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Free Literature Review On Combination Of Prn Narcotics With Massage Therapy In Pain Management
Abstract
PRN narcotics combined with massage therapy represent a typical clinical practice used to manage acute pain. Nonetheless, PRN narcotics have come under increasing scrutiny because of their association with safety and dependence problems. The present study presents a review of current literature on the use of massage as a pain management technique. Researchers have identified the effectiveness of foot massage, touch massage, vibration therapy combined with adjunctive massage, and rhythmical massage in the control of stress and postoperative pain. In a recent study, patients with back pain have reported experiencing chronic pain for about one to eight years following a spinal fusion. Hence, there is a need to carry out a study on the control of chronic pain based on an approach that combines PRN narcotics with massage therapy.
Keywords: PRN narcotics, massage, chronic pain, postoperative pain
In addition to massage, the utilization of “pro re nata” (PRN) or “as needed” narcotics is a typical clinical practice used to manage acute pain (Gordon et al., 2008). The PRN narcotics’ administration provides dosing flexibility aimed at meeting the unique needs of each patient. Nurses have reported the effectiveness of using narcotic analgesics and massage therapy as a combined treatment modality for short-term pain (Walton, 2010).
Problem Statement
In recent years, however, PRN narcotics have come under increasing scrutiny because of their association with safety and dependence issues (Vimont, 2011). Usually, the administration of range orders is influenced by exaggerated opioid safety concerns and inadequate understanding “of analgesic titration” (Gordon et al., 2008). In the present study, no previous research aimed at determining the effectiveness of a combined PRN narcotics and massage therapy in the management of chronic pain was found. Hence, there is a need to perform such an inquiry in order to determine the role of the combined therapy in treating long-lasting physical pain.
Hypothesis
The present paper hypothesizes that the combination of PRN narcotics and massage therapy might effectively relieve chronic pain.
Literature Review
Massage is considered as the most frequently utilized complementary treatment technique in nursing. Joy, Arora, and Tamang (2014) assessed the use of feet massage in post-operative care and reported its effectiveness in pain alleviation. The researchers noted that it provided numerous benefits, particularly the rejuvenation of a patient’s energy, improved blood circulation, relaxation, and tranquility. Joy et al. (2014) concluded that the technique was highly effective when used to manage pain following abdominal surgery in patients. Therefore, nurses can use foot massage as a cheap and easy technique for managing postsurgical pain in addition to pharmacological approaches. Furthermore, the method has an excellent safety record because it lacks adverse effects.
Recently, touch massage has been employed increasingly to alleviate the pain of patients in intensive care units. However, the absence of systematic studies on the technique’s effectiveness led Lindgren et al. (2013) to study a complex intervention in touch massage based on “the British Medical Research Council framework” (p. 269). The researchers aimed at assessing the touch massage’s effects on physiological stress and anxiety in patients awaiting elective aortic operation. The pilot study employed a randomized and regulated design involving twenty patients that had been scheduled to undergo an elective aortic operation. The study results showed significant variations in the levels of self-reported nervousness before touch massage and after the massage (Lindgren et al., 2013). Although the controls failed to report such variations, a substantial difference in the levels of self-reported nervousness between the controls and the group that underwent touch massage was noted. Nonetheless, no significant variations in physiological outcome parameters associated with stress between the controls and the patients that experienced touch massage were observed. The researchers concluded that touch massage was effective in reducing the levels of anxiety in patients prior to undergoing “elective aortic surgery” (Lindgren et al., 2013, p. 269). Thus, touch massage can ameliorate the post-operative and the intensive care of patients.
Walchli et al. (2014) conducted a study to examine physiologic effects associated with “rhythmical massage (RM),” which is an effective anthroposophic therapy (p. 507). In the investigation, the participants included patients that had been “referred to RM at the Paracelsus Hospital Richterswil” (Walchli et al., 2014, p. 507). The subjects received about ten sessions of RM, which were followed by periods of therapeutic rest. Electrocardiography (ECG) and infrared imaging were used to determine RM’s effects on the variability of heart rate and the surface temperature, respectively. Infrared imaging of the dorsal region of the patients required the participants to remove clothes and stand straight, at the beginning and the completion “of two waiting periods before and after RM” (Walchli et al., 2014, p. 507.). The researchers performed ECG from the start of the initial waiting duration until the second period ended. Following the RM, the results showed an instant increase in the temperature of the dorsal region (Walchli et al., 2014). In addition, the comparison of infrared images taken during the RM sessions indicated a trend towards enhanced warmth distribution due to the effect of progressive therapy. Records of ECG taken while the participants were seated showed that RM increased “heart rate variability (HRV)” significantly (Walchli et al., 2014). During “the RM sessions,” Walchli et al. (2014) noted that the initial value influenced HRV’s changes during the period of therapeutic rest with low values being enhanced whereas the high initial values were reduced. Therefore, the researchers concluded that RM increased the surface temperature of the patients’ dorsal region, sympathetic stimulation, and HRV. Finally, RM led to a progressive amelioration of the resting HRV’s regulation and the distribution of warmth (Walchli et al., 2014).
