The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [344]
Cannabis
Studies are currently taking place to examine the potential benefits of using cannabis for the management of chronic conditions, for example multiple sclerosis and cancer. Good-quality research is sparse (Wall et al. 2001) but there are a number of studies that allude to its benefits in managing chronic pain, spasticity and muscle spasms (Consroe et al. 1997, Martyn et al. 1995).
Anaesthetic interventions
Sometimes it is difficult to attain and maintain adequate pain control without significant side-effects and it is in situations such as this that anaesthetic interventions may be of benefit.
Effective control can be achieved by epidural or intrathecal (spinal) infusions:
as single injections for simple nerve blocks, or
regional nerve blocks which target individual nerves, plexi or ganglia (Hicks and Simpson 2004).
Examples include managing pelvic pain and postradiation brachial plexopathy.
These interventions can be useful, but careful consideration and assessment must take place to ensure that any potential side-effects are discussed with the patient (anaesthetic interventions may severely limit the patient’s activities) and that future planning is addressed with the patient and family as an epidural/intrathecal infusion may limit discharge options for the patient who is dying.
Non-pharmacological methods of managing pain
Optimal pain control is more likely to be achieved by combining non-pharmacological techniques with pharmacological techniques. Despite the lack of research evidence to support the effectiveness of many non-pharmacological techniques, their benefits to patients and families should not be underestimated.
Psychological interventions
A number of simple psychological interventions can improve a patient’s pain control by:
reducing anxiety, stress and muscle tension
distraction (distraction plays a role in pain management by pushing awareness of pain out of central cognition)
increasing control and pain-coping mechanisms
improving general well-being.
Some simple interventions include the following.
Creating trusting therapeutic relationships
By creating trusting relationships with patients, nurses are instrumental in reducing anxiety and helping patients to cope with pain (Carr and Mann 2000). Nurses can help to create a trusting relationship by:
listening to the patient
believing the patient’s pain experience (Seers 1996)
acting as a patient advocate
providing patients with appropriate physical and emotional support.
The use of gentle humour
Pasero (1998) suggests that many patients find gentle humour an effective way of coping with pain. Humour may be particularly helpful prior to a painful procedure as it can have a lasting effect. In the clinical setting, humorous tapes, books and videos can be made available for patient use.
Information/education
Patient information/education can make all the difference between effective and ineffective pain relief. Information/education helps to reduce anxiety (Hayward 1975, Taylor 2001) and enables patients to make informed decisions about their care. Patients should be given specific information about why pain control is important, what to expect in terms of pain relief, how they can participate in their management and what to do if pain is not controlled. Some caution is required, however, because not all patients respond positively to the same level of information. Patients with high levels of anxiety may find that detailed information can increase their anxiety and influence their pain control. To avoid this, patients can be given a choice of whether or not they receive simple or detailed information (Mitchell 1997).
Relaxation
Whilst scientific evidence for the effectiveness of relaxation techniques is limited (Carroll and Seers 1998, Seers and Carroll 1998), a number of studies have shown benefits for patients experiencing pain (Good et al. 1999, Lang et al. 2000, Sloman et al. 1994). Payne (1995) describes several relaxation