2. Different types of Pain Relief Pharmacological versus Non-Pharmacological Brooke Platte Katherine Patterson Lori Rosendale Nichole Roback

3. Introduction The reason for the development of this power point presentation is to discuss the benefits of one pharmacologic and one non- pharmacologic intervention for treatment of pain for advanced disease. The pharmacologic intervention of Morphine and non- pharmacologic of Massage Therapy was chosen to be analyzed. Morphine via the oral form is the drug of choice in the management of and has been placed by the World Health Organization (WHO) on its Essential drug list (Ripamonti, 2008). A complementary therapy which includes massage therapy is increasing in popularity. The evidence towards efficacy is not strong but the treatment itself helps due to the personal attention given to the patient by the therapist (Wee, 2011).

4. Pain What is pain? – According to Webster’s Dictionary, pain is the physical feeling caused by disease, injury, or something that hurts the body; mental or emotional suffering; sadness caused by some emotional or mental problem; someone or something that causes trouble or makes you feel annoyed or angry (Merriam-Webster, 2015) – Pain is subjective, meaning that it is what the patient states it is.

5. Pain Continued Perception of pain is aggravated by anxiety or fear of impending death, and loss of spiritual direction or meaning. For proper pain control these areas also need to be addressed (Wee, 2011).

6. Morphine Morphine is an opioid pain medication It is used to relieve moderate to severe pain Morphine acts on the central nervous system to relieve pain (Mayo Clinic, 2014) Patient’s admitted to hospice/palliative care require intensive medication management and Morphine is commonly prescribed (Sera, McPherson, & Holmes, 2014)

7. Morphine: Descriptive summary of the most relevant and best evidence related to these treatments “ WHO has endorsed it as the gold standard of opioids and it’s considered the first-line for moderate to severe pain” (Kuebler, 2014) Listed as the 3 rd most frequently prescribed medication for hospice and palliative care patients (Sera, McPherson, & Holmes, 2014) Opioid analgesics are the top prescribed pharmacologic class in patients with cancer, dementia and lung disease (Sera, McPherson, & Holmes, 2014) “Appropriate use of opioids and traditional sedatives for amelioration of symptoms among cancer patients near the end of life have been shown to be both efficacious and safe” (Sim, Ho, & Kumar, 2014)

8. Morphine: Analysis Sufficient pain relief is achieved during almost 80% of the time Morphine is used (Schug, et al, 1992) It is one of the most prescribed medications for hospice and palliative care due to the success it has for relieving pain and keeping patients comfortable at the end of life Oral morphine resulted as an effective analgesic in pain for those patients suffering from end stage cancer (Ripamonti, 2008).

9. Morphine: Rational/Recommendations Morphine has been proven to be effective to alleviate pain and keep patients comfortable at the end of life It should be used to treat this pain Health care providers should help patients and families understand the relief they will be able to obtain with Morphine and help to ease any fears they may have over using the medication such as side effects and addiction The WHO expert committee introduced Morphine as a major pain relieving drug and has strongly asserted the necessity of making it available globally (Rimamonti, 2008). If patient is unable to take orally then subcutaneous is the alternative route.

10. Massage Therapy “Massage therapy is manual manipulation of soft body tissues (muscle, connective tissue, tendons and ligaments) to enhance a person’s health and well- being.” “People seek massage therapy for a variety of reasons – to reduce stress and anxiety, relax muscles, rehabilitate injuries, reduce pain, and promote overall health and wellness.” (Northwestern Health Sciences University, 2014)

11. Massage Therapy: Descriptive summary of the most relevant and best evidence related to these treatments “Massage therapy provided the client with some tangible benefits, one being she was able to stop taking OTC NSAID’s for pain. The patient’s cervical range of motion increased within pain free limits.” (American Massage Therapy Association, 2012). “Studies have reported that most of the cancer patient’s pain reduced with therapeutic massage. Seventy-three percent of cancer patients use massage therapy in the USA.” (Somani, Merchant, & Lalani, 2013) “Massage therapy has been successfully used in reducing pain in arthritis and in several other pain syndromes including migraine headaches, lower back pain, carpal tunnel syndrome and fibromyalgia.” (Field, Diego, Delgado, Garcia, & Funk, 2011)

12. Massage Therapy: Analysis Although there are many alternative therapies available to patients who are in pain, massage therapy seems to be the top choice. Massage therapy has been proven to help reduce pain, as well as help with the anxiety and stress that accompanies a medical diagnoses that involves pain.

