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Course: Oncology Nursing

Topic: Nursing Management of Pain in Cancer Patient Part 2

The Nurses International Community

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Module Goals

Learners will be able to:

Identify non-pharmacological pain management in cancer patients.
Identify information for patient education/counseling on pain management at home.

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Non-pharmacological Pain Management in Cancer

Swarm et al., 2010

Pain likely to be relieved or functions improved with physical, cognitive or interventional modalities.

Physical Modalities:

Bed, bath or walking support
Positioning instructions
Physical therapy
Massage
Heat /Ice
Transcutaneous electrical nerve stimulation
Acupuncture/ Acupressure
Ultrasonic stimulation

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Non-pharmacological Pain Management in Cancer

Massage:

Involves manipulation of the body's soft tissue using various manual techniques and the application of pressure and traction.
Increase well-being through the reduction of stress and anxiety levels, and thus may contribute to pain control.

Reflexology:

Use of manual pressure applied to specific areas of the feet, hands or ears which relieves stress and bring about physiological changes and thereby reduction in pain perception.

Singh & Chaturvedi, 2015

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Non-pharmacological Pain Management in Cancer

Acupuncture

A scientific treatment method that assist the body in restoring its balance by means of stimulating some special points on the body with needles.
Is more effective in relieving joint pain and stiffness.
Also helps in preventing nausea and vomiting after chemotherapy.

Singh & Chaturvedi, 2015

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Non-pharmacological Pain Management in Cancer

Singh & Chaturvedi, 2015

Transcutaneous Electrical Nerve Stimulation (TENS)

The TENS unit delivers low-voltage electrical stimulation to leads which are placed over the skin on or near the painful sites.

Certain limitations of TENS therapy are:

Electrodes can not be placed on certain parts of the body, such as near eyes, on front of neck, open wounds or infections, near tumors, in pregnant women, or on genitals.
Contraindicated for people with pacemakers, implantable cardiac defibrillators.

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Non-pharmacological Pain Management in Cancer

Swarm et. al., 2010

Cognitive Modalities:

Imagery/Hypnosis
Distraction training
Relaxation training
Active coping training
Graded task assignment
Cognitive behavioral training
Spiritual training

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Non-pharmacological Pain Management in Cancer

Singh & Chaturvedi, 2015

Imagery:

In this the patient is taught self-guided imagery.
The patient is made to focus on a pleasant or distracting scene to attend to the sensation in the scene like sights, sounds, smell.

Hypnosis:

The therapist teach skills which helps the patient relax.

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Non-pharmacological Pain Management in Cancer

Comprehensive Cognitive Behavioral Therapy:

This therapy emphasizes the importance of learning different coping skills like relaxation, imagery, self calming statements, problem solving.
The patients systematically learn and master the skills of coping cancer pain.
The patients are encouraged to combine various coping skills to deal with daily challenges.

Singh & Chaturvedi, 2015

Contact info: info@nursesinternational.org

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Non-pharmacological Pain Management in Cancer

Swarm et al., 2010

Common interventional strategies:

Regional infusion:

Epidural: easy to place large volume of opioids.
Intrathecal:easy to internalize to implanted pump for infusion of opioids and local anesthetics.
Regional plexus: for the infusion of local anesthetics, used to anesthetize single extremity.

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Non-pharmacological Pain Management in Cancer

Swarm, et al., 2010

Common interventional strategies:

Percutaneous vertebroplasty:

It is an image-guided therapy in which a cement, a fast-setting polymer, is injected into a pathologic vertebral body.
Used for osteoporotic or malignant fractures to relieve pain and disability.

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Non-pharmacological Pain Management in Cancer

Swarm, R., 2010

Neuro Destructive procedure:

Destroy nerves or nerve connections usually the sensitive nerves that transmit pain.
The destructive effect may be created using several different methods, one of which is surgical: the neurosurgeon looks for the nerve and cuts through it.

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What would the nurse do?

Miss Rai, 52 yrs old, has metastatic cancer and is experiencing moderate pain. She has been taking analgesics to relieve the pain; however, the pain is not well controlled. She is planning for non-pharmacological management of pain. What are the different physical modalities she can apply to alleviate her pain? (Select all that apply)

Massage
TENS
Hot/Cold compress
Imagery

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Patient and Family Education in Cancer Pain

Physiopedia, 2020

Patient education has been defined as, "any set of planned activities designed to improve a patient's health behaviours, health status, or both."
These activities help the patient and family make sense of their pain and guide them towards effective, ongoing self-management.

