Nonpharmacological management of acute pain

Nonpharmacological interventions for acute pain include psychological and physical techniques. They may be used alone for mild pain or in combination with pharmacotherapy for moderate to severe pain; see General principles of acute pain management. Despite limited evidence supporting their use, nonpharmacological interventions are considered a key component of good clinical care.

Tailor the intervention to the individual and clinical context. This requires a comprehensive pain assessment, knowledge of available strategies and access to necessary resources.

Patient education is an important management strategy. Explain the possible diagnosis, investigation plan and management options. Patient education is part of informed consent to treatment, but also enhances expectation management and improves adherence to treatment strategies.

Other psychological and physical interventions are context specific.

Psychological interventions can assist with treatment adherence, management of painful procedures, early discharge and reduced analgesic use. Basic psychological techniques (eg distraction, relaxation, targeted reassurance) should be used during all acute pain presentations. Formal psychological interventions (eg preoperative cognitive behavioural therapy) may be useful for some patients.

Physical interventions alone may provide adequate pain relief for mild acute pain presentations (eg immobilisation, ice and compression for a muscle sprain). Although immobilisation may be required for some presentations (eg a fractured bone), physical activity is an important acute pain management strategy (eg postoperative rehabilitation). Passive physical techniques may be helpful in some situations, including transcutaneous electrical nerve stimulation, acupuncture, massage, and hot and cold therapy.

See #agg7-c04-s1__tagg7-c04-tbl2 for age-appropriate examples of nonpharmacological acute pain management strategies.