Overview of Pain and

Complementary Therapies

Colette Forde, RN, MSN

Director of RN Education

HCRA Funded Project

Awarded by NYS: 2010 and 2011

Instruction, backfill, materials

Grant amount:

- Approx $80,000 for instruction in

2010

- Approx $60,000 in backfill in 2010

Participating Facilities

Bishop Henry Hucles

CABS

Carmel Richmond

Cliffside

Daughters of Jacob

Isabella

Jewish Home –

Manhattan

Kateri Residence

Mary Manning Walsh

Morningside House

Rivington House

Terence Cardinal

Cooke

Village

Pain Statistics

Pain is the main reason for visiting

the emergency department > 50% of

cases 1

Present in 30% of family practice

visits 2

Prevalence rates for chronic pain,

range from 12 - 80% of population 3

Pain Statistics

It becomes more common as people

approach death

A study of 4,703 patients found that

26% had pain in the last two years of

life

Increased to 46% in the last month 4

Effects On Our Lives

Impairments in attention control

Working memory

Mental flexibility

Problem solving

Information processing speed 5

↑ depression, anxiety, fear, and

anger 6

Physiology of Pain

Classification

Thermal: heat or cold

Mechanical: crushing, tearing, etc.

Chemical: iodine in a cut, chili

powder in the eyes

Duration of Pain

Pain is usually transitory

Lasting only until the noxious

stimulus is removed or

Underlying damage or pathology has

healed

Duration of Pain

Chronic pain

Acute pain

Rheumatoid arthritis, peripheral neuropathy, cancer and idiopathic pain, may persist for years

When do we recognize

pain Pain perception

threshold is the

point at which

the stimulus

begins to hurt

When do we recognize

pain Pain tolerance

threshold:

reached when

the subject acts

to stop the pain

Differences in Pain

Perception Differences in

pain perception

and tolerance

thresholds:

Ethnicity,

Genetics, and

Sex

When do we recognize

pain People of

Mediterranean

origin report

some radiant

heat intensities

as painful

When do we recognize

painNorthern Europeans describe them

as warmth

Italian women tolerate less intense

electric shock than Jewish or Native

American women

When do we recognize

pain

Patients who experience painless

heart attacks have higher pain

thresholds for electric shock, muscle

cramp and heat 7

Women have lower pain perception

and tolerance thresholds than men

Sex differences appears to apply to

all ages, including newborn infants

CAM: Complementary and Alternative Medicine

Types of CAM

Acupuncture

Alexander technique

Aromatherapy

Biofeedback

Craniosacral therapy

Massage

Types of CAM

Mediation

Spiritual healing

Yoga

Tai Chi

Reflexology

Music therapy

Yoga

Prevalence of CAM Use

Country Year Sample Prevalence

Australia 1993 3004 (Random) 48.5%

Germany 2002 1750 62.3%

United States 2001 31,044 62%

Israel 2000 2505 10%

Canada 1995 17,626 15%

8

Modalities of Complementary

Pain Treatment

Massage

Method of manipulating soft tissue of body areas

using pressure

and traction

Muscular tension

History

Introduced into US in 19th Century

Practiced by physicians until early

20th century

Revival in 1970’s

Complementary therapy

Germany: Conventional medicine

Scientific Rationale

Mechanical pressure and friction of

the hands exerted on cutaneous and

subcutaneous structures affect the

body

Circulation of blood and lymph is

enhanced

Increased arterial and venous

perfusion

Scientific Rationale

Direct mechanical pressure

Effects mediated by nervous system

Beneficially affects areas of increased muscular tension

Therapy Session

Medical HistoryTx session lasts

30-60 mins Patients are

usually treated unclothed with a sheet or towel as a cover

Does it Work?

Beneficial effects

in low back pain,

musculoskeletal

pain, and peri-

operative pain

Does it Work?

Relaxation

effects: beneficial

effects on the

well-being of

most pain

patients

Conditions Frequently

Treated

Back pain

Musculoskeletal conditions

Constipation

Depression

Anxiety

Stress

Yoga Therapy

Mind-body

intervention

Includes gentle

stretching,

exercises for

breath control

and meditation

Prana Flow

Increases vital

energy (prana)

and facilitates its

flow

Scientific Rationale

Induces a deep

state of

relaxation

Bodily

suppleness and

muscular

strength

Scientific Rationale

Feeling of well-

being

Possible

reduction of

sympathetic

drive

Scientific Rationale

Breathing

exercises

counter the

rapid breathing

that

accompanies the

stress response

Scientific Rationale

Expand available

lung capacity

Reduces

muscular spasm

Conditions Frequently

Treated

Arthritis

Back pain

Headaches

Anxiety

Cardiovascular

problems

GI complaints

Conditions Frequently

Treated

Insomnia

Premenstrual

syndrome

Respiratory

problems

Stress

Pregnancy

Precautions

Overstretching

can lead to

physical injury,

especially when

stretching

diseased

ligaments and

joints

Course of Treatment

Best when it is

practiced daily

Should be

regarded as a

long term

treatment