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Vocabulary

art therapy
biofeedback
comfort positioning
distract
fMRI
guided imagery
hydrotherapy
labor pains
memory skills
music therapy
pain relief
panacea  
transcutaneous electrical nerve stimulation (TENS)  
virtual reality (VR)

Activity 1: Match the English term with the correct French term.

Activity 2: Complete the definitions using the terms from the vocabulary list.

1. ___________________________:  placing a child in an upright position on a caregiver’s                                lap whilst hugging the child has been shown to reduce discomfort and anxiety during procedures such as vaccination.
2. ___________________________: type of relaxation technique that uses the visualisation of peaceful environments to reduce feelings of stress or discomfort
3. ___________________________:  use of a mild electric current to reduce pain signals going to the brain and spinal cord
4. ___________________________:  also called a cure-all, something which cures all illnesses
5. ___________________________: strong, painful contractions of the uterus which occur during birth
6. ___________________________:  computer-generated simulation of an environment that a person can interact with using a special electronic headset
7. ___________________________:  technique used to receive information about body functions so that small changes can be made, e.g., muscle relaxion, to reduce pain
8. ___________________________: use of water to reduce muscle strain or joint pain
9. ___________________________: use of pleasant sounds to help patients reduce the amount of pain they perceive.
10. __________________________: active involvement in painting or drawing to not only distract from painful stimuli but also as a way of teaching relaxation techniques and mood alteration.
11. __________________________: the stroking of a trained therapy animal is thought to reduce stress hormones (e.g., epinephrine and cortisol) as well as increasing levels of  endorphins, the body’s natural pain relief.
12. __________________________:  drugs which work with nerve endings in the nervous system to prevent pain signals getting to the brain.
13. __________________________: measures the metabolic function of the brain when it is activated by different types of sensation (sight, sound, touch, taste, smell) or during an activity, e.g., problem solving or physical movement.
14. __________________________: helping patients to engage in an activity that takes them away from thoughts of a painful stimulus, e.g., an injection.

Activity 3: Read the text about music therapy and answer the questions that follow.

“Where’s the Music?” Using Music Therapy for Pain Management

Jacqueline Redding, MSN, RN-BC, Sharon Plaugher, RN, Joanne Cole, RN, June Crum, RN, Crystal Ambrosino, RN, Judith Hodge, RN, Lori Ladd, RN, Cynthia Garvan, PhD, and Linda Cowan, PhD, ARNP, FNP-BC

Abstract

Staff at the Malcolm Randall VAMC (MRVAMC) outpatient pain clinic in Gainesville, Florida, found that procedures to reduce a patient’s pain could initially cause pain and anxiety. Typical nursing care plans involved measures to reduce anxiety in patients undergoing interventional procedures expected to produce pain, including identifying and reinforcing coping strategies, providing reassurance and comfort, and giving patients clear explanations slowly and calmly. The MRVAMC nursing staff therefore also advocated to add music therapy to the existing plan.

BACKGROUND

As part of a quality improvement (QI) project, the authors conducted a literature search to find scientific evidence for the use of music therapy. Multiple medical databases were analyzed to find studies that included total time, dose of sedative medications, pain scores, patient experience, and willingness to repeat the same procedure in the future with use of music vs no music. The literature review revealed that music therapy demonstrated effectiveness in decreasing anxiety and pain, supporting relaxation, reducing sedation medication during procedures, and improving patient satisfaction.

As a result of the literature search the authors conducted a prospective, randomized controlled study to investigate music therapy as an adjunct intervention during painful procedures.

RESULTS

Of the 60 consenting patients, 44 participated in the study. Twenty-three were randomized to the music intervention and 21 to the no music control group. Both pain and anxiety were significantly reduced (P

DISCUSSION

Although there was not a statistically significant difference in pain or anxiety reduction due to group assignment, a 2-point reduction in self-reported pain or anxiety may be considered clinically important and has been supported in older studies. Importantly, 87% of participants in the music intervention group reported that listening to music was helpful during the procedure

1. What comment did staff at the Staff at the outpatient pain clinic in Florida make about pain relieving procedures?
2. What four measures do nurses recommend to reduce patient anxiety before pain relieving procedures?
3. What sorts of things did studies around the effectiveness of music therapy look at?
4. In which areas was music therapy found to be effective in?
5. Was music therapy viewed as a therapy in place of drug therapy?
6. What was the result of the study of using music versus no music
7. How did the participants in the music intervention group of the study feel about music therapy?

Activity 4: Watch the video about the use of virtual reality in pain management. Answer the questions about the video by completing the nurse’s words in the dialogue. Use the words below to help you.