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Patient and Family Education in Cancer Pain

Message to be conveyed to the patient and family are:

Potent analgesics should be taken only as prescribed. Do not self adjust dosage or frequency unless discuss with the doctor.
Morphine and morphine like drugs are used to relieve pain:

When these drugs are used to treat cancer pain, addiction is rarely a problem.
These are controlled substances that need to be properly safeguarded in the home.
These medication must be used with caution and should not be mixed with alcohol or illicit substances.

Swarm et al., 2010

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Patient and Family Education in Cancer Pain

For educating the patient and family the health professional should:

Assess the knowledge and literacy of the patient and family to ensure the understanding of education.

Messages to be conveyed to the patient and family are:

Relief of pain is medically important and there is no benefit suffering from pain.
Pain can be usually well controlled with pain medication.

For persistent pain taking analgesics on regular schedule will improve the pain control.

If the pain medication do not work, many alternatives are available.

Swarm et al., 2010

Contact info: info@nursesinternational.org

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Patient and Family Education in Cancer Pain

Message to be conveyed to the patient and family are:

Communication with healthcare provider is crucial:

Health care providers can not tell how much pain unless you tell them.
Health care providers want to know any problems that you think pain medication is causing.
Tell you health care providers if any difficulty getting the medication or concern about taking them.
Expect optimal management for pain and side effects. Inform patients that they have right to expect pain management as part of overall care.

Swarm et. al., 2010

Contact info: info@nursesinternational.org

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Patient and Family Education in Cancer Pain

Message to be conveyed to the patient and family are:

The following must be reviewed with each patient and family and provided in written form:

The list of each medication prescribed
A description of what each medication is for
An instruction as to how and when to take each one
A list of potential side effects and what to do if they occur
A list of medication to be discontinued
A list of phone number to reach the health care worker if problems happen
A follow up plan

Swarm et al., 2010

Contact info: info@nursesinternational.org

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Patient and Family Education in Cancer Pain

Swarm et al., 2010

Message to be conveyed to the patient and family are:

The patient should call the healthcare worker if :

Has a problem taking medication
New pain, change in pain or pain not relieved with medication
Nausea and vomiting that prevent for eating
Constipation and can not pass stool for 3 days
Difficulty arousing the patient form sleep at day time
Confusion

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Patient and Family Education in Cancer Pain

Swarm et al., 2010

Message to be conveyed to the patient and family are:

The health care worker needs to be familiar with the regulation pertaining to operation of machinery or vehicles while taking potentially sedating medicine and advice the patient and family accordingly.

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What would the nurse do?

Mr Le, a 27 year-old patient, is diagnosed with lumbar radiculopathy. The patient's pain is controlled by an opioid medication and his condition is stable. His physician has planned to discharge him from the hospital. What are the common discharge instructions that need to be reviewed and given in a written form?

A list of each medications prescribed
A list of potential side effects and what to do if they occur
A list of phone number to call back if any problem occur
A follow up plan

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References:

Patient Education in Pain Management. (2020, November 17). Physiopedia, . Retrieved 11:01, April 19, 2021 from https://www.physio-pedia.com/index.php?title=Patient_Education_in_Pain_Management&oldid=259638

Singh, P., & Chaturvedi, A. (2015). Complementary and alternative medicine in cancer pain management: a systematic review. Indian journal of palliative care, 21(1), 105–115. https://doi.org/10.4103/0973-1075.150202

Swarm, R., Abernethy, A., Anghelescu, D. L., Benedetti, C., Blinderman, C. D., Boston, B., Cleeland, C., Coyle, N., deLeon-Casasola, O. A., Eilers, J. G., Ferrell, B., Janjan, N. A., Karver, S., Levy, M. H., Lynch, M., Moryl, N., Murphy, B. A., Nesbit, S. A., Oakes, L., Obbens, E. A., Paice, J. A., Rabow, M. W., Syrjala, K. L., Urba, S., & Weinstein, S. M. (2010). Adult Cancer Pain, Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw, 8(9), 1046-1086. Retrieved Apr 19, 2021, from https://jnccn.org/view/journals/jnccn/8/9/article-p1046.xml

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