Non-Pharmacologic Management and Strategies for Adults Patients with Chronic Pain
Pedro Michael Casas, RN, BSN-BC
Universidad Ana G. Méndez
NUR502- Nursing Science and the Research Process
January,2022
Master of Nursing Practice degree.
Non-Pharmacologic Management and Strategies for Adults Patients with Chronic Pain
Pain is defined as “an unpleasant sensory and emotional experience associated withactual or potential tissue damage or described in terms of such damage” when there is nophysical imbalance (Menskey cited from Finnerup, 2019). Pain is feature is to shield the framevia way of means of alerting it to dangerous occasions and to sell recuperation via way of meansof inducing sensitivity to motion or different stimuli which can put off recovery. However, acheisn’t constantly related to tissue harm and does now no longer constantly have a shieldingfeature. This is the case with neuropathic ache resulting from damage or ailment of thesomatosensory components of the worried device and different continual ache which includefibromyalgia and migraine (Treede et al., 2019). Acute and continual ache can purpose miseryand disrupt everyday life. Factors influencing the selection of treatment.
Pharmacological and interventional treatments for chronic pain often provide little or nopain relief and are often perceived as inadequate by the patient (Chou et al., 2017). The choice ofpain treatment depends on many factors and heterogeneity, and a large number of acute andchronic pain conditions prevent a general treatment algorithm. (Berman et al., 2010).
The purpose of this Literature Review is to identify the non-pharmacologic management and strategies for adults patients with chronic pain.
Significance of the Practice Problem
Chronic pain (CP) is defined as pain lasting for three months or more; and may be experienced in relation to a specific body site, such as low back pain, or be present in multiple sites of the body. A recent study reported that approximately 43% of UK adults live with CP; and between 11% and 17% report widespread pain (McQueenie et al., 2021).
CP has been connected to many bodily and intellectual situations and contributes to excessive healthcare prices and misplaced productivity. In the United States, a restricted range of research estimate that the superiority of persistent ache stages from 11% to 40% (IPRCC, 2016). 2016, approximately 20.4% of U.S. adults suffered from persistent aches, and 8.0% of US adults suffered from excessive-effect persistent ache. Both had been greater, not unusual place amongst adults dwelling in poverty, adults who had now no longer finished excessive school, and adults with public fitness insurance.
The 2016 National Pain Strategy is known as for greater particular estimates of thesuperiority of CP and excessive-effect persistent ache (HICP), that’s described as persistent achethat regularly limits lifestyles sports or to reliably set up the superiority of persistent ache andresource withinside the improvement and implementation of population-huge ache interventions(McQueenie et al., 2021). National estimates of high-impact chronic pain can help differentpeople with limitations in major life domains, including work, social, recreational, and self-careactivities, from those who maintain normal activities despite CP, providing a betterunderstanding of the population in need of pain treatment services.
Non-drug therapies have become an essential part of the management of CP. Althoughthey can be used as stand-alone therapies, non-drug treatments are often used to augment andsupplement drug treatments. Non-pharmacologic approaches can be classified as behavioral,cognitive, complementary, and physical therapies.
Research Question
What are the non-pharmacologic management and strategies for adults patients with chronic pain?
Objectives:
1-Identify the non-pharmacologic management and strategies for adults patients with chronic pain.
2- Describe the advantages of non-pharmacologic treatments in chronic pain.
3- Analyze the barriers to extent the use of non-pharmacologic therapies in the management of chronic pain.
TheoreticalFramework
The Theory of Unpleasant Symptoms provides 3 most important components: the manifestations that the affected person is encountering; the variables that affect them, each of their tendency and of their advancement; and the results of that revel in. Experienced facet results are the focus of the model, taken into consideration as markers of development withinside the health reputation of the person, which frequently appear on several activities and correspondingly, and notwithstanding the truth that they may be specific with regards to each other, gift 4 ordinary measurements: power, time, enduring and quality (Lenz, 1997).
The Theory focuses to a few effective instructions of those measurements which can be the physiological, mental, and situational elements that discover with each other beyond their man or woman institutions with the facet results. The closing section of the Theory is the presentation or end result that mirrors the sensible and mental reactions given the revel in of the indications. At that factor TOUS stresses the intricacy of manifestations, at the same time as likewise suggesting potential preventive and board systems (Lenz, 1997).
As in line with the speculation, the 3 associated classifications of impacting elements affect the occasion of as a minimum one facet results and the way they may be capable. The symptom(s), thus, impacts the person’s presentation, which could grievance to affect the indication revel in and the affecting variables. The speculation does exclude unequivocal mediations. All matters taken into consideration, it’s miles popular that a big quantity of the segments and connections withinside the TOUS will be centered for mediation (Gomez et al., 2019).
Synthesis of Literature
The recent article of Niederstrasser and Attridge published in 2022 in the journal PloSOne was named “Associations between pain and physical activity among older adults”. Theobjective of this study was to examine whether physical activity, adjusted for gender, age, wealthlevel and overweight or obesity, predicts the risk of persistent musculoskeletal pain. Transverseor longitudinal over the course of ten years.
