University Nursing Report: Evidence-Based Pain Management Strategies

This report presents an evidence-based nursing research analysis focusing on non-pharmacological interventions for chronic pain management, particularly in post-operative and palliative care settings. The research explores the concept and importance of evidence-based practice, outlining the five steps involved (ask, access, appraise, apply, and assess). The study investigates the efficacy of music therapy compared to analgesics, highlighting two key articles that support the use of music for pain relief. The report includes a detailed PICO question, database searches (Cochrane, Medline, JBI), and a PRISMA flow diagram to illustrate the selection process. The appraisal of selected articles emphasizes the strengths and limitations of each study, followed by recommendations for implementing music therapy guided autogenic relaxation. The report also addresses potential barriers to implementation and outlines the evaluation process, emphasizing the use of the Numeric Rating Scale (NRS) and monitoring improvements in well-being. The conclusion reinforces the effectiveness of music as a non-pharmacological intervention, advocating for patient education to overcome potential objections to the therapy. References are provided to support the findings.

Running head: EVIDENCE BASED NURSING RESEARCH
Evidence Based Nursing Research
Name of the Student
Name of the University
Author Note

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Concept and importance of evidence-based practice in pain management
Chronic pain is a major concern irrespective of the age of the individuals. However,
mainly the older adults are the major victims of chronic pain. Though pain management is
targeted as the main priority, it continues to be addressed inadequately. The use of
pharmacological medications for the management of pain is associated with numerous side-
effects and hence the importance of non-pharmacological strategies for the management of
chronic pain is gaining prominence. The professional nurses are in a unique position for
facilitating the acquisitions and subsequent utilization of the non-pharmacological strategies
for pain management (Duke et al., 2013). According to Gelinas et al. (2013) there is lack of
proper evidence-based practices in the domain of non-pharmacological management of pain.
However, evidence-based practice is an importance aspect of nursing interventions (Craig &
Smyth, 2012). The concept of evidence-based practice is guided by 5 steps and this includes
ask, access, appraise, apply and access. Ask deals with formulation of the clinical question,
access helps to track down the best possible evidence, appraise consists of validity of the
evidences and consideration of its usefulness. Apply deals with integration of results within
the clinical expertise of the nursing professionals and final assessment deals with evaluation
of the effectiveness of the process (Melnyk & Fineout-overholt, 2015). The following paper
aims to highlight the best-suited evidence-based practice for non-pharmacological
interventions for chronic pain management.
Background
According to Nicholas et al. (2013) community dwelling adults who are aged over 65
years reports of having chronic pain in relation to accomplish daily living activities. The pain
arises either from arthritis or due to previous dispositions of some chronic diseases. The
adults in the post-operative care or in palliative care also suffer from chronic pain. Increase in

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the level of chronic pain hampers the quality of life of the adults. For effective management
of pain, non-pharmacological interventions care increasingly accepted due to side effects
associated with the pharmacological interventions. However, there is little evidence of the
widespread application and utility of non-pharmacological interventions for the management
of chronic pain among the older adults (Nicholas et al, 2013).
Thus, the main clinical question of this study is to what is the effect of music in
comparison to analgesic, as non-pharmacological intervention for the effective management
of pain among the adults in the post-operative care and palliative care unit?
Ask: PICO Questions
Population (P) Adults in post-operative care or palliative care
Intervention (I) Non-pharmacological pain management strategy
Comparison (C) Analgesic
Outcome (O) Pain relief and improved well-being
Time frame (T) 20 to 30 minutes

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Access: Research of the research articles
(Source of Prisma Table: Moher et al., 2009)
Search Parameters Used
Keywords used Pain Management AND Music AND Adults
Time filter 2013 to 2015
Records identified through database
searching (n= 125)
Studies included (n = 2)
Records after Duplicates removed ( 55)
Records screened
(n= 25)
Full text articles excluded with reasons
(n=13)
 Not as an intervention (n=3)
 Music used in combination
with other interventions (n=5)
 Conducted over children only
(n= 4)
 Pain score measured through
self-administered questions (1)
Full-text articles assessed for eligibility
(n=15)
Records excluded based on title
only
(n=30) Identification
Screening
Eligibility
Included
Medline (Ovid)
(n=25)
Joanna Briggs
Institution (JBI)
(n= 19)
Medline
(n=35)
Cochrane library
(n=46)

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Language English
Appraise: Summary and critique of the Selected Articles
Gutgsell, K. J., Schluchter, M., Margevicius, S., DeGolia, P. A., McLaughlin, B., Harris,
M., ... & Wiencek, C. (2013). Music therapy reduces pain in palliative care
patients: a randomized controlled trial. Journal of Pain and Symptom
Management, 45(5), 822-831.
Gutgsell et al. (2013) conducted the study in order to study the role of single music
therapy session in pain management of palliative care patients. Gutgsell et al. (2013) studied
200 in-patients of the University Hospitals Case Medical Care who are enrolled between
2009 to 2011. The patients were randomly assigned to two different groups. One groups
received medical and nursing care along with the scheduled use of analgesic while the other
group received the standard music therapy (30 minutes). The pre and posttest results were
used to assess the level of pain with the use of numeric rating scale and this was considered
as primary outcome. The secondary outcome of study includes functional pain scale,
consolability scale and activity of legs and expression in face. The intervention mainly
included music-therapy guided autogenic relaxation and live music. The analysis of the
results highlighted significant greater decrease in the numeric rating scale pain score among
the music therapy groups however no significant change was noticed in the secondary
outcomes however, the mean change in functional group is significantly greater. Gutgsell et
al. (2013) stated that therapist-guided autogenic relaxation and live music is effective in
decreasing the pain among the palliative care patients. As per the CASP checklist, the main
strengths of the study is the trial access the clearly focused issue with clearly discussed
population studies (palliative care), interventions given (music therapy) and the comparator

