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The pain experience is a product of a person’s past pain experiences, values, cultural expectations, and emotions. Pain is a subjective measurement and varies among patients. Nonpharmacologic pain-control measures include massage, meditation, acupuncture, relaxation breathing, guided imagery, and heat and cold application.undefined#ref2">2,3 Such measures should be used in conjunction with pharmacologic interventions and can reduce the amount of analgesic medication required. Nonpharmacologic techniques help diminish the physical effects of pain, alter a patient’s perception of pain, and provide the patient with a greater sense of control. Nonpharmacologic interventions are appropriate for patients who find them appealing or have incomplete pain relief with drug therapy alone.2,4
Certain diagnostic and therapeutic procedures commonly cause pain. Evidence suggests that fewer than half of surgical patients report adequate postoperative pain relief.5 Many times, multimodal regimens for postoperative pain relief are required. The administration of an analgesic before implementing a nonpharmacologic strategy, such as guided imagery, may help the patient gain a level of comfort. Adding nonpharmacologic interventions may enhance the effects consistent with the biopsychosocial model of pain.5 The patient, setting, and surgical procedure affect the exact components of effective pain relief.5 Because everyone responds differently to nonpharmacologic techniques, finding the methods that are most effective for a patient takes time. A combination of techniques is often beneficial.
Guided imagery is a creative sensory experience that reduces pain perception and minimizes the reaction to pain. It draws on internal experiences of memories, dreams, fantasies, and visions, and it explores the inner world of experience, protects the patient’s privacy, and fosters the imagination. The goal of imagery is to have the patient use one or more of the senses to create an image of a desired result. This image creates a positive psychophysiologic response. Focusing the imagination helps patients change their perceptions about their disease, treatment, and healing ability, which helps relieve pain, tension, and stress. Choosing images that the patient finds pleasant requires careful assessment by the health care team member. Otherwise, the health care team member could mistakenly describe images of objects or things that a patient fears or dislikes. For example, a scene of rolling waves at the seashore may be restful to one patient but desolate or frightening to another.3 To be most effective, guided imagery requires individual coaching of the patient. A major barrier to this therapy is that individual coaching is not always feasible. However, when the patient understands how to use guided imagery, the technique can produce positive results.1
Rationale: Development of specific images helps remove the perception of pain.
Rationale: The patient’s ability to concentrate decreases the perception of pain.
Rationale: This method of breathing promotes muscle relaxation and overall relaxation.3
Rationale: Guided imagery requires an intense level of concentration that takes time to achieve.
Rationale: This assessment determines the effectiveness of the procedure, the level of relaxation, and the degree of pain relief. It also indicates which procedures were the most effective.
Álvarez-García, C., Yaban, Z.Ş. (2020). The effects of preoperative guided imagery interventions on preoperative anxiety and postoperative pain: A meta-analysis. Complementary Therapies in Clinical Practice, 38, 101077. doi:10.1016/j.ctcp.2019.101077
American Nurses Association (ANA). (2018). Position statement: The ethical responsibility to manage pain and the suffering it causes. Retrieved April 12, 2022, from https://www.nursingworld.org/~495e9b/globalassets/docs/ana/ethics/theethicalresponsibilitytomanagepainandthesufferingitcauses2018.pdf
Joint Commission, The. (2017). R3 report: Pain assessment and management standards for hospitals. Retrieved April 12, 2022, from https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/r3_report_issue_11_2_11_19_rev.pdf
National Center for Complementary and Integrative Health. (2021). Relaxation techniques: What you need to know. Retrieved April 12, 2022, from https://www.nccih.nih.gov/health/relaxation-techniques-what-you-need-to-know
Adapted from Perry, A.G. and others (Eds.). (2022). Clinical nursing skills & techniques (10th ed.). St. Louis: Elsevier.
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