Advances in medical technologies are compelling healthcare givers and policymakers to review existing paradigms, particularly areas such as pain management. Until recently, pain intervention strategies excluded the input of the patient in determining the effectiveness of pain management. Instead, past pain management paradigms relied on pharmacologic regimens that included opioids, non-steroidal anti-inflammatory drugs, acetaminophen and nerve blocks to manage persistent pain (Gupta, Scott, & Dukewich, 2018). A review of emerging trends in pain management, with a focus on caregiver and patient collaborations as well as the use of novel technologies, reveals current advances in pain management.
Portelli and Eldred (2018) highlight the need to adopt a bio-psychosocial approach to the management of pain (p. 135). A bio-psychosocial approach acknowledges that although pain is physical, it can also be subjective, with a patient’s perception of pain being crucial in determining the extent to which interventions are effective (Woodbury, Hannah & Mastrantonio, 2016). The unpleasant symptom theory espouses an expanded assessment of pain because it takes into consideration physiological, situational and psychological variables (Woodbury et al., 2016). By contextualizing pain in relation to the medically relevant life experiences of the patient prior to their admission, caregivers are able to determine the pain management strategies that can improve relief and patient safety outcomes.
History and statistics
Studies on pain management have reviewed facets such as the innovative post-surgical interventions, the use of virtual reality technologies in mitigating pain perception and smart phone applications in managing pain (Woodbury et al., 2016; Gupta et al., 2018; Portelli & Eldred, 2016). For example, Gupta et al. (2018) evaluated the use of virtual technologies (VR) in mitigating postoperative pain, particularly among burn injury patients (p. 152). VR provides an immersive experience for patients that can distract them from pain, an outcome with neurophysiologic implications (Gupta et al., 2018). The theory underpinning the use of VR in pain management is that the attention caregivers direct towards pain relief is limited and that the use of distraction is useful in reducing the resources necessary to mitigate pain (Gupta et al., 2018).
Portelli & Eldred’s (2016) review of 195 iPhone and android pain management applications found that most of the applications presented minimal theoretical content for enabling behavioral change and self-management (p. 138). Finally, Woodbury et al. (2016) looked at the collaboration of patients and their caregivers in determining the efficacy of the pain alleviation interventions and the implications of patient involvement in holistic pain management (n.p). Notably, lack of information among users on medical criteria to utilize in determining which pain management applications to use hinder the practicability of this potential intervention. To illustrate, the marketing of pain management applications involves the use of unprofessional advice that may worsen pain in lieu of alleviating it (Gupta et al., 2018).
Significance to health issues
Pain management is an important metric in tracking the rate at which patients recover. In particular, the comfort function rates pain vis-à-vis clinical interventions aimed at alleviating the same and the patient’s perception of pain (Woodbury et al., 2016). Applications aimed at pain management are presently unregulated, meaning that the efficacy the designers of the applications claim are user-rated driven (Portelli & Eldred, 2016). The implication is that apps, while potentially crucial in evolving novel pain management paradigms going forward, are presently not adhering to evidence-based guidelines (Portelli & Eldred, 2016).
Relatedly, studies have found the distraction mechanisms that VR technologies bring to pain management as being effective in both pediatric and adult patient populations (Gupta et al., 2018). The primary hindrances to the accelerated adoption of novel technology-based interventions in pain management is the dearth of research with respect to emerging interventions and policy redundancies (Gupta et al., 2018; (Portelli & Eldred, 2016).
Role of nurse
In a study by Woodbury et al. (2016), 85% of nursing staff expressed dissatisfaction with extant pain management interventions in their units (n.p.). Further, the disaffected nurses also mentioned they would not recommend the pain management interventions to other units in their facilities (Woodbury et al., 2016). The incorporation of the bio-psychosocial approach into clinical practices can be useful inducting nursing staff into the use of data-driven pain management paradigms (Portelli & Eldred, 2016). Collaboration between patients and caregivers is crucial to the development and implantation of pain evaluation criteria (Woodbury et al., 2016).
Relevance to nursing practice
Ineffectual pain management interventions, particularly in post-operative contexts, can result in inactivity with deleterious outcomes that include pulmonary embolism, pneumonia, ileus, among other developments (Woodbury et al., 2016). The post-discharge monitoring and management of pain has in the recent past been a challenge for caregivers given the limited contact they have with patients. Equally, discharged patients were until recently unable to report any changes on the status of their pain and other symptoms to their caregivers. However, the introduction of technology in pain management paradigms makes telemedicine accessible to caregivers to determine pain levels and recommend next steps (Portelli & Eldred, 2016). Similarly, telemedicine enables patients to update their caregivers on the status of their pain, among other symptoms, and receive directions on further actions.
In conclusion he increasing use of technology, particularly VR, in alleviating pain presents a more cost effective long-term approach in pain management for both patients and caregivers. The abuse of medication meant for relieving pain is a growing national problem that the introduction of technological paradigms in pain management can mitigate. In addition to VR, mobile device-based applications can bridge patients and caregivers, providing a cheap, reliable and long-term approach to pain management. Finally, the involvement of patients in the evaluation of the pain they experience in addition to the biofeedback from interventions significantly improves the efficacy of the approaches caregivers use.
Gupta, A., Scott, K., & Dukewich, M. (2018). Innovative technology using virtual reality in the treatment of pain: Does it reduce pain via distraction, or is there more to it? Pain Medicine, 19(1), 151-159. https://academic.oup.com/painmedicine/article/19/1/151/4100671
Portelli, P., & Eldred, C. (2016). A quality review of smartphone applications for the management of pain. British journal of pain, 10(3), 135-140. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994774/ Woodbury, M., Hannah, T., & Mastrantonio, N. (2016). Pain target: An innovative approach to pain management. American Nursing Today 11(12). https://www.americannursetoday.com/pain-target-innovative-approach-pain-management
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