1. Non-pharmacological treatment Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account for individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician, or health care provider, to determine the best course of treatment for the patient. Treat the Pain and its partners assume no responsibility for any injury or damage to persons or property arising out of or related to any use of these materials, or for any errors or omissions. Last updated on January 12, 2015

2. Objectives Discuss various forms of non-pharmacological methods for addressing pain Review how and when the various methods can complement pharmacological options 2

3. Non-pharmacological treatment Pain is influenced by psychological, cultural, social, and spiritual factors which should also be addressed Non-pharmacological treatments do not replace pharmacological treatment, but they may be complementary – Reduce symptoms – Affect pain perception – Assist with relaxation – Improve sleep Beating Pain, 2 nd Ed. APCA (2012)3 TOTAL PAIN PHYSICAL PSYCHOLOGICALEMOTIONAL SPIRITUAL

4. Non-pharmacological treatment Symptoms may be reduced with use of: Surgery: Can address the source of pain Radiotherapy: Treat local pain due to tumor infiltration Beating Pain, 2 nd Ed. APCA (2012)4

5. Non-pharmacological treatment Other non-pharmacological treatments may reduce the perception of pain, assist in relaxation, or improve sleep Dance therapy: Uses movement to improve mental and physical well-being Music therapy: Listening to or making music may lower stress and improve mood Acupuncture: Insertion and manipulation of needles, pressure, or low-frequency electric current at specific points Beating Pain, 2 nd Ed. APCA (2012)5

6. Non-pharmacological treatment Physical therapy: Movement helps to build strength, maintain energy, and contributes to overall well-being Positioning therapy: Moving bedridden patients and changing their position prevents bed sores and injury Massage therapy: Rubbing and manipulating muscles, which increases circulation and relaxation Beating Pain, 2 nd Ed. APCA (2012)6

7. Non-pharmacological treatment Social support: Supportive counseling and referrals to community resources and services can assist patients with finding needed emotional support Spiritual and religious support: Depending on their beliefs and faith, some patients may find support through prayer and meditation Herbs: May be helpful or harmful Hot and cold therapy: Either one may help to decrease pain Beating Pain, 2 nd Ed. APCA (2012)7

8. Non-pharmacological treatment Relaxation: Most commonly used non-pharmacological technique-teach patients to intentionally relax to reduce tension and stress Deep and slow breathing: Influences autonomic and pain processing in combination with relaxation Distraction: Focus the patient’s attention away from the pain Reflexology: Use pressure points in the hand and feet that correspond to other parts of the body Aromatherapy: Use essential oils to balance, relax, and stimulate the body, mind, and soul Beating Pain, 2 nd Ed. APCA (2012)8

9. Remember Not all of these approaches will work for everyone Non-pharmacological treatments complement pharmacological treatment-they should not be used as a substitute for pharmacological treatment Do not assume that all non-pharmacological treatments are safe. – Some have contraindications – Just because natural remedies, such as herbs, have been around for a long time does not mean that they work or that they are harmless Beating Pain, 2 nd Ed. APCA (2012)9

10. Take home messages Non-pharmacological methods may help in pain management Non-pharmacological methods may have contraindications Non-pharmacological methods should complement, not replace, pharmacological treatments 10

11. References African Palliative Care Association. Beating Pain: a pocketguide for pain management in Africa, 2nd Ed. [Internet]. 2012. Available from: http://www.africanpalliativecare.org/images/stories/pdf/beating_pain.pdf African Palliative Care Association. Using opioids to manage pain: a pocket guide for health professionals in Africa [Internet]. 2010. Available from: http://www.africanpalliativecare.org/images/stories/pdf/using_opiods.pdf Amery J, editor. Children’s Palliative Care in Africa [Internet]. 2009. Available from: http://www.icpcn.org/wp-content/uploads/2013/08/Childrens-Palliative-Care-in- Africa-Full-Text.pdf Kopf A, Patel N, editors. Guide to Pain Management in Low-Resource Settings [Internet]. 2010. Available from: http://www.iasp- pain.org/files/Content/ContentFolders/Publications2/FreeBooks/Guide_to_Pain_ Management_in_Low-Resource_Settings.pdf The Palliative Care Association of Uganda and the Uganda Ministry of Health. Introductory Palliative Care Course for Healthcare Professionals. 2013. 11