E L N E C Geriatric Curriculum

E L N E C Geriatric CurriculumEnd-of-Life Nursing Education Consortium

Session 5 Pain Management:

Non-Drug Interventions

Fairfield UniversityQuinnipiac University

School of Nursing ELDER Project

E L N E C Geriatric Curriculum

Objectives: Upon completion of this session, the participant will be able to…1. List some non-drug therapies used to

relieve EOL pain symptoms.2. Describe special considerations and

precautions for using specific non-drug therapies.

3. Develop a toolkit that reflects non-drug interventions used in your facility/agency to manage pain at EOL.

Activity

E L N E C Geriatric Curriculum

Non-Drug TechniquesPsychological• Distraction• Relaxation• Meditation • Music• Art Therapy• Comfort Foods• Guided Imagery

Physical• Massage• Reflexology • Cold• Heat• Positioning• Exercise• Aromatherapy • Therapeutic Touch• Reiki • Acupuncture

E L N E C Geriatric Curriculum

Observations Prior to Starting Therapy• Understanding of options• Attitude and comfort • Family interest and

availability• Need for education• Ability to participate

E L N E C Geriatric Curriculum

Non-Drug Symptom Relief

E L N E C Geriatric Curriculum

MassageDecreases pain by soothing the skin

and relaxing tense muscles

Contraindications include: metatastic bones—massage can cause fractures of theses areasplatelet count less than 35,000-40,000---can cause bruisingblood clots---can create thrombus formation

E L N E C Geriatric Curriculum

Massage Examples• Brief touch such as rubbing someone’s

shoulder or handholding• A warm foot soak and rub• Wrapping feet in a warm, moist towel• Massaging a hand with warm lotion

Keep in mind the type of pain the person is experiencing, and that certain types of pain may be relieved (arthritis), while others worsen by touch (neuropathic).

E L N E C Geriatric Curriculum

Reflexology

1. reduce stress, 2. promote relaxation

and sleep, 3. improve

circulation, and energize

4. reduce pain, anxiety, nausea and vomiting.

E L N E C Geriatric Curriculum

Reflexology

E L N E C Geriatric Curriculum

Reflexology

E L N E C Geriatric Curriculum

Applications of Cold• Reduces pain by:

–numbing nerve endings– reducing muscle spasms–decreasing inflammation

• Also decreases the desire to scratch areas that itch!.Avoid areas being treated by radiation, areas with poor circulation, and open wounds.

E L N E C Geriatric Curriculum

Cold Examples• An ice pack to the neck and

upper shoulders• Ice massage to the knee with

a Dixie Cup™• Ice cloth to the hip opposite

the one that hurtsRemember that applications of cold require a physician's order; application of heat and cold may be limited to licensed staff. Never use menthol-based products with heat as they can cause burns.

E L N E C Geriatric Curriculum

Hot Applications• Relieves pain by

reducing inflammation and soreness

• Also decreases sensitivity to pain and increases blood flow to the skin

Avoid heat if the pain increases. Think “warm” not “hot.” Keep a layer of material (pillowcase, towel) between the heat source and the skin. Remember that moisture increases the effect of both heat and cold.

E L N E C Geriatric Curriculum

Heat Examples• Warm washcloth to head• Hot water bottle to

abdomen• Jacuzzi™ bath

You need a physician order for the use of heat/cold to manage pain. Avoid the use of menthol-containing products with heat as they can cause deeper heat absorption and burns. No Ben-Gay™!

E L N E C Geriatric Curriculum

Positioning/Movement• Positioning eases pain by placing

the body into postures that maintain or promote normal function of the muscles

• Movement helps maintain or restore ease of function in joints, bones, nerves, and ligaments

E L N E C Geriatric Curriculum

Positioning/Movement Examples

• Use of full-length body pillow• Pillow between knees when

lying on either side• Pretend to write the alphabet

by using the feet – switch feet every 6 or 8 letters

E L N E C Geriatric Curriculum

Aromatherapy

Lavender -------------

Citrus -----------------

Cypress ---------------

Indications• Insomnia/anxiety• Agitation

• Depression/grief

• Transition• Breathing difficulties

E L N E C Geriatric Curriculum

Examples of Aromatherapy

• Essential oils • Hydrotherapy baths• Massage• Diffuser• Compress • Candles• Atomizer or spritzer• Anointing

E L N E C Geriatric Curriculum

Therapeutic Touch

• Energy exchange• Rebalancing

E L N E C Geriatric Curriculum

Reiki

• Hands-on healing art• Balances the biofield• Strengthens the body to heal itself

E L N E C Geriatric Curriculum

Acupuncture

• Needle placed in designated areas• Releases energy blockages• Licensed acupuncturist

E L N E C Geriatric Curriculum

DistractionUsed to focus attention on

something other than pain. By decreasing concentration on pain,

it becomes more bearable.

E L N E C Geriatric Curriculum

Distraction Example• Compile a file of pictures• Have resident describe

picture by:– Talking about the picture– Pretending they are in the

picture– Telling a story about the picture

• Choose a new picture as soon as their interest decreases in the current one

E L N E C Geriatric Curriculum

Relaxation

• Described as freedom from physical and mental tension

• Relaxation techniques reduce stress, muscle tension and reduce pain

E L N E C Geriatric Curriculum

Relaxation Examples

• Put on headphones with a tape of calming music

• Breathe in deeply; exhale slowly

• Think of a calm setting or peaceful place that you’ve enjoyed visiting

E L N E C Geriatric Curriculum

Meditation

• Intentional self regulation of attention• Enhances concentration and awareness• Helps relieve physical and emotional pain• Promotes feelings of acceptance, well-being, and inner peace

E L N E C Geriatric Curriculum

Music

Decreases pain by:• Providing distraction• Reducing anxiety• Prompting recall of pleasant

memories• Interrupting the stress response

E L N E C Geriatric Curriculum

Art Therapy

• Creative expression• Uncover unconscious strengths• Trained professional

E L N E C Geriatric Curriculum

Comfort Foods

Assists in decreasing pain by:• Providing distraction• Evoking comforting memories• Promoting relaxation and physical

calm

E L N E C Geriatric Curriculum

Goals of Therapy

• Promote relaxation• Reduce stress• Reduce muscle tension• Decrease anxiety• Relieve pain & other

symptoms• Reduce side effects of

the disease & treatments

• Improve sleep• Decrease sense of

suffering & abandonment

• Promote safety & trust in caregivers

• Increase sense of well-being & control regarding matters of daily living & death

E L N E C Geriatric Curriculum

Activity: Building a Toolkit

E L N E C Geriatric Curriculum

We can’t change the course of the illness, but we can help patients through it with a gentle and caring touch.

E L N E C Geriatric Curriculum

References City of Hope & the American Association of Colleges of Nursing, 2007; Revised,

2010. The End-of-Life Nursing Education Consortium (ELNEC)- Geriatric Training Program and Curriculum is a project of the City of Hope (Betty R.

Ferrell, PhD, FAAN, Principal Investigator) in collaboration with the American Association of Colleges of Nursing (Pam Malloy, RN, MN, OCN, Co-

Investigator).

Ferrell, B. & Coyle, N, (2010). Oxford Textbook of Palliative Nursing. New York: Oxford University Press, Inc.

http://www.hov.org/dementia_programs.aspx (music video)

Supported by DHHS/HRSA/BHPR/Division of Nursing Grant # D62HP06858