Participants self-reported their level of physical activity and whether they were often bothered by bone, joint or muscle pain. Logistic regression analysis was used to reveal the nature of the relationship between musculoskeletal pain and physical activity in cross-sectional and longitudinal sections over 10 years. The data comes from the English Longitudinal Study of Aging, which includes 5,802 people residing in England aged 50 and over. The sample was drawn from nine waves of basic population data records, collected between 2002/2003 and 2020/2021, with two-year intervals between waves. The sample volume was 5802 individuals (Niederstrasser et al., 2022).
Therefore, only high levels of physical activity were associated with a reduced risk of experiencing musculoskeletal pain compared with a longitudinally sedentary lifestyle. Having little wealth, being a woman, being overweight or obese were all risk factors for suffering from musculoskeletal pain. These researchers concluded that the development of interventions aimed at alleviating and preventing musculoskeletal pain disorders could benefit from the incorporation of physical activity programs, weight loss and aspects that address the wealth inequality to maximize their effectiveness. (Niederstrasser et al., 2022).
Edmond et al., in their article “Use of Non-Pharmacological Pain Treatment Modalities Among Veterans with Chronic Pain: Results from a Cross-Sectional Survey”, published in the Journal of General Internal Medicine aimed to examine the rates and correlations of the use of non-drug pain treatment modalities (NMP) modalities in a sample of veterans who served in recent conflicts. Despite strong evidence for the effectiveness of NMPs, little is known about the prevalence or correlates of NMP use.
This was a descriptive exploratory study. The researchers examined demographic and clinical rates and correlations of self-reported use of NMPs that were operationalized as psychological/behavioral therapies, exercise/movement therapies, and manual therapies to calculate descriptive statistics and examined the bivariate associations and multivariate associations using logistic regression. Participants were 460 Veterans who approved of pain lasting ≥3 months who completed the Female Veteran Cohort Study baseline survey, who were encouraged to complete a survey with the required information and completed the tool (Edmond et al., 2018).
This was a descriptive exploratory study. The researchers examined demographic and clinical rates and correlations of self-reported use of NMPs that were operationalized as psychological/behavioral therapies, exercise/movement therapies, and manual therapies to calculate descriptive statistics and examined the bivariate associations and multivariate associations using logistic regression. Participants were 460 Veterans who approved of pain lasting ≥3 months who completed the Female Veteran Cohort Study baseline survey, who were encouraged to complete a survey with the required information and completed the tool (Edmond et al., 2018).
These consequences diagnosed demographic and scientific traits amongst exceptional MNPs, which might also additionally suggest variations in veterans’ remedy possibilities or company referral patterns. Further study of provider referral patterns and treatment preferences of veterans is needed to inform interventions to increase MNP use (Edmond et al., 2018).
Kuligowski and colleagues in their paper of 2021 entitled “Manual Therapy in Cervical and Lumbar Radiculopathy: A Systematic Review of the Literature”, published in the International Journal of Environmental Research and Public Health aimed to 1) describe and update current knowledge on the accuracy of manual therapy in the treatment of cervical and lumbar radiculopathy, 2) identify the limitations of current studies and suggest areas for future research.
The researchers used the PubMed and Web of Science databases up to April 2020 and applied inclusion criteria to select articles. Only publications defined as a randomized controlled study were included. The final selection of articles yielded 27 articles including 21 on cervical (CR) and 6 on lumbar radiculopathy (LR). Included studies should be assessed for methodological quality for risk of bias using the Physiotherapy Evidence Database (PEDro) scale. This scale consists of a checklist of 11 yes- or no-scored questions that provide a methodological quality score. A score of 9-10 is considered excellent, 6-8 is good, 4-5 is average, and 3 or less represents poor quality (Kuligowski et al., 2021).
The PEDro rating for CR turned into 6.6 (SD 1.3) and for LR 6.7 (SD 1.6). Traction-primarily based totally strategies are the maximum often selected shape of remedy for CR and are powerful in lowering aches and enhancing practical outcomes. the covered guides used a one-of-a-kind shape of guide therapy, making it hard to synthesize know-how in this group. Of the covered guides, 93% had been of medium or low first-class, indicating that first-class development is wanted for this sort of research (Kuligowski et al., 2021).
In conclusion, the researchers stated that traction-based techniques were the most frequently chosen form of treatment for CR and were also effective in reducing pain and improving functional outcomes. Mobilization techniques often lack information on predeparture patient examination, making it difficult to assess their effectiveness. The exercise programs themselves are effective and improve patient outcomes, but there is no standardization of specific activities for the specific pathology algorithm. Due to a background of radiculopathy and possible symptoms, decision making, including neurodynamic testing, should be mandatory for all CR and LR subjects. According to the available literature, the multimodal approach with traction component is the more effective for CR and the multimodal approach with traction component, spinal mobilization and core muscle activation for LR No single method therapy is recommended for treatment of both CR and LR (Kuligowski et al., 2021).
