these comorbidities can influence the progress to a substance use disorder. Chronic pain was two times more likely to be associated with psychiatric diagnoses in a study by Pereira, França, de Paiva, Andrade, and Viana (2017). The diagnoses Pereira et al. (2017) included were mood disorders, anxiety disorders, attention disorders, and substance use disorders. Given multiple diagnoses and medications, medical management of a client’s symptoms requires expert attention. Often healthcare professionals can play a role in helping a client organize and take the appropriate medication at the appropriate times. Below is a limited list of CAM treatments commonly used in pain management: ● Acupuncture : Though widely used for pain relief, continues to have little evidence supporting the mechanisms of action that produce the analgesic-like effects (Lin et al., 2016). Recently, there is increasing evidence to support the use of acupuncture for pain management (Ning & Lao, 2015). Ning and Lao (2015) found that often there are challenges with the design of studies, most critically with the selection of controls and the design of sham needling. In a systematic review of randomized control trials, Xiang, Cheng, Shen, Xu, and Liu (2017) found low to moderate quality evidence supporting the use of acupuncture for immediate pain relief when compared to sham acupuncture, analgesic injection, or no treatment. One qualitative study shows improvements in quality of life measures resulting from the use of acupuncture (Kligler et al., 2015). Many reported the therapeutic connection between the mind and body and the effects this had on stress reduction, resulting in deep relaxation. Others found it helpful for other conditions (depression, anxiety, and sleep) that were not the primary focus of treatment. When asked specifically about the effectiveness for pain management, participants reported acupuncture to be helpful; however, the relief was only temporary (Kligler et al., 2015). ● Tai chi : A review of the literature identified a number of studies of moderate quality that found tai chi to be more effective than no treatment or treatment as usual for short-term reduction of pain resulting from osteoarthritis, back pain, and headache (Hall et al., 2017). Chenchen et al. (2016) evaluated the effectiveness of tai chi to standard physical therapy treatment for osteoarthritis pain in the knee. Although findings indicate no significant difference between the tai chi and physical therapy treatment in management of pain, the authors do identify a significant improvement in depression symptoms as measured by the Beck Depression Inventory-II scores and the physical components on the 36-item Short Form Health
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Book Code: SWUS1524B
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