Evidence-Based Nursing Interventions for Chronic Pain Management

This report provides a comprehensive overview of the effectiveness of various nursing interventions for adult patients experiencing chronic pain. The findings are based on a systematic review of the literature and other evidence-based sources. The review identifies several effective interventions, including sensorial stimulation (Snoezelen), music therapy, cognitive behavioral programs, psycho-education programs, physical exercise programs, magnetic field therapy, and guided imagery. The report highlights the importance of a collaborative approach involving nurses, physicians, and patients' primary carers. It also emphasizes the potential of interventions such as M technique hand massage, telehealth interventions, and the management of acute pain to prevent the development of chronic pain and affective disorders. The report concludes with best practice recommendations, emphasizing the potential of nursing interventions in chronic pain management and the importance of a multidisciplinary approach to improve patient outcomes. The report also cites studies that highlight the most common activities used by nurses to manage chronic pain in patients, such as establishing a relationship with the patient, discussing therapeutic modalities, and personalized training for the patient.

Chronic Pain: Nursing Interventions
31 January 2019
Author
Dieu Huong Nguyen, MBBS, MHHSM, MPH
Question
What is the best available evidence regarding the effectiveness of nursing interventions for adult patients
experiencing chronic pain?
Clinical Bottom Line
Chronic pain, which is the third most common health problem, is defined as constant or recurring
unpleasant sensory and emotional experience, of a term longer than six months. 1 Chronic pain can have
a substantial impact on a person’s quality of life, causing disabilities, limitations and loss of independence.
Chronic pain is widespread and contributes to morbidity and mortality in people who experience it. There
are many different and varied causes of chronic pain, with the most common location being the lower
back, and the most common condition being arthritis. 1 Chronic pain also has significant economic costs
associated with it. Approaches to pain treatment include psychological, pharmacological, and physical.
Non-pharmacological treatments have been recommended as adjunct treatments for those living with,
and experiencing, chronic pain. Nursing interventions may include physical and psychological therapy. 1
• A systematic review was performed to assess the effectiveness of nursing interventions for chronic pain.
Different interventions were identified in the review. These included: sensorial stimulation, music therapy,
cognitive behavioral programs, psycho-education programs, physical exercise programs, magnetic field
therapy and guided imagery. Specifically, the review identified: 1 (Level 1)
• The Snoezelen intervention, a sensory stimulation intervention for relaxation and distraction, was found
to significantly reduce pain values in adults with chronic pain, although there were limitations in
methodological study design.
• Music therapy was found to be an effective intervention for the reduction of chronic pain in older patients
with osteoarthritis, a finding that was statistically significant. Another study assessing music therapy for
articular pain found that music was a cheap and safe intervention which resulted in statistically significant
reductions in pain and depression.
• A cognitive behavioral program in a multidisciplinary pain treatment center resulted in a significant
reduction in pain intensity, and improved quality of life and quality of sleep compared to general
practitioner care group and a waiting list control group.
• Another study assessed a psycho-education program, the Chronic Pain Self-Management Program,
which resulted in statistically significant reductions in pain and improvements in self-efficacy.
• A study assessing a physical exercise program did not find improvements in pain for residents of an
aged care home with urinary incontinence and musculoskeletal pain;
1

• Magnetic field therapy was assessed in people who experienced primary chronic headaches. The
magnetic field group, the placebo group and the control group all experienced statistically significant
reductions in pain during the study. There were, however, methodological limitations of the study.
• Guided imagery was assessed for relieving tension chronic headache, and compared to a control group.
Statistically significant improvements in headache frequency were seen for the guided imagery group, and
in terms of body pain, vitality and mental health.
• Guidelines on pain management state that as many sufferers with chronic pain are known to have higher
postoperative pain scores and a prolonged pain resolution after surgery, identifying and treating their pain
aggressively after surgery could positively impact their long-term pain state. Managing acute pain in
intensive care unit (ICU) patients may help to prevent the development of affective disorders that often
accompany chronic pain. An altered emotional and cognitive state is considered an important contributor
to the excessive suffering that characterizes chronic pain conditions. 2 (Level 5)
• Evidence from a review concluded that concurrent or past pain may be the greatest risk factor for the
development of chronic pain. Furthermore, those with chronic pain are often challenged by affective
disorders such as depression, which may affect recovery.3 (Level 4)
• Evidence from a randomized controlled trial (RCT) suggested that a smartphone-delivered intervention
can reduce symptom levels and functional impairment, and most importantly prevent catastrophizing.
Patients documented their pain thrice daily and received personalized feedback from a therapist based on
cognitive behavioral principles.4 (Level 2)
• A systematic review reported that chronic pain often goes untreated because patients refuse to visit a
healthcare institute. The most significant factors associated with help-seeking behavior for chronic pain
are increasing age, female gender, severity of pain and disability. Psychosocial factors include past
help-seeking, outcome expectancy, social cost and social influence. 5 (Level 4)
• A prospective RCT was conducted to examine the effect of a hand massage technique (M technique)
with or without aromatherapy, against nurse’s presence alone for older adults with chronic pain. The study
found that M technique hand massage with or without aromatherapy significantly decreased chronic pain
intensity compared to nurse presence visits.6 (Level 1)
• A multisite, RCT was conducted to evaluate the effectiveness of a health care delivery model that trains
nurse practitioners to deliver pain coping skills training to patients with osteoarthritis in community
practices. Results revealed significant improvements in a range of pain-related variables including pain
intensity, coping with pain, self-efficacy for controlling pain, activity interference due to pain, and the use
of pain medication when compared with usual care. 7 (Level 1)
• A study conducted using a cross-sectional survey has shown that the most common activities utilized by
nurses to manage chronic pain in patients are: establishment of a relationship with the patient, discussion
of therapeutic modalities with the treating physician, and personalized training for the patient. The nurses
within this population assessed attribute barriers in chronic pain management to lack of interventions as
well as knowledge pertaining to this area. 8 (Level 4)
• An RCT showed that management of patients with chronic pain, using a collaborative approach
comprising a nurse care manager, physician pain specialist and the patients’ primary carer, assisted in
improving patient outcomes. This was executed via telephone follow up over 12 months. 9 (Level 1)
• An RCT evaluated the effectiveness of a nurse-delivered telehealth intervention of cognitive behavioral
therapy (CBT) versus supportive psychotherapy for chronic back pain. The authors reported a significant
improvement in the Roland Morris Disability Questionnaire (RMDQ), pain intensity and Clinical Global
Impression Scale in the telehealth intervention group. It was concluded that CBT telehealth intervention
was as beneficial as supportive psychotherapy.10 (Level 1)
Characteristics of the Evidence
The evidence included in this summary is from a structured search of the literature and selected
evidence-based health care databases. Evidence in this summary is from:
• A systematic review including eight trials. 1
• Evidence-based guidelines from the United States. 2
• A review of the literature.3
• An RCT that involved 140 women.4
• A systematic review of 23 cross-sectional studies, population studies and qualitative studies. 5
• A prospective RCT of three groups of 39-40 participants. 6
• A multisite, RCT with 129 patients in intervention group and 127 patients in control groups. 7
• A cross-sectional survey study. 8
2