Ketenci and Zure published the paper “Pharmacological and non-pharmacological treatment approaches to chronic lumbar back pain” that appeared in Turkish Journal of Physical Medicine and Rehabilitation. This was a narrative review wherein the researchers did now no longer claim the strategies and databases used. The reason of the evaluation changed into to research the modern-day pharmacological and non-pharmacological remedy processes in persistent pain. A specific pathology causing low back pain can be rarely identified; therefore, most of back pain is referred to as non-specific low back pain. In case of persistence for more than 12 weeks, it is referred to as chronic low back pain (CLBP). Low back pain is a condition that disrupts functionality, social participation, mental and financial well-being and needs to be examined in biophysical, psychological, and social dimensions. Although a few hints incorporate pointers for extra unique situations including spinal stenosis and lumbar disc herniation, because of the common coexistence of those conditions and the problems in specifying the purpose of low again pain, the maximum not common technique and maximum suitable to CLBP is to evaluate the affected person in well-known in place of defining the primary affecting factor (Ketenci and Zure, 2021).
Currently, the many treatment options in the treatment of CLBP have not been proven to be superior to one another. The choice between these options should be based on physician and patient preference, while these treatment options are generally encouraged to be used in combination. There is a consensus on that the continuation of the activity and active participation of the patient in the treatment constitute the first steps of all current treatment recommendations. Currently the most up-to-date diagnosis, evaluation, and treatment guide is the 2020 guide created by the North American Spine Society (NASS) with the collaboration of researchers from different branches working in this field. Nowadays bed rest in the early stage has been abandoned in the treatment of both CLBP and acute low back pain (Ketenci and Zure, 2021).
Patients should be reassured that back pain is a controllable condition and symptoms would subside over time, encouraged to stay active and continue daily activities, including work. Patient education must ensure the patients’ understanding of the natural course of symptoms and their own responsibility in pain management as mandatory part of all treatments. As psychologic support it is recommended treatment packages such as cognitive behavioral therapy (CBT), progressive relaxation, and mindfulness-based stress reduction. These recommendations should be evaluated for individuals who do not respond to these treatments and have persistent low back or radicular pain (Ketenci and Zure, 2021).
Kostadinović et al (2020) published their work entitled “Efficacy of the lumbar stabilization and thoracic mobilization exercise program on pain intensity and functional disability reduction in chronic low back pain patients with lumbar radiculopathy: A randomized controlled trial” This study was published in the Journal of Back Musculoskeletal Rehabilitation
These researchers completed a RCT aimed to examine the lumbar stabilization workout application in a closed and open kinetic chain (LSCO) and lumbar stabilization physical activities and thoracic mobilization application in a closed kinetic chain (LSTMC), and evaluated the medical effectiveness of every application, as argument that even if workout applications withinside the remedy of continual lumbar ache are pretty diverse, it’s been validated that stabilization physical activities are the best.
This was a prospective, randomized, managed trial that protected eighty continual low returned ache (CLBP) sufferers with lumbar radiculopathy. The distribution via way of means of sexes become 35 male and 45 female. The mean age become 48.45 ± 10.22 years. The sufferers have been divided in groups that completed exceptional units of physical activities. As the treatment options obtained there have been laser therapy, transcutaneous electro-nerve stimulation, and an 8-week kinesiotherapy; the remaining protected physical activities to reinforce the deep lumbar backbone stabilizers. After 4 and 8 weeks all of the final results variables have been retested (Kostadinović et al.,2020).
The consequences exhibited statistically significant (p< 0.05) advanced healing of the LSTMC institution topics as compared to the LSCO institution in all size durations for each the ache depth and practical incapacity parameters. These researchers concluded that sufferers who completed the lumbar stabilization and thoracic mobilization workout application in a closed kinetic chain had the best discount of ache depth and practical incapacity (Kostadinović et al.,2020).
Plaza-Manzano et al, also conducted a RCT and published his paper under the title “Effects of Adding a Neurodynamic Mobilization to Motor Control Training in Patients with Lumbar Radiculopathy Due to Disc Herniation: A Randomized Clinical Trial”, this work was published in 2020 in the American Journal of Physical and Medical Rehabilitation.
The reason of this study was to analyze the outcomes of such as neural mobilization in a motor manipulate exercising software on ache, related disability, neuropathic symptoms, proper leg lift, and threshold. stress ache in lumbar radiculopathy. This was a randomized clinical trial that included 32 people with low back pain, with confirmed herniated disc and lumbar radiculopathy. Patients had been randomly assigned to obtain 8 periods of neurodynamic mobilization plus motor manage sports (group 1; n=16) or motor manage sports only (group 2; n=16). Outcome variables had been ache, disability, neuropathic symptoms, proper leg lift, and stress ache threshold at baseline, after 4 visits, after 8 visits, and after 2 months (PlazaManzano et al., 2020).
