Non Pharmacological Management of Pain

It is important to remember that pain is exacerbated by anxiety, distress and depression, so a holistic approach is important.  In anxiety, excitatory serotonergic descending pathways from the brain to the spinal cord will increase the sensitivity of the pain system.  

Conversely, inhibitory adrenergic descending pathways can be engaged with relaxation, distraction and reassurance, thus decreasing the experience of pain.

Other non-pharmacological methods of pain management include splinting fractures, dressing wounds, changing mattresses or chairs for more comfort, elevation of the limb, physiotherapy to address muscle spasm, heat or ice packs.

If a patient is in severe pain, you must exclude complications such as compartment syndrome, ischaemia, bowel perforation, cardiac event. 

If pain and distress experienced appear greater than that expected, and acute pathology has been ruled out, it is important to ask the patient what they think is the cause of their pain. Occasionally patients may have firm but mistaken ideas about their pain which in itself increases anxiety and distress, leading to increased pain.  This may include an assumption that pain indicates a recurrence of cancer, a complication of surgery or a diagnosis that is being hidden from them.  Similarly, patients may be reluctant to mobilise for fear of precipitating a complication - the stitches will fail, the anastomosis will break down, the fracture will recur – such that any increased pain simply reinforces this perception.  As well as ensuring that adequate analgesia is available, these patients benefit from clear, careful explanations and reassurance.