Preface

Pain control and disease management have been grown hand in hand since the dawn of life and the early practice of medicine by ancient humans.

When patients come to us with their pain, they present us with a challenging opportunity to understand them, tackle how their pain is affecting their lives, discover what is causing their pain, and finally the opportunity to prescribe medications and advise on necessary lifestyle changes to help them gain relief from their pain.

Healthcare professionals are encountered daily with different pain scenarios and they are asked to find appropriate solutions. The clinical presentation may be acute or chronic, and successful management involves an accurate diagnosis and implementation of a suitable therapy or therapies. For beginners in pain management, this can pose a significant chal‐ lenge as well as for senior pain physicians.

This book will serve as a ready reference for those embarking on pain management. Its in‐ tent is not to be a heavy book that can only be stored on a bookshelf, but a pocket-sized reference that can be carried, be easily navigated, and be available whenever a conceptual gap compromises pain physicians and their ability to treat their patients.

Though this book is intended for new trainees in the field of pain management as well as senior pain practitioners, it should also be noted that it deals with pain in special circum‐ stances and sometimes rare pain conditions that may meet the pain practice.

This book provides the latest updates on pain management in special circumstances and highlights the recent advances for evidence-based pain management.

While we did our best to prevent any misinformation of any form, we would urge our readers to inform us of any such error, including spelling or contextual errors. We also would advise that this book certainly does not replace professional or expert guidance and consultation.

We are grateful to Ms. Maja Bozicevic for her continuous help in all stages of this book. I owe my own achievements to my wife, my daughter, and my sons and I cannot thank them enough. Also, we are grateful to Professor Marco A.E. Marcus for his constant support while editing this unique book, *Pain Management in Special Circumstances*, and to all participating authors for their contributions.

> **Dr. Nabil A. Shallik MSc, MD** Hamad Medical Corporation Doha, Qatar

**Chapter 1**

**Provisional chapter**

**Non-Pharmacological Pain Management**

treatments is that they are relatively inexpensive and safe.

Non-pharmacological therapies are typically categorized into

tion (TENS), acupuncture and progressive muscle relaxation.

**Keywords:** pain, non-pharmacological, physical, psychological, spiritual

**Non-Pharmacological Pain Management**

DOI: 10.5772/intechopen.79689

Non-pharmacological pain therapy refers to interventions that do not involve the use of medications to treat pain. The goals of non-pharmacological interventions are to decrease fear, distress and anxiety, and to reduce pain and provide patients with a sense of control. When deciding the most effective non-pharmacological technique, take into consideration the patient's age, developmental level, medical history and prior experiences, current degree of pain and/or anticipated pain. The advantage of non-pharmacological

Physical (sensory) interventions typically are patient-specific and inhibit nociceptive input

Some measures that can reduce pain intensity and improve the patient quality of life such as massage, positioning, hot and cold treatment, transcutaneous electrical nerve stimula-

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Ahmed El Geziry, Yasser Toble, Fathi Al Kadhi, Muhammad Pervaiz and Mohammad Al Nobani

Ahmed El Geziry, Yasser Toble, Fathi Al Kadhi, Muhammad Pervaiz and Mohammad Al Nobani

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79689

**Abstract**

**1. Introduction**

**1.** Physical (sensory) interventions

and pain perception.

#### **Chapter 1 Provisional chapter**

#### **Non-Pharmacological Pain Management Non-Pharmacological Pain Management**

Ahmed El Geziry, Yasser Toble, Fathi Al Kadhi, Muhammad Pervaiz and Mohammad Al Nobani Ahmed El Geziry, Yasser Toble, Fathi Al Kadhi, Muhammad Pervaiz and Mohammad Al Nobani

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79689

**Abstract**

Non-pharmacological pain therapy refers to interventions that do not involve the use of medications to treat pain. The goals of non-pharmacological interventions are to decrease fear, distress and anxiety, and to reduce pain and provide patients with a sense of control. When deciding the most effective non-pharmacological technique, take into consideration the patient's age, developmental level, medical history and prior experiences, current degree of pain and/or anticipated pain. The advantage of non-pharmacological treatments is that they are relatively inexpensive and safe.