As results, the investigator found that there was no difference between the groups forpain, related disability, or pressure pain threshold in any follow-up period, as both groupsachieved similar and significant improvements, although patients assigned to the neurodynamicprogram group had better improvements. in neuropathic symptoms and right leg elevation thanthe motor control exercise group, and this difference was statistically significant.
The researchers concluded that the inclusion of neurodynamic mobilization in a motor manage workout application ended in discounts in neuropathic signs and symptoms and mechanical sensitivity, verifiable withinside the directly leg lift, however did now no longer bring about adjustments more significance of ache, related incapacity or strain ache threshold in comparison to motor skills. control exercise program alone in people with lumbar radiculopathy. They recommended that future studies are needed to further confirm these findings, as the differences between the groups did not reach clinical relevance (Plaza-Manzano et al., 2020).
Tse and colleagues conducted an interventional study and published it under the title “Effectiveness of a Peer-Led Pain Management Program in Relieving Chronic Pain and Enhancing Pain Self-Efficacy Among Older Adults: A Clustered Randomized Controlled Trial” The article was published in Frontiers in Medicine in 2021.
It was a clustered CRT wherein participated 262 patients. Of them, 146 had been randomized and allotted as experimental group and 116 as control group institutions. The predominant preliminary ache rating accounted 6.36 on a 10-factor Likert Scale, taken into consideration high, hence the individuals had terrible coping as indicated through the low ache self-efficacy. Accordingly, depression and a low great of lifestyles rating changed into found. After finishing touch of the intervention there has been a great improvement in ache self-efficacy, ache interference in addition to great of lifestyles for the individuals withinside the experimental institution, however now no longer withinside the control group. The sustained development withinside the experimental institution as a minimum ultimate in 3-month observe up (Tse et al., 2021).
The study proved to be powerful in coping with ache and ache-associated conditions for nursing domestic citizens with persistent ache. The peer volunteers worried withinside the ache control software taught applicable ache understanding and ache control techniques to assist the individuals. No suggestions had been domed by those researchers (Tse et al., 2021).
Adnan in the paper published in 2022 entitled “Effectiveness of bent leg raise technique and neurodynamic in patients with radiating low back pain”, pursued the objective to compare the effectiveness of bent leg raise technique and neurodynamic in patients with low back pain that radiates up to the knee. These researchers chose a pre-post design. Patients with radiating low lower back ache of each gender elderly 18-60 years have been covered withinside the look at and divided into comparative groups. Thirty- contributors elderly 38.81±9.94 four years, participated withinside the look at (Adnan et al., 2022).
Patients in group A received the bent-leg Mulligan technique while patients in group B received the neurodynamic approach. Both groups received five sessions per week for four weeks. To assess clinical outcomes, the Numerical Pain Rating Scale, Oswestry Disability Index, and Goniometer were used to assess pain, functional disability, and right leg lifting range. before and after interventions (Adnan et al., 2022).
There were no significant differences between the two groups at baseline, so group comparability was assured. After treatment, within group A showed only the three variables. that is, pain, functional disability, and range of right leg lift improved significantly in both groups. However, the overall post-treatment between the groups showed that there were no significant differences between the two groups. The researchers concluded that neurodynamic and bent leg lifting techniques significantly improved pain, functional disability, and straight leg lifting range in patients with low back pain radiating to the knee. However, there were no significant differences between the groups that received the neurodynamics or the bent leg lifting technique (Adnan et al., 2022).
Carta and colleagues in their recent paper of 2021 “The neurodynamic treatment induces biological changes in sensory and motor neurons in vitro” explained the mechanism that produces relief of pain. They conducted basic research to clarify what explains in their publication. The inquiry aimed to outline in vitro whether or not NDT protocols may want to result in selective organic outcomes on sensory and motor neurons, additionally investigating the feasible worried molecular mechanisms taking a function at the back of this change (Carta et al., 2021).
Nerves are subjected to tensile forces in numerous paradigms inclusive of damage and regeneration, joint movement, and rehabilitation treatments, as withinside the case of neurodynamic therapy (NDT). CND induces repeated selective uniaxial tension on the nerve and has been described as an effective treatment for relieving pain in patients. The biological mechanisms activated by CND that promote nerve healing processes are still unknown and even a dose-response analysis is not currently available to define a standard treatment protocol. The results obtained show that CNDs induce dose-dependent changes that promote cell differentiation, neurite growth and neuron survival, in particular nociceptive neurons. In particular, NDT significantly upregulated PIEZO1 gene expression. Gene that encodes an ion channel expressed in mouse and human sensory neurons and is linked to the transduction of mechanical stimuli and the suppression of pain. Other genes implicated in neuroinflammation-related mechanical allodynia were not altered by CND. The effects of the study make contributions to growing the information underlying the organic mechanisms activated in reaction to CND and to information their effectiveness in enhancing the physiological approaches of nerve regeneration and ache reduction. (Carta et al., 2021).