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used (use of analgesic) and the outcomes considered (decrease in pain score). The
randomization was also done in a proper manner as the selected group of patients were
randomly disseminated into two groups. The main limitations of the study are the study
personnel were not blinded to the treatment outcomes and this might lead to biased results.
Moreover, the results might not be applicable to local population as selected population was
palliative care adults.
Özer, N., Özlü, Z. K., Arslan, S., & Günes, N. (2013). Effect of music on postoperative
pain and physiologic parameters of patients after open heart surgery. Pain
Management Nursing, 14(1), 20-28.
The aim of the study conducted by Özer et al. (2013) was to investigate the effect of
listening to music of personal choice on decreasing the intensity of pain and other
physiological parameters among post open-heart surgery patients. Özer et al. (2013) mainly
used quasi-experimental study over 87 patients who under-went open heart surgery. 44
patients were assigned in the music group (20-minite of music) and 43 patients were groups
as placebo and aged between 18 to 78 years. The level of pain was measured through
Numeric Pain Score (NRS) and the parameters for the physiological assessment include
oxygen saturation, heart rate and blood pressure. The analysis of the results highlighted no
difference in the physiological parameter however, the NRS showed significant decrease
among the patients assigned under the music groups. Thus Özer et al. (2013) concluded that
music is safe and cost-effective method for reduction in chronic pain. According to the
critical appraisal checklist of quasi-experimental study of Jonna Briggs Institute, the main
strength of the article is, the people under one group received the same treatment. Moreover,
multiple measurements of the outcome was done through pre and post exposure. The
outcome was reliable as the author gave a detailed list of the pain score along with the
parameters of the physiological outcome. The main limitation of the study is, participants

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included in both the group do not have similar parameters. The age group selected was 18
and 78, the level of pain among the older adults and much higher than the young adults were
and this might lead to discrepancy in results.
Apply: Evidence Based Recommendation
Thus, the main evidence-based non-pharmacologic intervention that was selected for
the effective management of chronic pain is use of music of the choice of the patients for
about 30 minutes per day for getting music-therapy guided autogenic relaxation. The
implementation of the evidence-based information can be done under the presence of a
nursing professional and a music therapist. At first, the patient will be asked to pay attention
to breathing for about one minute. Then the therapist will ask the patient for autogenic muscle
relaxation by paying attention to the scalp muscles and allowing them to release and move
down slowly with similar focus on specific muscles. This muscle relaxation will end with the
feet while music playing in the background (Özer et al., 2013). According to Smith et al.
(2018), music of choice helps in mental relaxation, which help to decrease painful secretion,
and relaxation of the muscles further help to decrease the painful stimuli.
Access: Barriers and the Process of Evaluation
The process of evaluation of the reduction in the pain score will be measured with the
help of NRS. Along with this, improved on the well-being will also be monitored through
analyzing the increase in the level of quality sleep at night and improvement in mobility. The
potential barrier in implementation of the music therapy is the patient rejection. However,
proper education of the patients in the domain of importance of the psychosocial needs and
perceived benefits of the music therapy will be helpful in overcoming the strong patient
objection (Chen, 2017).

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Summary
Thus from the above discussion, it can be concluded that the pharmacological
procedure for the management of pain is associated with several side effects. However,
debilitating pain is a common problem among the adults either in the post-operative care,
palliative care or in aged care. The analysis of the two literary articles highlighted that music
can be used as an effective evidence-based non-pharmacological intervention for the
management of pain in comparison to the use of analgesic as pharmacological interventions.
However, proper patient education about the importance of the music therapy is required to
be conducted in order to overcome the patient’s denial of the accepting the music therapy.

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References
Chen, Y. C. (2017). Barriers to Music Therapy Participation for Cancer Patients during
Hospitalization (Doctoral dissertation, Ohio University).
Craig, J.V., & Smyth, R.L. (Eds.). (2012). The evidence-based practice manual for nurses
(3rd ed.). Oxford: Churchill Livingstone Elsevier.
Duke, G., Haas, B. K., Yarbrough, S., & Northam, S. (2013). Pain management knowledge
and attitudes of baccalaureate nursing students and faculty. Pain Management
Nursing, 14(1), 11-19.
Gelinas, C., Arbour, C., Michaud, C., Robar, L., & Côté, J. (2013). Patients and ICU nurses'
perspectives of non‐pharmacological interventions for pain management. Nursing in
critical care, 18(6), 307-318.
Gutgsell, K. J., Schluchter, M., Margevicius, S., DeGolia, P. A., McLaughlin, B., Harris,
M., ... & Wiencek, C. (2013). Music therapy reduces pain in palliative care patients: a
randomized controlled trial. Journal of Pain and Symptom Management, 45(5), 822-
831.
Melnyk, B. M., & Fineout-overholt, E. (2015). Evidence-based practice in nursing and
health care: A guide to best practice (3rd ed.). Philadelphia: Wolters Kluwer.
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for
systematic reviews and meta-analyses: the PRISMA statement. Annals of internal
medicine, 151(4), 264-269.

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Nicholas, M. K., Asghari, A., Blyth, F. M., Wood, B. M., Murray, R., McCabe, R., ... &
Overton, S. (2013). Self-management intervention for chronic pain in older adults: a
randomised controlled trial. PAIN®, 154(6), 824-835.
Smith, C. A., Levett, K. M., Collins, C. T., Armour, M., Dahlen, H. G., & Suganuma, M.
(2018). Relaxation techniques for pain management in labour. Cochrane Database of
Systematic Reviews, (3).