In another study, Taylor et al. (2003) examined vibration therapy and “adjunctive postoperative massage” and reported their influence on physiologic stress responsiveness, negative affect, and temporary postsurgical pain (p. 77). The researchers concluded that “adjunctive gentle Swedish massage therapy” might have small effects on distress and affective pain, as well as postoperative pain in women that undergo abdominal laparotomy (Taylor et al., 2003, p. 86). In addition, various vibration and massage interventions might benefit patients experiencing distress and high levels of pain. Nevertheless, Taylor et al. (2003) recommended further investigations and clinical trials of such techniques. In a related study, Halm (2015) assessed the impact of massage on “cardiac surgery patients” (p. 176). The author reported that massage lessened tension and anxiety in most patients, although the intervention failed to affect depression and mood. Massage also minimized muscular tension, respiratory rate, and blood pressure (Halm, 2015).
Approximately eighty percent of people report low back pain at least once in their lifetimes (Wall & Melzack, 2006). While most patients recover in a few days or weeks, a few develop “chronic low back pain (CLBP)” (Bentsen et al., 2008, p. 154). Typically, patients with the condition experience acute discomfort in the legs, feet, shoulders, neck, and hip. Bentsen et al. (2008) investigated the future expectations and pain experiences of CLBP patients that had undergone spinal fusion. The author observed that most CLBP patients continued to experience chronic pain for about one to eight years following the spinal fusion. In addition, a positive future outlook in the patients appeared to be linked to relatively lesser pain (Bentsen et al., 2008). Therefore, psychoeducational interventions might prove valuable to patients that lack positive future outlooks and experience persistent pain.
Conclusion
PRN narcotics combined with massage therapy have been used extensively to provide relief from acute pain. Nonetheless, the present review hypothesized that the combination of PRN narcotics with massage therapy might effectively relieve chronic pain. Studies have identified the potency of foot massage, touch massage, vibration therapy and “adjunctive postoperative massage” (Taylor et al., 2003, p. 77), and rhythmical massage in the management of stress and postoperative pain. However, Bentsen et al. (2008) reported that CLBP patients continued to experience chronic pain for about one to eight years following a spinal fusion. Therefore, there is a need to conduct a study on the management of chronic pain based on an approach that combines PRN narcotics with massage therapy.
References
Bentsen, S.B, Rustoen T., Wahl, A. K. & Miaskowski, C. (2008). The pain experience and future expectations of chronic low back pain patients following spinal fusion. Journal of Clinical Nursing, 17(7b), 153-159. doi: 10.1111/j.1365-2702.2007.02234.x
Gordon, D. B., Pellino, T. A., Higgins, G. A., Pasero, C., & Murphy-Ende K. (2008). Nurses’ opinions on appropriate administration of PRN range opioid analgesic orders for acute pain. Pain Managing Nursing, 9(3), 131-140. doi: 10.1016/j.pmn.2008.03.003.
Halm, M. A. (2015). East meets west: effects of massage on the experience of cardiac surgery patients. American Journal of Critical Care, 24(2), 176-180. doi: http://dx.doi.org/10.4037/ajcc2015947
J., Chitra, Arora, S., & Tamang, E. L. (2014). A study to assess the effectiveness of foot massage on pain among patients after abdominal surgery in a selected hospital of Delhi. International Journal of Nursing Education, 6(2), 112-116. doi: 10.5958/0974-9357.2014.00616.3
Lindgren, L., Lehtipalo, S., Winso, O., Karlsson, M., Wiklund, U., & Brulin, C. (2013). Touch massage: A pilot study of a complex intervention. British Association of Critical Care Nurses, 18(6), 269-277. doi: 10.1111/nicc.12017
Taylor, A. G., Galper, D. I., Taylor, P., Rice, L. W., Andersen, W., Irvin, W., Wang, X. -Q., & Harrell Jr., F. E. (2003). Effects of adjunctive Swedish massage and vibration therapy on short-term postoperative outcomes: A randomized, controlled trial. Journal of Alternative and Complementary Medicine, 9(1), 77–89. doi:10.1089/107555303321222964.
Vimont, C. (2011). Challenges of treating chronic pain in people with opioid dependence. Retrieved from http://www.drugfree.org/join-together/challenges-of-treating-chronic-pain-in-people-with-opioid-dependence/
Walchli, C., Saltzwedel, G., Kruerke, D., Kaufmann, C., Schnorr, B., Rist, L., & Simoes-Wust, A. P. (2014). Physiologic effects of rhythmical massage: A prospective exploratory cohort study. Journal of Alternative and Complementary Medicine, 20(6), 507–515. doi: 10.1089/acm.2012.0833
Wall, P. & Melzack, R. (2006). Textbook of pain. London, UK: Elsevier, Churchill Livingstone.
Walton, T. (2010). Medical conditions and massage therapy: A decision tree approach. Philadelphia, PA: Lippincott Williams & Wilkins.