Jesson in 2020 published the paper “Physiotherapy for people with painful peripheral neuropathies: a narrative review of its efficacy and safety” which was a narrative review aimed to summarize the current literature on the efficacy and safety of physiotherapy to reduce pain and disability in people with radicular pain and chemotherapy-induced peripheral neuropathy, which are two common peripheral neuropathies.
Pharmacological therapies for peripheral neuropathic ache has the handiest modest results and are regularly restricted via way of means of severe unfavorable responses. Alternative remedy tactics inclusive of physiotherapy control have for that reason received hobby withinside the control of humans with peripheral neuropathies. For chemotherapy-caused peripheral neuropathy, the cutting-edge proof-primarily based totally on 8 randomized managed trials indicates that exercising might also additionally lessen signs and symptoms in sufferers with mounted neuropathy, however there’s a loss of proof for its preventative impact in sufferers who do now no longer but have signs and symptoms. For radicular ache, maximum trials investigated interventions focused at enhancing motor manage or decreasing neural mechano-sensitivity (Jesson et al., 2020).
The consequences of those research have been equivocal, with a few indications that neural tissue control might also additionally display a few advantages in decreasing ache. Adverse occasions to physiotherapy appeared rare; however, those have been now no longer constantly stated throughout all research. Although it’s miles encouraging to peer that the proof base for physiotherapy withinside the remedy of peripheral neuropathic ache is developing steadily, the combined exceptional of to be had research presently prevents organization remedy recommendations. Based on promising initial data, pointers are made on capacity instructions to transport the field forward (Jesson et al.,2020).
Kuligowski, in his review published in 2021 with the title “Manual Therapy in Cervical and Lumbar Radiculopathy: A Systematic Review of the Literature”, aimed to explain and replace present-day expertise of guide remedy accuracy in treating cervical and lumbar radiculopathy, to become aware of the constraints in present-day studies, and to indicate regions for destiny research. The researchers used PubMed and Web of Science, and the subsequent inclusion standards had been used: (1) presence of radiculopathy; (2) remedy described as guide remedy (i.e., traction, manipulation, mobilization); and (3) booklet described as a Randomized Controlled Trial.
Twenty-seven articles were accepted: 21 on cervical (CR) and 6 on lumbar radiculopathy (LR). The mean PEDro score for CR was 6.6 (SD 1.3) and for LR 6.7 (SD 1.6). for CR and are effective in reducing pain and improving functional outcomes. In LR, each of the included publications used a different form of manual therapy, making it difficult to summarize the knowledge in this group. The quality of the publications was moderate or low, suggesting that quality improvement is needed for this type of research (Kuligowski et al., 2021).
Traction-orientated strategies are the maximum usually selected shape of remedy for CR and also are powerful in decreasing ache and enhancing practical consequences. Mobilization strategies regularly lack data approximately the affected person’s pre-baseline assessment, making it hard to evaluate their effectiveness. The education applications themselves are green and enhance affected person consequences, however there may be no standardization of particular sports for the particular pathology algorithm. Because of a record of radiculopathy and feasible symptoms, the decision-making process, along with neurodynamic testing, ought to be obligatory for anyone with CR and LR. Based at the to be had literature, the multimodal method with a traction aspect is the maximum green for CR and the multimodal method with a traction aspect, spinal mobilizations, and center muscle activation for LR (Kuligowski et al., 2021).
To give an explanation for and update modern-day data of manual treatment accuracy in treating cervical and lumbar radiculopathy, to grow to be privy to the restrictions in modern-day studies, and to suggest areas for future research. The researchers used PubMed and Web of Science, and the following inclusion requirements had been used: (1) presence of radiculopathy; (2) treatment defined as manual treatment (i.e., traction, manipulation, mobilization); and (3) manual defined as a Randomized Controlled Trial (Kuligowski et al., 2021).
Ahmadi and his colleagues posted the study “Comparison of the consequences of the Feldenkrais approach as opposed to center balance workout withinside the control of continual low lower back ache: a randomized manipulate trial” withinside the mag Clinical Rehabilitation in 2020, aimed to investigate the effect of the Feldenkrais Method in contrast to center stability bodily sports on pain, incapacity, tremendous of existence, and interoceptive recognition in patients with persistent nonspecific low back pain. Sixty patients with persistent nonspecific low back pain had been further randomized into the Feldenkrais Method in place of center stability exercising corporations.
The intervention institution obtained the Feldenkrais Method, together with theoretical content material education and supervised motion therapy, periods consistent with week for 5 weeks. The manipulate institution obtained education applications and center balance physical activities at domestic for 5 weeks. All sufferers have been assessed the usage of the World Health Organization first-class of existence questionnaire. , McGill Pain Questionnaire, Oswestry Disability Questionnaire, and Interoceptive Awareness Multidimensional Assessment Questionnaire. All consequences have been measured at baseline and the give up of the intervention (Ahmadi et al., 2020).