• An RCT that included 250 patients. 9
• An RCT that involved 61 participants.10
Best Practice Recommendations
• Nursing interventions can be simple and effective for chronic pain and may be considered in addition to
pharmacological treatments. Promising treatments include music therapy, cognitive behavioral therapy,
magnetic therapy, guided imagery, education, and sensory stimulation. (Grade B)
• Managing acute pain may help prevent affective disorders that often be set chronic pain sufferers.
(Grade B)
• M technique hand massage is a safe, simple, but effective intervention in chronic pain management.
(Grade B)
• A collaborative approach comprising a nurse care manager, physician pain specialist and the patients’
primary carer can assist in improving patient outcomes. (Grade A
References
1. Castillo-Bueno MD, Moreno-Pina JP, Martínez-Puente MV, Artiles-Suárez MM, Company-Sancho MC,
García-Andrés, et al. Effectiveness of nursing intervention for adult patients experiencing chronic pain: a
systematic review. JBI Library of Systematic Reviews. 2010;8(28):1112-1168.
2. Jarzyna D, Jungquist CR, Pasero C, Willens JS, Nisbet A, Oakes L, et al. American Society for Pain
Management. Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression.
Pain Manag Nurs. 2011;12(3).
3. Kyranou M, Puntillo K. The transition from acute to chronic pain: might intensive care unit patients be at
risk? Ann Intensive Care. 2012;2(1):36.
4. Kristjansdottir OB, Fors EA, Eide E, Finset A, Stensrud TL, van Dulmen S, et al. A smartphone-based
intervention with diaries and therapist feedback to reduce catastrophizing and increase functioning in
women with chronic widespread pain. part 2: 11-month follow-up results of a randomized trial. J Med
Internet Res. 2013;15(3):e72.
5. Cornally N, McCarthy G. Help-seeking behaviour for the treatment of chronic pain. Br J Community
Nurs. 2011;16(2):90-8.
6. Cino K. Aromatherapy hand massage for older adults with chronic pain living in long-term care. J Holist
Nurs. 2014; 32(4):304-13.
7. Broderick JE, Keefe FJ, Bruckenthal P, Junghaenel DU, Schneider S, et al. Nurse practitioners can
effectively deliver pain coping skills training to osteoarthritis patients with chronic pain: A randomized,
controlled trial. Pain. 2014; 155(9):1743-54.
8. Bergeron DA, Bourgault P, Gallagher F. Nursing activities in family medicine groups for patients with
chronic pain. Pain Res Manag. 2015;20(2):101-6.
9. Kroenke K, Krebs EE, Wu J, Yu Z, Chumbler NR, Bair MJ. Telecare collaborative management of
chronic pain in primary care: a randomized clinical trial. JAMA. 2014;312(3):240-8.
10. Rutledge T, Atkinson JH, Holloway R, Chircop-Rollick T, D'Andrea J, Garfin SR, et al. Randomized
controlled trial of nurse-delivered cognitive-behavioral therapy versus supportive psychotherapy telehealth
interventions for chronic back pain. J Pain. 2018; 19(9):1033-39.
The author declares no conflicts of interest in accordance with International Committee of Medical Journal Editors (ICMJE) standards.
How to cite: Dieu Huong Nguyen, MBBS, MHHSM, MPH. Evidence Summary. Chronic Pain: Nursing Interventions. The Joanna Briggs Institute EBP
Database, JBI@Ovid. 2019; JBI4241.
For details on the method for development see Munn Z, Lockwood C, Moola S. The development and use of evidence summaries for point of care
information systems: A streamlined rapid review approach. Worldviews Evid Based Nurs. 2015;12(3):131-8.
Note: The information contained in this Evidence Summary must only be used by people who have the appropriate expertise in the field to
which the information relates. The applicability of any information must be established before relying on it. While care has been taken to
ensure that this Evidence Summary summarizes available research and expert consensus, any loss, damage, cost or expense or liability
suffered or incurred as a result of reliance on this information (whether arising in contract, negligence, or otherwise) is, to the extent
permitted by law, excluded.
Copyright © 2019 The Joanna Briggs Institute licensed for use by the corporate member during the term
of membership.
3