Project overview statement 

Both children and adults suffer from chronic pain. This project is to inform you of the most up to date and best practices to treat the population of chronic pain due to its vast difference from acute pain.

Objectives

After participating in the nursing education, the learner will be able to list risk factors for developing chronic pain.

After participating in the nursing education, the learner will be able to identify populations at risk for chronic pain.

After participating in the nursing education, the learner will be able to carry out interventions for treatment of chronic pain.

Who is at risk for developing chronic pain?

  • Anyone who has suffered an Injury. This is known as a biological risk factor.
  • Anyone who is under pressure and social stress. This is known as a social risk factor. Examples of where this stress takes place includes the workplace, home life, and social life. 
  • Anyone who is experiencing life stressors. This is known as a psychological risk factor. Pain that is exacerbated life stressors- Psychological stress factor
  • Anyone who experiences an interruption in the processing of pain between body and the brain.

Chronic pain in the pediatric population

  • Checa-Peñalver et al., conducted a systematic review to research chronic pain in the pediatric population and how it affects the child as well as their parents. 
  • Personalized care for the treatment of chronic pain is crucial to promoting coping strategies and maximizing function. Treating chronic pain adequately can mitigate the risk of anxiety and depression (Checa-Peñalver et al., 2024). 
  • Nonpharmacological treatment of chronic pain reduces the risk of dependence on controlled substances. Alternative therapies include hypnotherapy, cognitive behavioral therapy, and music therapy help alleviate pain. Some apps and virtual options increase compliance among children. Quality of life, emotional, physical, and social well-being were improved using nonpharmacological therapies (Checa-Peñalver et al., 2024). 
  • Birnie et al., conducted a systematic review to discover the gaps in evidence for interventions in chronic pain for pediatrics and help to further patient-oriented research.  
  • In both children and adults, chronic pain is the leading cause of disability. Identification of priorities has made it more likely for coordination of care to be improved (Birnie et al., 2020). 
  • The most evidence was provided in areas of pharmacological and psychological interventions for pediatric chronic pain (Birnie et al., 2020)

How can diet improve chronic pain? 

  • According to a systematic review conducted in the USA by Frediani et al., this study demonstrates the effect of certain supplements and diet reccomendations for 3 types of chronic pain including diabetic peripheral neuropathy, chemotherapy induced neuropathy, complex regional pain syndrome. Here is what the study results yielded: 
  • The purpose of the following study was to discover how diet, vitamins, and supplements affect pain management in adults who suffer from chronic pain. 
  • In regard to diabetic peripheral neuropathy, vitamins B12, vitamin E, and vitamin D are helpful in managing chronic pain. Diet reccomendations include a broad spectrum low-fat and plant-based foods (Frediani et al., 2023). 
  • For chemotherapy induced neuropathy vitamin E, vitamin B12, glutamine, carnitine, magnesium, calcium, and antioxidants should be contained within foods and supplemented as needed (Frediani et al., 2023). 
  • Concerning complex regional pain syndrome vitamin C was helpful to study participants (Frediani et al., 2023). 
  • Additionally, other miscellaneous types of chronic pain not categorized were supplemented with St. John’s Wort and magnesium (Frediani et al., 2023). 
  • The conclusion suggests that alpha-lipoic acid, acetyl- l- carnitine, and vitamin D are beneficial in the treatment of chronic pain while other supplements had varying evidence (Frediani et al., 2023).

Improving sleep with chronic pain

  • To assess sleep in those who suffer from chronic pain Papaconstantinou et al., conducted a systematic review in the USA to discover the relationship between poor sleep and persistent pain. 
  • Poor sleep due to pain is typically undertreated because of the difficulty associated with the assessment and management of chronic pain (Papaconstantinou et al., 2021). 
  • Cognitive behavioral coping techniques were reported to provide a significant improvement with sleep (Papaconstantinou et al., 2021).
  • Recommendations include providing education and screening to help detect and treat this problem (Papaconstantinou et al., 2021). 

Mind-body connection and antidepressants 

  • Gnall et al., conducted a meta-analysis to research mind-body therapies in the treatment of chronic pain. 
  • Interoception is the feeling of physical sensations that are identified from the inside of the body. Subtopics of interoception that also had improvements were decreased worrying, more trust, self-regulation, body listening, regulation of attention, and emotional awareness (Gnall et al., 2024). 
  • Interoceptive awareness helps to decrease chronic pain in adults. Pain interference and intensity were improved with the use of mind-body therapy. Interoception should be used as a tool to treat chronic pain (Gnall et al., 2024). 
  • To identify long-term treatment of pain using psychomotor physiotherapy Øien et al., conducted a meta-synthesis to discover the relationship between the voices of those who experience chronic pain and how it influences a person’s identity. 
  • Voices, the body, and the mind influence one another interchangeably. Through multiple studies' patients’ felt massage, touch, movement, and self-reflection helped to better emotionally express themselves while dealing with chronic pain (Øien et al., 2022). 
  • Birkinshaw et al., conducted a meta-analysis to determine indications for antidepressants in the treatment of chronic pain.
  • Duloxetine and milnacipran are effective in the treatment of chronic pain. Nonpharmacological methods have the potential to be just as effective (Birkinshaw et al., 2024).