There have been statistically widespread variations among corporations for first-class of existence (P = 0.006, from 45.51 to 60.49), interoceptive focus (P > 0.001, from 2. 74 to 4.06) and incapacity (P = 0.021, from 27.17 to 14.5) in prefer of the Feldenkrais approach. McGill ache rating was considerably reduced in each the Feldenkrais (from 15.33 to 3.63) and manipulate corporations (from 13.17 to 4.17), however, there have been no among group´s variations (P = 0.16). As end the researchers said that the Feldenkrais approach intervention gave expanded advantages in enhancing first-class of existence, enhancing interoceptive focus and decreasing incapacity index. Mueller and Niederer published the article “Dose-response-relationship of stabilization exercises in patients with chronic non-specific low back pain: a systematic review with meta-regression” in the magazine Science Repository in 2020. A systematic review with meta-regression was conducted using PubMed, Web of Knowledge, and Cochrane databases. The researchers argued to justify this review that stabilization exercise (SE) is evident for the management of chronic nonspecific low back pain (LBP), but the optimal dose-response relationship for the utmost treatment success is still unknown. Thus, the purpose is to systematically review the dose-response relationship of stabilization exercises on pain and disability in patients with chronic nonspecific LBP.
Eligibility criteria were RCTs on patients with chronic nonspecific LBP, written in English/German and adopting a longitudinal core-specific/stabilizing/motor control exercise intervention with at least one outcome for pain intensity and/or disability. Metaregressions(dependent variable = effect sizes (Cohens d) of the interventions (for pain and for disability), independent variable = training characteristics (duration, frequency, time per session)), and controlled for (low) study quality (PEDro) and (low) sample sizes (n) were conducted to reveal the optimal dose required for therapy success. From the 3,415 studies initially selected, 50 studies (n = 2,786 LBP patients) were included = 1,239 patients received SE. Training duration was 7.0 ± 3.3 weeks, training frequency was 3.1 ± 1.8 sessions per week with an average training time of 44.6 ± 18.0 minutes per session. The mean process effect size was D = 1.80 (pain) and D = 1.70 (disability). The total R2 was 0.445 and 0.17. Moderate-quality evidence (R2 = 0.231) found that training duration of 20 to 30 minutes caused the greatest effect (for both pain and disability, log association). Low-quality evidence (R² = 0.125) found that training 3 to 5 times per week had the greatest effect of SE in patients with chronic nonspecific low back pain (inverted U-shaped association).In patients with nonspecific chronic low back pain, stabilization exercise with a training frequency of 3 to 5 times per week (Grade C) and a training time of 20 to 30 minutes per session (Grade A) has elicited the greatest effect on pain and disability (Mueller and Niederer, 2020).
Ahmed and colleagues in 2021 created the paper “The effect of muscles energy technique in the management of chronic mechanical low back pain: A scoping review” and published it in the Journal of Back Musculoskeletal Rehabilitation. The objectives of this review were to explore and summarize the available evidence related to the effectiveness of the Muscle Energy Technique (MET) in the management of chronic mechanical low back pain (MLBP).
The MET is one of the therapies of preference for the control of MLBP; however, there’s a paucity of proof to justify its effectiveness. A systematic seek turned into done comprising of a digital seek of on-line databases the use of key seeks phrases and subsided via way of means of a hand seek to discover the prevailing literature on the subject which turned into summarized and discussed. Initially 25,195 hits had been recognized which had been screened to have a look at their eligibility primarily based totally on predetermined inclusion standards after getting rid of replica articles. Eleven articles met the inclusion standards and had been discussed (Ahmed et al., 2021).
Overall, there are few posted articles at the impact of MET in continual MLBP. However, evaluation of retrieved articles confirmed that the MET technique is a positive intervention this is safe (i.e. without damaging effects) and can be powerful as a stand-on my own remedy or in aggregate with different strategies. therapeutics for continual MLBP sufferers with the capacity to provide several bodily and psychosocial benefits (Ahmed et al., 2021).
The study developed by Angioni and colleagues entitled “Spa therapy induces clinical improvement and protein changes in patients with chronic back pain” primarily aimed at assessing serum changes on a large panel of proteins in patients with chronic back pain following spa therapy, as well as evaluating different spa therapy regimens as a preliminary exploratory clinical study. The study was published in the magazine Reumatismo in 2019.
The study included 66 patients with persistent again ache secondary to osteoarthritis havebeen randomly enrolled and dealt with each day dust packs and bicarbonate-alkalinemineral water baths, or a thermal hydrotherapy rehabilitation scheme, the mixture of the 2regimens or standard medicine only (manipulate group), for 2 weeks. Clinical variables havebeen evaluated at baseline, after 2 and 12 weeks. One thousand serum proteins have beenexamined earlier than and after a two-week dust tubtub remedy. All spa remedy organizationsconfirmed scientific advantage as decided through enhancements in VAS ache, Roland Morrisincapacity questionnaire and neck incapacity index at each time points (Angioni et al., 2019).
