Pain relief from nonpharmacological interventions in the intensive care unit: A scoping review

Abstract

Aims and Objectives: To describe what is known from the existing literature on nonpharmacological interventions targeting pain in patients admitted to the ICU. Background: Patients receiving intensive care nursing are exposed to a wide range of pain provoking tissue damage, diseases, surgery and other medical procedures in addition to the pain caused by nursing care procedures. The present shift to light sedation to improve patient outcomes and comfort underscores the need for effective pain management. Opioids are the mainstay for treating pain in the ICUs, whereas nonpharmacological treatments are understudied and possibly under-used. Method: A scoping review was undertaken using five of the six steps in the Arksey and O´Malley framework: (a) identification of the research question, (b) identification of relevant studies, (c) study selection, (d) charting the data and (e) collating, summarising and reporting the results. CINAHL, MEDLINE, PubMed, BMJ Best Practice, British Nursing Index and AMED databases were searched using relevant keywords to capture extensive evidence. Data were analysed using the six-step criteria for scoping reviews suggested by Arksey and O´Malley for data extraction. To ensure quality and transparency, we enclosed the relevant Equator checklist PRISMA. Results: Our search yielded 10,985 articles of which 12 studies were included. Tools for pain assessments were VAS, NRS, ESAS and BPS. Interventions explored were hypnosis, simple massage, distraction, relaxation, spiritual care, harp music, music therapy, listening to natural sounds, passive exercise, acupuncture, ice packs and emotional support. Reduction in pain intensity was conferred for hypnosis, acupuncture and natural sounds. Conclusion: The findings support further investigations of acupuncture, hypnosis and listening to natural sounds. Relevance to Clinical Practice: The main finding suggests the use of comprehensive multimodal interventions to investigate the effects of nonpharmacological treatment protocols on pain intensity, pain proportion and the impact on opioid consumption and sedation requirements. | 1489 SANDVIK et Al.

Individual Traits and Pain Treatment: The Case of Hypnotizability

“…In highs, suggestions-induced analgesia, which can be focused on the sensory and/or emotional dimension of pain, is not accompanied by release of endogenous opiates, but is sustained by the modulation of the activity and connectivity of the pain matrix (Faymonville et al, 2006;Casiglia et al, 2020). Interestingly, the suggestions for analgesia have been found effective also in healthy mediums undergoing nociceptive stimulation (Fidanza et al, 2017) and in chronic pain patients independently from hypnotizability (Elkins et al, 2007;Jensen, 2011;Jensen and Patterson, 2014;Mazzola et al, 2017;Facco et al, 2018;Sandvik et al, 2020). This can be accounted for by expectation of/motivation to analgesia (Milling et al, 2005;Krystek and Kumar, 2016;Montgomery et al, 2018;Perri et al, 2020) leading to placebo responses (Benedetti, 2013) which can reduce pain and pain-related psychological symptoms in the general population (Liossi et al, 2006;Brugnoli, 2016;Wortzel and Spiegel, 2017;Rousseaux et al, 2020).…”

Nursing interventions in intensive care unit patients with breathing difficulties: A scoping review of the evidence

“…It is interesting that alternative methods such as nonpharmacological therapies could be useful and used as adjuncts when treating patients in an ICU. Scoping reviews of other areas, such as pain relief, suggest the use of comprehensive multimodal interventions to investigate the effects of nonpharmacological treatment protocols on pain intensity and pain proportion and their impact on opioid consumption, 47 as the possibly serious adverse effects of these drugs should be considered when applied in treatment. 48 Nonpharmacological and nontechnical interventions have few negative effects, are cheap, easy to provide, and safe, 49 and might be beneficial when combined with classical pharmacological therapies.…”

Sykepleiere er avgjørende for god smertebehandling

“…Vi har gjennomført en litteraturgjennomgang av hvilke ikkemedikamentelle tiltak som er gjennomført på intensivavdelinger for å lindre smerte (24). Vi fant tolv artikler som hadde undersøkt ikke-medikamentelle tiltak, og som hadde brukt et smertevurderingsverktøy.…”

“…Ved å evaluere e ekten av de ulike tiltakene var det kun hypnose, akupunktur og naturlige lyder som viste en klinisk og statistisk relevant endring i smerteintensiteten (24).…”