Registered Nurses´ Association of Ontario
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Non–Pharmacological Methods of Pain Control
Various strategies can enhance or complement pharmacological interventions, which may include behavioural/cognitive interventions or physical modalities.
Not all interventions are effective for all persons with pain, and determining the most appropriate choice can be challenging (ICSI, 2006).
The following is a summary of interventions identified in the guideline and supplement.
Behavioural/Cognitive Interventions for Acute Pain
- Desensitization
- Positive reinforcement
- Relaxation
- Preparation
- Memory change
- Hypnosis
- Thought stopping and positive self-statements
- Distraction
- Modeling and rehearsal
Type of treatment:
Desensitization
Description:
Systematic gradual exposure to feared situations or objects.
Goal:
Decrease anxiety.
Type of treatment:
Positive reinforcement
Description:
Positive statements and tangible rewards after a painful procedure.
Goal:
Transform meaning of pain from a punative to challenging event.
Description:
Progressive relaxation of muscle groups combined with controlled breathing.
Goal:
Decrease anxiety and pain.
Description:
Explaining the steps of the procedure and providing sensory information
about the procedure.
Goal:
Help child to develp a realistic expectation about a procedure.
Type of treatment:
Memory change
Description:
Helping child to more positively reframe any negative memories
about previous procedures.
Goal:
To reduce anticipatory distress and, over time, procedural distress, through realistic memories.
Description:
Dissociate from painful experience through involvement in imagined
fantasy that is fun and safe.
Goal:
Take focus away from procedure and enhance sense of mastery through
metaphor in imagined experience.
Type of treatment:
Thought stopping and positive self-statements
Description:
During times of anxiety, the child repeats “stop” when anxious
thoughts occur, and repeats a set of positive thoughts.
Goal:
Replace catastrophic thinking and reduce anxiety.
Description:
Techniques include counting,
blowing bubbles, or talking about
topics unrelated to the procedure.
Goal:
Shift attention away from the procedure and pain onto more enjoyable things.
Type of treatment:
Modeling and rehearsal:
Description:
Demonstration of a mock procedure by another child or adult who demonstrates positive coping behaviours; children can then practice procedure using coping techniques.
Goal:
Provide information about the procedure and suggest helpful strategies that can be used during procedure to cope with pain and anxiety.
Other approaches that may be successful include:
- Verbal preparation and communication with health care providers
- Sensorimotor strategies: especially with infants, the use of pacifiers, swaddling, rocking and holding
- Imaginative involvement: especially with children, using imaginatvie stories or "pain switches" or "anesthetic gloves"
- Physical strategies: application of heat or cold, massage, immobilization, rest or exercise
- Music, art and play therapies
