Non+Pharmacological+Mangement

Non-pharmacological analgesic methods include:
 * Non-pharmacological analgesic techniques**
 * First aid techniques - RICE (rest, ice, compression, elevation)
 * Physiotheraphy - exercise techniques that promote strength and flexibility, or muscle relaxation techniques such as massage
 * Counter-irritants - scratching, liniments, rubefacients ?????????
 * TENS - a method of treating chronic pain by passing small electrical currents into the spinal cord or sensory nerves via electrodes applied to the skin
 * Acupuncture - a traiditional Chinese technique where needles are inserted into the skin at specific points to produce analgesia
 * Psychotherapeutic methods - hypnosis, behavious modification, biofeedback,= techniques, assertiveness training, art and music therapy, the placebo effect
 * Surgery - such as neurectomy (removal of part of a nerve), leucotomy (removal of part of hte white matter of the CNS), cortical ablation (removal of part of the cerebral cortex)
 * Community support groups
 * Complementary and alternative medicine - aromatherapy, herbal medicines, spinal manioulation

From: //Clinical Psychomotor Skills pg 153//

Indications for use of heat and cold treatment for pain vary. The patients' preference for either heat or cold treatment should be considered, as some patients find cold distressing. Heat: is used to increase circulation and thus oxygen and nutrient flow to an area that is painful by vasodilation of the arterioles, reduced blood viscosity and increased capillary permeability within the painful area. The extra circulation/oxygen/nutrients assist in reducing swelling and inflammation, reducing ischaemia. Heat also recuces muscle spasm and induces muscle relaxation.

Cold: is used to promote vasoconstriction and thus reduces oedema and bleeding in an area. Cold reduces the inflammatory process and decreases contractility of muscles and cellular metabolism. Cold initially causes hyperaesthesia in the area to which it is applied, later numbness and paraesthesia set in.

Age is important to consider - be careful when using on very young and very old as both tend to tolerate heat poorly Consiousness - Patient needs to be conscious enough to say whether it is excessively hot or cold Skin integrity - Broken skin has increased sensitivity to hot/cold Altered circulation - poor circulation (cardiac failure, diabetes mellitus, peripheral vascular disease) can result in heat not being dissipated properly resulting in local tissue damage.
 * Assessment for hot/cold therapy**

Heat not suitable for patients: Recent traumatic injury (increased vasodilation => bleeding not encouraged) Active haemorrhage Acute inflammation (e.g. appendicitis) because of increased oedema Pregnancy (heat may affect fetal growth) skin disorders metallic implants (metal is an excellent heat conductor)

Cold not suitable for patients: open wounds (damaged or delayed healing) impaired circulation (vasocontriction will further impair nourishment of tissues) cold allergy or hypersensitivity (can cause hives, erythema, muscles spasms) shivering (can cause increased metabolic rate and raised temperature)