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September 2006

Complimentary Therapies and Pain Management:
How Do We Integrate Them Into Practice?

As nurses caring for our patients, we are very concerned about their levels of comfort. We help alleviate pain with opioids, Non Steroidal Anti-Inflammatory Drugs (NSAID) and the like, but is there something more we can incorporate into our practices to help alleviate suffering?

Billions of dollars are spent each year on complimentary/alternative therapies to help us heal. This phenomenon has created confusion and chaos among physicians and other health care professionals to become knowledgeable about what is being offered and how it may impact a course of conventional medicine.

When it comes to pain management and incorporating complimentary therapies into practice, we must do a pretty intense assessment of acute pain with each individual and find the right pharmacological agent before we can begin to integrate complimentary therapies. For chronic pain, the answer may be different. We may know the cause of chronic pain, and pharmacological agents do not completely alleviate the pain. Therefore, we can help individuals explore non-pharmacological approaches to pain management.

Nurses must examine their own philosophical base before they embark on pain management using complimentary therapies. If we believe opioids or pharmacological agents are the only acceptable way of managing pain, we probably will find complimentary therapies non-enchanting. If we believe, however, that pharmacological agents are not the only ways to manage pain, our issue becomes one of ‘quality of life’, and we will be more likely to explore complimentary therapies.

In my practice of working with oncology patients over the past twenty years, I have been witness to some remarkable stories regarding pain management, sometimes by accident. For example, on a cancer retreat program one fall, a gentleman with advanced prostate cancer came to the retreat. He brought all of his pain medication but was still very uncomfortable. The group was doing an art project and he was very interested in doing his own journal. He was having difficulty managing his pain, however. He took his two Dilaudid, and I suggested he lay down for a few minutes. He came back to the table in 15 minutes, and for the next two hours worked diligently and intently on making his own journal. After the journal was complete, he looked at me with tears in his eyes and said, “You know, for the past two hours, I felt no pain. I’ve never had two hours free of pain in the past year.”

I remember a woman in her 40’s with small children at home who suffered from metastatic bone pain from breast cancer. She was having difficulty getting complete pain management from her opioid regimen, and after discussing her openness to exploring complimentary therapies, she agreed to try a gentle Swedish massage. We spoke with the massage therapist prior to her massage about her risk for injury from deep massage. After a gentle, one-hour Swedish massage, the woman wept because she had't felt that good in months. We discovered, quite by accident, that if she could get relaxed, her opioid medication worked better and the quality of her life improved tremendously. We set up regular massage therapy for her. 
           
For some people, perhaps acupuncture is helpful ... for others it may be aromatherapy. The most important point to remember as we help people access complimentary therapies is to be sure our patients are placed in competent, reputable practitioners’ hands, and that they communicate with the physicians’ help in accessing them. Together we can all help improve the quality of life of the people who seek our help. Remember, it may not be in the curing that we do our best healing.

Lynne Kinseth, ARNP, M.S.N., AOCN
Director, Mercy Cancer Center Des Moines, Iowa

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