The Nurse’s Role in Integrative Pain Management

This week I was invited to present a live web conference on “Holistic and Integrative Modalities for Pain Management” for the Visiting Nurse Association of America (VNAA), a national association that represents hospice and home care nurses.  To be invited to speak on this topic clearly indicates the interest in these practices for patients who are in pain in all settings and the need to address this critical issue in health care.

The Institute of Medicine (IOM) delivered its national strategic document on the massive issue of pain on June 29, 2011, “Relieving Pain in America: A Blueprint for Transforming, Prevention, Care, Education and Research”.

Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the IOM in examining pain as a public health problem, as pain is the most common reason for physician consultation in the United States.

In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America.

What about all of the nurses who are already using holistic and integrative nursing modalities as part of patient care and for pain management? Nursing already has a model of care that needs to be understood and included when health policy analysts seek solutions on how to implement supportive, non-invasive, cost effective practices for pain management.

It is well documented that in hospitals and diverse health care settings, nurses are increasingly integrating a variety of healing modalities into patient care for anxiety, stress, to lower pain perception and for pain management. These include energy-based practices such as Therapeutic Touch, Massage, Reiki, and Healing Touch. Nurses increasingly study and integrate mind/body techniques including relaxation exercises, guided imagery and mindfulness practices- often for their own self-care to relieve the stresses that they experience professionally and personally, which then translates into higher quality care for their patients.

There is a growing body of research on these nursing interventions to decrease pain, lower inflammatory processes, induce the relaxation response, and support the healing process (See References below).

Why aren’t nurses taught these skills and tools in their nursing education, and supported to integrate these non-invasive healing strategies as part of nursing care?

While the demand by consumers continues to grow, how will these nursing modalities be included in clinical or policy strategies?

As nurses, how can each of us increase our visibility and seek opportunities to demonstrate our work as we continue to study and develop new skills, participate in research, and impact healthcare policy?

What modalities do you practice for your own self-care and to offer to your patients?

References:

1. Apostle-Mitchell M. & MacDonald G. (1997).  An innovative approach to pain management in critical care: therapeutic touch.  Off J Can Assoc Crit Care Nurs. Fall;8(3):19-22.
2. Cutshall S.M., Wentworth L.J., Engen D., Sundt T.M., & Kelly R.F. (2010).  Effect of massage therapy on pain, anxiety, and tension in cardiac surgical patients: a pilot study.  Complement Ther Clin Pract. May;16(2):92-5.
3. Garland E.L., Gaylord S.A., Palsson O., Faurot K., Douglass Mann J, & Whitehead W. (2011). Therapeutic mechanisms of a mindfulness-based treatment for IBS:  effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. J Behav Med, Dec 8.
4. Fadel Zeidan, Ph.D. (2012).  Meditation Can Provide Greater Pain Relief Than Powerful Medication.  Journal of Neuroscience, April 9, 2012. 
5. Umbreit A.W. (2000).  Healing Touch:  Applications in the acute care setting.  AACN Clinical Issues. Feb; 11(1): 105-19.
6. Zeidan F., Martucci K.T., Kraft R.A., Gordon N.S., McHaffie J.G., & Coghill R.C.  (2011).  Brain mechanisms supporting the modulation of pain by mindfulness meditation.  J Neurosci. Apr 6;31(14):5540-8.