DOI: 10.5772/intechopen.79689

**Keywords:** pain, non-pharmacological, physical, psychological, spiritual

## **1. Introduction**

Non-pharmacological therapies are typically categorized into

**1.** Physical (sensory) interventions

Physical (sensory) interventions typically are patient-specific and inhibit nociceptive input and pain perception.

Some measures that can reduce pain intensity and improve the patient quality of life such as massage, positioning, hot and cold treatment, transcutaneous electrical nerve stimulation (TENS), acupuncture and progressive muscle relaxation.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**2.** Psychological interventions

Continuous pain may lead to development of maladaptive status and behavior that worsen day to day function, increase distress, or enhancing the experience of pain. Patients suffering pain tend to show increased vulnerability to a variety of psychiatric illnesses, including depressive and anxiety disorders, and posttraumatic stress disorder. In fact, the relationship between depression and pain is likely to be bidirectional, so that the presence of a depressive disorder has been identified as a key risk factor in the transition from acute to chronic pain.

in some cases, reduced severity of physical symptoms. Depression and anxiety have shown

Non-Pharmacological Pain Management http://dx.doi.org/10.5772/intechopen.79689 3

Positioning is a physical intervention that includes maintaining a proper body alignment to

It helps to prevent further complications, reduces the risk for developing injuries, prevents developing bed ulcers and most importantly reduce alleviate pain. Therefore, positioning the

Positioning can help with many patients as it can relieve muscle pain, tension and discomfort. It can improve blood circulation which in turn prevents ulcers from developing. Moreover, elevating extremities while positioning can be beneficial in decreasing pain and prevent

Several studies have shown reduction in pain, anxiety, nausea and heart rate in patients treated with active warming for pain related to mild trauma, cystitis, urolithiasis, cholelithiasis, appendicitis, colitis, and rectal trauma. This is an inexpensive and easy-to-use therapy with minimal side effects when used appropriately. Cold therapy includes applying a cool substance or device to any part of the body. Numerous studies have reported that cold treatment can increase pain threshold, decrease edema, and suppress the inflammatory process. Cold compresses may be used between 15 and 30 min time periods and up to 2–3 times per day.

Hot and cold therapy has been used for many decades and centuries to relieve pain, which includes muscle pain, joints pain, extremities pain, back pain and arthritis. Some studies show evidence that ice and heat therapies are effective and can reduce pain when compared to over

**1.** Heat stimulates the thermo receptors in the skin and deeper tissues. This can help to reduce

**2.** Heat reduces striated muscle spasm by minimizing muscle spindle excitability and reduc-

**3.** By warming joints, heat reduces the viscosity of synovial fluid, which alleviates painful

Although through history hot and cold-water therapy is frequently used in home environment. However, these home therapies can create some complications such as burns and water leak. Nowadays, mostly in hospital setting, they use wheat-based heat packs and electrical

One study showed that "superficial heat relieves pain in a number of different ways:

patient correctly and re-positioning can help with the above complications [5].

significantly improve with massage.

reduce stress and anxiety, especially in children.

the counter meds such as Paracetamol and Ibuprofen.

pain by closing the gating system in the spinal cord.

stiffness during movement and increase joint range" [5].

heating pads, which are safer and give the maximum effect of analgesics [6].

ing tension in muscle trigger points.

**2.2. Positioning**

edema as well.

**2.3. Hot and cold**

Most commonly used psychological interventions are: cognitive behavioral therapy, mindfulness-based stress reduction, acceptance and commitment therapy (ACT), guided imagery and biofeedback.

**3.** Others

Spirituality and religion in pain management and music therapy.
