Pain management is an important aspect of surgical care, and pain levels vary among postoperative patients. Postoperative pain management is important because it leads to better outcomes and reduces the risk of long-term pain. Although postoperative analgesics are the mainstay of treatment, this review explores the emerging concept of preoperative pain management with promising potential. Such interventions include educating patients about expected pain outcomes and available pain medications. Non-pharmacological methods, such as relaxation exercises, have also been shown to be effective after abdominal surgery, and educating patients about the availability of such methods can encourage the use of available treatments. An important focus is the preoperative psychological and emotional well-being of the patient, because it strongly predicts pain and pain prognosis. An educational program can be used effectively to treat, manage preoperative anxiety, and reduce pain levels. Hypnosis is another technique for reducing stress. Finally, long-term preoperative opioid use was associated with higher pain scores and pain duration. This provides a rationale that preoperative opioid weaning can lead to favorable postoperative outcomes. Although many of these techniques have not been specifically tested in abdominal surgery recipients, they pave the way for new pain management strategies that may be acceptable for visceral surgery patients. This review directs readers and researchers to new and emerging areas that have the potential to change current pain management guidelines.
Pain Management through Paramedic Practices
The recognition of pain management as an important component of health care practice is reflected in the use of evidence-based guidelines for pain relief. However, this is only focused on acute pain and pharmacological interventions. Reference to non-pharmacological treatments is rare in clinical guidelines for health care professionals in Australia, apart from standard measures such as splinting, cooling and sedation. References to complementary and alternative therapies such as acupuncture are rare in health care literature and health education support resources.
Pain Relief through Pharmacological Methods=
Non-pharmacological interventions to alleviate pain rely on inhibition of pain signaling. Pain is caused by nociceptive transmission via small afferents to the spinal cord and subsequently to the higher brain nuclei and cerebral cortex. Nociceptive signals are mediated by peripheral and central components that can facilitate or suppress this input . These signals are modulated by midbrain networks that have bidirectional control over nociceptive transmission through the spinal cord. Several neurotransmitters are involved in mediating nociceptive signals including substance P, which facilitates transmission, and endogenous opioid-based compounds, which inhibit transmission. Non-pharmacological analgesia therefore involves inhibition of nociceptive input by activating separate ant nociceptive outputs. Procedures such as transcutaneous electrical nerve stimulation (TENS) and acupoint stimulation rely on inhibition of the nociceptive signal to produce an analgesic effect.
Non-pharmacological methods to pain assistance are usually related with non-acute situations and can be categorized as follows:
- Psychological mediations (including diversion, anxiety management, hypnosis and other cognitive-behavioral interpolations),
- Acupuncture and acupressure,
- Transcutaneous electrical nerve stimulation,
- Physical-treatments (including bodywork, heat/cold, rehabilitation, osteopathy and chiropractic).
This approach to pain management can complement or replace pharmacological treatment in some types of pain. Chronic pain (commonly encountered in medical practice) is a condition where a variety of interventions can be used to manage complex pain conditions such as cancer, low back pain, and endometriosis. Evidence of effectiveness is variable and may depend on the type of pain, type of intervention, patient characteristics, skills and experience of the clinician, and heterogeneous study population. For example, considerable variation in the effectiveness of acupuncture has been reported in the literature.
Transcutaneous Electrical Nerve Stimulation (TENS)
Research on the use of non-pharmacological interventions in health care practice is limited. This lack of research may reflect the evolving nature of health care practice as a health care profession. Also, non-pharmacological interventions for pain management associated with acute trauma or health emergencies may have limited impetus for research in this area, especially given the time-consuming nature of each interval in the patient’s treatment process. This performance is closely monitored. The drive to reduce the time spent with each patient is intended to increase efficiency and can limit the use of non-pharmacological treatment, which is more time-consuming to administer than opioids. In addition, the bias of physicians and service providers in favor of non-pharmacologic interventions for pain relief may prevent clinical trials comparing the effectiveness of these treatments.
Although TENS has been used clinically for three decades, the mechanism by which it produces analgesia has only recently been described. The gate control theory is the most commonly used theory to support the pain-relieving effects of TENS. Gate control theory explains how stimuli that activate non-sensory fibers can inhibit pain. Pain is reduced when the area is rubbed or stimulated due to the activation of non-nociceptive fibers, which reduce the nociceptive response in the dense horn of the spinal cord.
Acupuncture, Electro-acupuncture, and Acupressure
Stimulation of specific points on the body, commonly known as acupuncture, is a widely recognized therapeutic technique for treating pain and illness. Acupoint stimulation, like manual acupuncture, involves inserting and manipulating fine needles through the skin at specific points on the body to create a sensation known as de-qi. Treatments that involve acupoint stimulation include electro-acupuncture and acupressure. Electro-acupuncture requires the delivery of electric current through inserted needles. Acupressure involves the use of fingers and hands to stimulate acupoints in the body to relieve pain and clinical symptoms. Acupressure deals with the similar acupoints and highpoints as acupuncture. The only difference between the two interventions is that acupressure stimulates acupressure with finger pressure instead of fine points.
Effect of Warming Interventions on Pain
Unlike passive heating, where no external heat source other than the person’s body heat is used, active or resistance heating involves the use of an external heat source to warm the patient. This can be in the form of a heated blanket or room temperature. -A double-blind randomized study reported that fifty patients with minor injuries such as limited bleeding, fractures, or contusions who received active heat experienced less pain and anxiety compared to fifty who received passive heat. As the skin temperature increases, the subcutaneous temperature increases accordingly. Another study using this technique, published by the same group of researchers, showed that patients with abdominal pain from renal colic experienced less pain, anxiety, nausea, and heart palpitations, with an overall improvement in patient satisfaction.
Is this method effective?
There are many reasons why paramedic and emergency care practices are moving toward more advanced pharmacological interventions for the treatment of acute and chronic pain. This aligns with the areas of advanced life support and patient management strategies that are researched and continue to benefit from growing evidence. Although medical practice has focused on pharmacologic interventions for pain relief, there is a growing literature suggesting that a range of pharmacologic options may also play an important role in pain management in individuals cared for by physicians.
Medicine, as a growing profession, must examine several modalities and consider alternative and alternative therapies that can be used to reduce pain and reduce reliance on pharmacological interventions as the first line of pain management. If proven to be effective, the cost-saving analgesic effect can translate into lower costs and better patient outcomes with less adverse effects. However, more research is needed to develop the level of evidence needed to support practical changes.