13. Massage Therapy: Rational/ Recommendations There's only one amateur that should have your complete trust: yourself. As reported by the University of Washington, you can give yourself an effective massage. Just put a little oil or lotion on your hands and glide them over the sore spots. You'll be in the perfect position to know what helps and what hurts. The effectiveness of massage lies in a simple and direct strategy: working from the external, outer mechanisms of pain to the primary, root cause. Massage therapists utilize a holistic approach, focusing on the entire body system and its relationship to soft tissue. Their care isn’t focused only on the site of pain (American Massage Therapy Association, 2012).

14. Conclusion One method alone may not entirely relieve a persons pain. It has been shown that by using Morphine and Massage therapy together helps relieve a patients pain more effectively than by using just one intervention alone. When anxiety and fear are alleviated the effects of Morphine are more readily felt by the patient.

15. References American Massage Therapy Association. (2012) Pain in the neck. Massage Therapy Journal, 51(3). Retrieved from http://0go.galegroup.com.libcat.ferris.edu/ps/retrieve.do?sgHitCount Type=None&sort=DASORT&inPS=true&prodId=AONE&userGroupNam e=lom_ferrissu&tabID=T002&searchId=R2&resultListType=RESULT_LIST&cont entSegment=&searchType=BasicSearchForm&currentPosition=1&contentSet= GALE%7CA302299179&&docId=GALE|A302299179&docTyp e=GALE&role= http://0go.galegroup.com.libcat.ferris.edu/ps/retrieve.do?sgHitCount Field, T., Diego, M., Delgado, J., Garcia, D., & Funk, C. (2011) Hand pain is reduced by massage therapy. Complimentary Therapies in Clinical Practice, 17(4). Retrieved from http://0go.galegroup.com.libcat.ferris.edu/ps/retrieve.do?sgHitCountType=No ne&sort=DASORT&inPS=true&prodId=AONE&userGroupName=lom_ferrissu& tabIeD=T002&searchId=R5&resultListType=RESULT_LIST&contentSegment=& http://0go.galegroup.com.libcat.ferris.edu/ps/retrieve.do?sgHitCountType=No searchType=BasicSearchForm&currentPosition=1&contentSet=GALE%7CA269 041371&&docId=GALE|A269041371&docType=GALE&role=

16. References Continued Kuebler, K.M. (2014). Using morphine in end-of- life care. Nursing 2014. Doi: 10.1097/01.NURSE.0000444548.72595.ac Mayo Clinic (2014). Drugs & supplements: morphine (oral). Retrieved from: http://www.mayoclinic.org/drugs- supplements/morphine-oral route/description/drg_20074216 Merriam-Webster (2015). Definition of: Pain. Retrieved from www.merriam webster.com/dictionary/painwww.merriam webster.com/dictionary/pain

17. References Cont. Northwestern Health Sciences University. (2014). What is massage therapy? Northwestern Health Sciences University. Retrieved from http://www.nwhealth.edu/school-of-massage- therapy/massage-therapy-definition/ http://www.nwhealth.edu/school-of-massage- Ripamonti, C. & Bandieri, E. (2008). Pain therapy. Critical Reviews of Oncology/ Hematology, 70, 145-159 Schug, S.A., Zech, D, Grond, S, Jung, H, Meuser, T & Stobbe, B. (1992). A long-term survey of morphine in cancer pain patients. Journal of Pain and Symptom Management, 7(5), 259-266. Doi: 10.1016/0885- 3924(92)90059-Q

18. References Cont. Sera, L, McPherson, M.L. & Holmes, H.M. (2014). Commonly prescribed medications in a population of hospice patients. American Journal of Hospice & Palliative Medicine, 31(2), 126- 131. Doi: 10.1177/1049909113476132 Sim, S.W., Ho, S, Krishna, R, & Kumar, R.K. (2014). Use of opioids and sedatives at end-of-life. Indian Journal of Palliative Care, 20(2), 160-165. Doi: 10.4103/0973- 1075.132654 University of Washington Department of Orthopaedics and Sports Medicine. Managing arthritis pain: Other pain management techniques. January 2005 http://www.orthop.washington.edu/uw/livingwith/tab ID__3376/ItemID__96/PageID__136/Articles/Default.aspx http://www.orthop.washington.edu/uw/livingwith/tab ID__3376/ItemID__96/Pa Wee, B. & Hillier, R. (2011). Pain control. Journal of Medicine, 39:11, 639-644