Editor's Note: For wound care patients struggling with pain, what alternative pain management techniques are available? Thanoon Thabet, BSN, RN, WTA-C discusses various pain management therapies available for clinicians looking for solutions outside of medications. Methods discussed include transcutaneous electrical nerve stimulation, cognitive behavioral therapy, and virtual reality.

Non-Pharmacological Pain Management: What’s Out There? from HMP on Vimeo.

Transcript

My name is Thanoon Thabet and I work at Bronxville, in NewYork-Presbyterian Westchester medical center.

I'm a nurse in medical surgical units and I've recently acquired my Wound Treatment Associate Certification (WTA-C). Currently I’m in walk school, acquiring my stress specialty in Wound, Ostomy and Continence.

For pain management, what non-pharmacological methods do you see emerging in wound care?

When we look worldwide, mainly in China and USA, we see that the dominant intervention for pain management is drugs. There's less intervention in non-pharmacological ways and if you do see case studies and evidence in literature, there is a plethora of studies that do suggest that these non-pharmacological pain management methods help.

And if you have a look at one, the TENS, Transcutaneous Electrical Nerve Stimulation, which basically stimulates the nerves around where the wound is and blocks the pain signals going to the brain. Another theory as to how this method helps is, when you stimulate these nerves, it releases endorphins, which are the body’s natural painkillers. So that's one way.

Other interventions are cognitive behavioral therapies, music therapy, there's yoga, there is hypnotics, and my favorite one is, right now that's emerging, is virtual reality. The way virtual reality works is through 2 different theories. One theory is that it helps distract the patient. So, it takes the patient away from painful stimuli and increases their attention to pleasant stimuli.

It takes them away from the painful world when you change their dressings to a more pleasant world.

So, virtual reality submerges the patient into different environments, like they're in the ocean, they're swimming with dolphins, they're with penguins, etc. One may ask “how does this relate to physical pain?” There is a connection between when patients experience stress and anxiety due to wounds that correlates with pain. Because stress and anxiety releases catecholamines, cortisol, which then inhibit oxygen and the patient's immunity, so that subsequently will affect how the patient perceives pain.

So that is one way how virtual reality affects patient’s pain levels psychologically. And there are other studies that suggest it changes behaviors in the brain, like the thalamus or where there's a lot of pain activity. So, psychologically and revealed through neuroscience, that's how it also affects it.

This method of pain management is worth honestly trying for these patients because I've had patients where we need to do a wound dressing and it's very painful and, at the moment, I need to somehow distract them. But it's very difficult to do that unless because these VRs can be patient customized, and the patient can choose whatever environment that they want.

About the Speaker

Thanoon Thabet, BSN, RN, WTA-C is an early career Clinical Nurse who holds a Wound Treatment Associate certification (WTA-C) through the Wound, Ostomy, and Continence Nursing Certification Board (WOCNCB). His clinical focus is adult-geriatric medical and surgical nursing, with plans to pursue future full tri-specialty certification in WOC Nursing. He values nursing mentorship and is passionate about engaging in scholarship activities such as evidence-based practice, academic advancement, and nursing leadership.