The following serum proteins were determined substantially increased (≥2.5 fold) afterspa remedy: inhibin beta A subunit (INHBA), activin A receptor kind 2B (ACVR2B),angiopoietin-1 (ANGPT1), beta-2-microglobulin (B2M), boom differentiation aspect 10(GDF10), C-X-C motif chemokine ligand five (CXCL5), fibroblast boom aspect 2 (FGF2),fibroblast boom aspect 12 (FGF12), oxidized low density lipoprotein receptor 1 (OLR1), matrixmetallopeptidase 13 (MMP13). Three proteins have been determined substantially decreased(≤0.65 fold): apolipoprotein C-III (Apoc3), interleukin 23 alpha subunit p19 (IL23A) andsyndecan-1 (SDC1). The researchers showed that spa remedies changed into useful for persistentagain ache and proved to result in modifications in proteins worried in capabilities includinggene expression modulation, differentiation, angiogenesis, tissue repair, acute and persistentinflammatory response (Angioni et al., 2019).
Uzunkulaoğlu in his study aimed to investigate the effectiveness of Kinesio taping (KT) and sham KT on pain, lumbar range of motion (ROM) and disability in chronic non-specific low back pain. The study was entitled “The effectiveness of Kinesio taping on pain and clinical features in chronic non-specific low back pain: A randomized controlled clinical trial” and published in the Turkish journal of physical medicine and rehabilitation in 2018.
This randomized, placebo-controlled study in which 60 patients (22 male, 38 females; mean age 21.5 ± 1.7 years, range, 19-25 years) with chronic low back pain were randomized to intervention groups or placebo. Group 1 (n=30) was treated with KT and group 2 (n=30) was treated with dummy tape six times at three-day intervals. Patients were assessed for pain, modified Schober’s test value, ground clearance and lumbar range of motion, and disability at baseline and at the end of the first and sixth months of surgery. Pain was assessed using the visual analog scale (VAS), while ROM was assessed by modified Schober’s test value, ground clearance, and lateral lumbar flexion of ROM. Disability was assessed with the Oswestry Disability Index (ODI) (Uzunkulaoğlu et al., 2018).
Statistically significant improvements for all parameters were found for both groups after one month of intervention (p<0.05). These researchers concluded that Kinesio taping provided significant improvements in pain, ROM, and short-term disability. These positive effects were maintained for ROM and long-term disability, but not for pain (Uzunkulaoğlu et al., 2018).
Practice recommendations
The management of chronic pain has been one of the greatest challenges in the general medical field since time immemorial and, with the development of medical specialties, it has been part of the daily work of many of them. In particular, chronic pain associated with the osteo-myo-articular system affects the work of various specialties such as rheumatology, traumatology, sports medicine, and others and is gaining more importance as the world population ages, dragging a greater burden of this type of disease that requires medical attention.
The management of chronic pain is torn between the intensive use of pharmacology that is generally aggressive and that attracts other health problems, and its contained use and aided by other less invasive non-pharmacological strategies, but in which the effectiveness required to recover must be achieved. in patients an acceptable quality of life.
This search for recent publications on the subject has addressed the topic of non-pharmacological treatments for chronic pain and has reviewed to date the strategies developed by different medical specialties that have to deal with this important health problem, which have included the use of treatments non-pharmacological of different types, the combined use of pharmacological and non-pharmacological treatments and even the use of alternative and traditional medicine.
Methods such as physical and psychological therapies of a different nature, together with the use of natural medicine resources, seem to be promising alternatives that lead to better results. In particular, the goal of removing patients from pharmacological dependence that may include the use of opiates to manage their pain should be a permanent incentive to continue developing methods and strategies that allow complaining patients to achieve well-being.
Likewise, to the extent that physical intervention techniques such as physiotherapy, moxibustion and other alternative techniques can be studied through the pathophysiological mechanisms from which they act, there will be greater clarity and better projection of future techniques. Engaging recent “omics” insights that identify inflammation or the generation of noxious and pro-inflammatory substances will certainly help to be part of the solution.
ProjectDescription
This project will be completed through a literature review. I will select publications from the last 5 years that address the study research question and objectives. I will use the following resources: PubMed, Google Scholar, Medline, Cochrane, CINHAL, as well as the Ana G Mendez Virtual Libraries. I will review at least 30 peer-reviewed articles published between 2017 and 2022. The keywords that I will use for my investigation are pain, chronic, neuropathic, non-pharmacological, acupuncture.
