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Ovid: Oxford Handbook of Palliative Care

Editors: Watson, Max S.; Lucas, Caroline F.; Hoy, Andrew M.; Back, Ian N. Title: Oxford Handbook of Palliative Care, 1st Edition Copyright ©2005 Oxford University Press > Table of Contents > Symptom Management > Chapter 6a – The management of pain > Other non-pharmacological pain interventions Other non-pharmacological pain interventions A range of techniques and expertise exists complementing the pharmacological and interventional approaches, which have dominated this module thus far. These techniques are not just an adjunct to medication but point to the centrality of holistic patient-centred care. Not all approaches will be appropriate for every patient, but for some traditional medicine has little to offer either.

Table 6a.16 Complementary therapies and other non-pharmacological interventions
Complementary therapies Other non-pharmacological interventions
Acupuncture Positioning
Reflexology Catheterization
Aromatherapy Reassurance
Art therapy Good communication
Music therapy Diversional therapy
Touch therapy TENS
Splinting of a fractured limb
Psychological support
Figure. No caption available.

See also chapter 11. Pain and difficulties in communication High prevalence of pain in the elderly population is a recognized reality. Almost half of those who die from cancer are over 75 years old. One study showed that 40–80 per cent of elderly in institutions are in pain. There is evidence that many patients suffering from some form of dementia receive no pain relief at all, despite the presence of a concomitant, potentially painful illness. The reason for this lies in the difficulty in assessing those with communication difficulties. Additionally, the elderly often minimize their pain making it even more difficult to evaluate. The patient’s unusual behaviour and its return to normal with adequate analgesia, may be the only indication of pain. There have been various attempts to evaluate pain in such circumstances. The DOLOPLUS1 was developed in 1993. It is based on observations of the behaviour of patients in ten different situations that could be associated with pain. The pain is classified into somatic, psychomotor and psychosocial aspects and scores are allocated. A collective score level confirms the presence of pain. Footnotes 1 (2001) Lefebvre-Chapiro, S. and the DOLOPLUS group. (2001) The DOLOPLUS 2 scale- evaluating pain in the elderly. European Journal of Palliative Care, 8, 5: 191–4 P.235
Examples of unusual behaviour indicating pain2 Verbal expression e.g.

  • crying when touched
  • shouting
  • becoming very quiet
  • swearing
  • grunting
  • talking without making sense

Facial expression e.g.

  • grimacing/wincing
  • closing eyes
  • worried expression

Behavioural expression e.g.

  • jumping on touch
  • hand pointing to body area
  • increasing confusion
  • rocking/shaking
  • not eating
  • staying in bed/chair
  • withdrawn/no expression
  • grumpy mood

Physical expression e.g.

  • cold
  • pale
  • clammmy
  • change in colour
  • change in vital signs if acute pain (e.g. BP, pulse)

Footnotes 2 Galloway S. and Turner, L. (1999) Pain assessment in older adults who are cognitively impaired. Journal of Gerontological Nursing 25, 37: 34–9. Further reading Back I. N., Finlay I. (1995) Analgesic effect of topical opioids on painful skin ulcers. J Pain Symptom Manage,10, 7: 493. Flock P., Gibbs L., Sykes N. (2000) Diamorphine-metronidazole gel effective for treatment of painful infected leg ulcers. J Pain Symptom Manage, 20, 6: 396–7. Scottish Intercollegiate Guidelines Network (2000) Control of pain in patients with cancer. Edinburgh: SIGN. Ventafridda V., Ripamonti C., De Conno F., Bianchi M., Pazuconi F., Panerai A. E. (1987) Antidepressants increase the bioavailability of morphine in cancer patients (letter). Lancet i: 1204.

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