1. What is VR (virtual reality)?

Virtual reality is a type of technology that provides a computer-generated ___________ of a three-dimensional image. It is like a ____________________.

2. How can VR help with pain management?

Patients who are in pain can be shown peaceful scenes which help ___________ them from unpleasant or ______________________ situations.
Distracting patients from painful situations can reduce the amount of strong ____________ they take.
Reducing a patient’s opiate intake can _________________ the side effects caused by them, e.g. constipation.

3. What else can VR be used for?

   VR is also used to teach ________________ and breathing techniques which can help to manage   
    pain as well.

4. Why do some patients say they don’t like wearing VR goggles?

   Some patients complained that the older goggles were a little __________ and didn’t fit well. The newer goggles are more comfortable because they fit ____________.
  Some patients also said that wearing goggles made them feel that they had lost _______
  of their environment.

5. Which conditions exclude the use of VR goggles?

VR goggles cannot be used by patients who have __________ or motion sickness, who have had a __________ (cerebrovascular event) or who have seizures. Patients in ___________ for infection control are also not able to use VR.

6. What is an important consideration when setting up a VR program for a pain?

It is important to find out what type of ________________ the patient enjoys to ensure the program provides a relaxing experience.

Extension activity;

Using the information in this short talk, make a poster or patient information leaflet about the use of cold and warmth in pain relief.

Heat and Cold packs

One of the simplest forms of non-pharma pain relief is the use of cold or warmth to a local area where pain is experienced. These days, there are many different kinds of cold packs and heat packs which can be carried in a First Aid kit and used as a first line relief of pain or as ongoing relief of chronic pain.
Firstly, let’s look at cold packs and their uses. Cold packs help to reduce pain by constricting blood vessels, slowing down the inflammatory process and reducing swelling and redness. Cold therapy is most effective if used during the first 48 hours following an injury
There are several different types of cold packs that are used for applying cold therapy.

Instant cold packs:

Instant cold packs contain two internal bags. One bag contains water and the other holds a chemical such as calcium ammonium nitrate. As the bag is shaken or hit, the water and chemical mixes leading to an endothermic reaction. This results in a cold pack which stays cold for about 15-20 minutes. The packs should not be applied directly to the skin to avoid ice burns. Instant cold packs are very useful as First Aid for the treatment of sprains, bruises or insect bites if ice is not readily available. The packs do not need to be refrigerated and are lightweight and portable. The disadvantages of instant cold packs are that they are single-use only and only stay cold for a short period compared with other methods. They can’t be used at a heat pack.

Clay packs:

are made of ceramic clay and non-toxic oils and mould into the shape of an injured body part. Clay packs stay hot or cold longer than gel packs and never freeze solid. The disadvantage of clay packs is that they take longer to freeze or heat. Also, if placed in direct sunlight or overheated, the pack may dry out. Like other cold and heat packs, clay packs should not be placed directly on the skin. A cloth covering should be used to protect the skin. Clay packs should only be used on the affected area for about 15-20 minutes.

Gel packs:

are made of non-toxic types of gel, e.g. hydroxyethyl cellulose, polymer, sodium polyacrylate or vinyl-coated silica gel. Ice packs are placed in a freezer for at least 2 hours. They should always be kept flat so they can be moulded to injured body parts easily. Gel packs should not be applied for more than 15 to 20 minutes to avoid damage to the skin. Repeat applications are possible after allowing the skin to return to its normal temperature.
Gel packs are mostly intended for acute pain and fresh injuries. such as ligament sprains, muscle strains and bruises. Gel packs should never be used if a person has a sensory deficit such as reduced sensitivity caused by diabetes. Gel packs should also not be used on stiff muscles or stiff joints or if a person has poor circulation

Heat Therapy

Warmth is also useful in relieving pain. Heat packs are used to ease joint stiffness and improve joint flexibility. Blood flow to damaged tissues promotes the healing of damaged tissues and helps to relax tired muscles.
There are two types of heat therapy: dry and moist heat.
* Dry heat, also called conducted heat therapy includes heating pads, dry heating packs and some saunas.
* Moist heat, also called convection heat includes steamed towels, hot water bottles, moist heating packs or hot baths.
Heat therapy can be applied locally onto small areas of pain, e.g., a stiff muscle. Larger areas can be treated with steamed towels or large heat packs, e.g., across both shoulders.
Heat therapy should not be used if the area to be treated is bruised or swollen or in an area with an open wound. In addition, heat therapy is contraindicated with people with certain pre-existing conditions; these include diabetes, vascular diseases, DVT and multiple sclerosis.
People with heart disease or hypertension should seek medical advice before using heat therapy. Saunas and hot tubs are not recommended during pregnancy.

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Virginia ALLUM Author and Consultant in English for Medical Purposes