The results obtained from the study will help to review the state of the art in the nonpharmacological management of chronic pain in adults. This way this review will contribute to answering my research question which is: What are the non-pharmacological management and strategies of adults with chronic pain? The search aims to identify non-pharmacological management and strategies of adults with chronic pain, to describe the advantages of non-pharmacologic treatments in chronic pain, and to analyze the barriers to increasing the use of non-pharmacologic therapies in the management of chronic pain. The information obtained from the literature review will be kept for 5 years, locked in the principal investigator’s home office. After five years, any information will be destroyed by a paper shredder and discarded by the principal investigator. The principal investigator and his mentor will be the only ones authorized to have access to the information obtained..
Project Evaluation Results
After the data is collected, the analysis will be done with selected information that will beincluded in the final report. One of the steps is to remove the errors that might have occurredduring data collection in the analysis of data. During data analysis, several processes will occur,all related to the data information available in the different kinds of literature that have beenexamined. I will review both primary research evidence and also systematic reviews, usingquantitative and qualitative evidence. Summarizing tables with all citations will be presented inAppendix A; B; appendix A will be used to summarize primary research evidence, andappendix B will be used for the summary of the systematic reviews.Appendix A will include the citation, question or hypothesis, theoretical foundation,research designed and sample size, key findings, recommendations or implications, and level ofevidence (I to VII), of each article. Appendix B will also include a citation, question, searchstrategy, inclusion/exclusion criteria, data, extraction and analysis, key findings,recommendations and implications, and level of evidence ranging from Level I to Level VII.
The level of evidence (LOE) was classified according to de following classification:
Level I: systematic reviews or meta-analysis
Level II: well-designed Randomized Controlled Trial (RTC)
Level III: well-designed controlled trials without randomization, quasi-experimental
Level IV: well-designed case control and cohort studies
Level V: systematic reviews of descriptive and qualitative studies
Level VI: single descriptive or qualitative study
Level VII: opinion of authorities and/or reports of expert committees.
Each article will be evaluated as relevant information, not to answer my researchquestion accurately.
Discussion and Implications for Nursing and Healthcare
The successful management of pain in general and chronic pain, in particular, has beenone of the goals of nursing since its origins and one to which nurses dedicate a large part of theirtime. Therefore, the knowledge and update level they receive on this important topic continues tobe of the utmost importance for their performance in the profession. This review has focused onthe non-pharmacological management of chronic pain in adults, which has also increased itsburden and presence accompanying the rapid aging of the population, as a result of greater lifeexpectancy.
Along with this, the diseases must be prepared and updated in what alternatives allow thepatient to be kept away from pharmacological therapies, some of which have negativerepercussions on organs and systems and can cause dependency. For this reason, the mainresearcher considers that the subject under review must meet the expectations of being useful forhealth caregivers in general and particularly the nurses.
The expected benefits of this study include an improved knowledge of the burses on thenon-pharmacological management of chronic pain in adults. The challenge of maintaining far thepatients from a dangerous and even frequently lethal dependence on drugs could be reached witha deep dominium of alternative treatments in this field. Thus, the nurses must keep attentive toeach step in this direction, in order to deliver the best advice to their patients.
Plans for Dissemination
At the end of this project, it will be disseminated by presenting an oral demonstrationwith PowerPoint to the professor and students of this course. Also, I will do a poster board withbrief information on my research and results to be exposed at Ana G Méndez, South FloridaCampus (SFC) gallery. A hard copy of the whole project will be available at Ana G Mendez,SFC Library, with open access to other students interested in this project and its results.
Summary and Conclusion
This paper will be devoted to answering the following question: What are the non-pharmacological management and strategies of adults with chronic pain? This topic is of theutmost importance in the context of the aging of the population and the increasing presence ofdegenerative illnesses which come with this process. Moreover, the theme is of specialimportance at the moment that there are policies to diminish the use of heavy pain-reliever drugs,that carry on other consequences for the individuals, as creating addictions and damaging othervital organs.
It is known that most pain-relieving drugs are not only addictive but can also be harmfulto other organs, particularly the renal system, which is overloaded with the elimination of theseresidues. Another danger in the case of the sustained use of these drugs is the synergistic actionthey can have with other drugs necessary in older adults in whom there are severalcomorbidities.
Therefore, whenever it is possible to work to reduce the burden of medication, it shouldbe done, trying to resort to less aggressive forms for the body. So far, this review has shown thatphysical therapies directed at specific regions are usually effective, allowing the dose of drugs torelieve pain to be reduced. Although it has not been the direction of this analysis of the literature,it is not idle to highlight the role that prevention can have in preventing adults and particularlyolder adults from developing osteo-myo-articular pain from the early stages of life. Frequentphysical exercise, postural care in the case of those who spend many hours sitting and othersituations should be put into perspective and patient education should be encouraged in thisregard.
So far, this literature review on the recently published studies helped to identify non-pharmacological management and strategies for adults with chronic pain, analyze some of theiradvantages both alone or mixed with less aggressive pain-relievers, and more. Thus, given theimportance of this promising approach, the principal investigator recommends to continuingreview more literature to reach more accurate results.
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