Can the internet help with chronic pain? 

  • To further assess the effectiveness of online pain management programs in varying characteristics of chronic pain Chew et al., conducted a meta-analysis. 
  • Online pain management is effective for various musculoskeletal conditions. The education decreased pain intensity. Quality of life was reportedly improved with decreased occurrence of depression during treatment (Chew et al., 2023). 
  • Online pain management is specifically the most effective in patients with fibromyalgia. Symptom management, coping skills, and lifestyle skills were included in online education (Chew et al., 2023).

 

Manual therapies and alternative medicine treatment 

  • A systematic review by Kendall et al., studied massage, manipulation, exercise, and mobilization for the treatment of chronic pain. The purpose of the study was to research the effects of manual interventions to improve musculoskeletal pain and to also understand how manual therapies can improve dynamic stability. Evidence corroborated that manual therapy leads to increased balance resulting in improved pain management while also reducing the risk for falls (Kendall et al., 2020). 
  • A separate systematic review by Yan et al., discovered how acupuncture can be an effective treatment for depression and pain together. 
  • The treatment of chronic pain becomes more difficult when accompanied by depression. Acupuncture can be more effective in the treatment of chronic pain than treatment with medications. This is because depression and pain are exacerbated by one another (Yan et al., 2020).

Implementation- Example Nursing Care Plans

References

Birkinshaw, H., Friedrich, C., Cole, P., Eccleston, C., Serfaty, M., Stewart, G.,White, S., Moore, A., Phillippo, D., & Pincus, T. (2024). Antidepressants for pain management in adults with chronic pain: A networkmeta-analysis. Health Technology Assessment, 1–155. https://doi.org/10.3310/mkrt2948  

Birnie, K. A., Ouellette, C., Do Amaral, T., & Stinson, J. N. (2020). Mapping the evidence and gaps of interventions for pediatric chronic pain to inform policy, research, and practice: A systematic review and Quality Assessment of Systematic Reviews. Canadian Journal of Pain, 4(1), 129–148. https://doi.org/10.1080/24740527.2020.1757384  

Checa-Peñalver, A., Lírio-Romero, C., Luiz Ferreira, E. A., Hernandes-Iglesias, S., García-Valdivieso, I., Pérez-Pozuelo, J. M., & Gómez-Cantarino, S. (2024). Effectiveness of Non-Pharmacological Interventions in the Management of Pediatric Chronic Pain: A Systematic Review. Children, 11(12),1420. https://doi.org/10.3390/children11121420

Chew, M. T., Chan, C., Kobayashi, S., Cheng, H. Y., Wong, T. M., & Nicholson, L. L. (2023). Online pain management programs for chronic, widespread musculoskeletal conditions: A systematic review with meta‐analysis. Pain Practice, 23(6), 664–683. https://doi.org/10.1111/papr.13227 

Frediani, J. K., Lal, A. A., Kim, E., Leslie, S. L., Boorman, D. W., & Singh, V. (2023). The role of diet and non‐pharmacologic supplements in the treatment of chronic neuropathic pain: A systematic review. Pain Practice, 24(1), 186–210. https://doi.org/10.1111/papr.13291  

Gnall, K. E., Sinnott, S. M., Laumann, L. E., Park, C. L., David, A., & Emrich, M. (2024). Changes in interoception in mind-body therapies for chronic pain: A systematic review and meta-analysis. International Journal of Behavioral Medicine, 31(6), 833–847. https://doi.org/10.1007/s12529-023 10249-z  

Jockers, Dr. (2024, October 6). Chronic pain: Root causes and natural support strategies. DrJockers.com. https://drjockers.com/chronic-pain/ 

Kendall, J. C., Vindigni, D., Polus, B. I., Azari, M. F., & Harman, S. C. (2020). Effects of manual therapies on stability in people with musculoskeletal pain: A systematic review. Chiropractic & Manual Therapies, 28(1). https://doi.org/10.1186/s12998-020-0300-9

Øien, A. M., & Dragesund, T. (2022). Identifying contrasting embodied voices of identity: a qualitative meta synthesis of experiences of change among patients with chronic musculoskeletal pain in long-term physiotherapy. Physiotherapy Theory and Practice, 40(1), 42–55 https://doi.org/10.1080/09593985.2022.2100298

Papaconstantinou, E., Cancelliere, C., Verville, L., Wong, J. J., Connell, G., Yu, H., Shearer, H., Timperley, C., Chung, C., Porter, B. J., Myrtos, D., Barrigar, M., & Taylor-Vaisey, A. (2021). Effectiveness of non pharmacological interventions on sleep characteristics among adults with musculoskeletal pain and a comorbid sleep problem: A systematic review. Chiropractic & Manual Therapies, 29(1). https://doi.org/10.1186/s12998-021-00381-6

This Way Up. (n.d.). Chronic Pain Explained. YouTube. https://youtu.be/33Eqandw_-4 

Yan, B., Zhu, S., Wang, Y., Da, G., & Tian, G. (2020). Effect of acupuncture on chronic pain with depression: A systematic review. Evidence-Based Complementary and Alternative Medicine, 2020(1).  https://doi.org/10.1155/2020/7479459