Physical Modalities
Cold: vasoconstriction, reduces edema (acute injury, 20 min on/off). Heat: vasodilation, reduces muscle spasm (chronic pain). Massage: reduces tension, promotes relaxation. TENS: gate control theory. Acupuncture: moderate evidence. Positioning. Exercise. Splinting.
Psychological Approaches
CBT: changes pain-related thoughts, improves coping. Mindfulness: non-judgmental awareness, reduces pain intensity. Guided imagery. Breathing techniques. Progressive muscle relaxation. Distraction: music, conversation. Music therapy. Hypnosis. Biofeedback.
Integrating with Care
Combine with pharmacologic management — multimodal approach. Assess patient preferences. Educate on self-management. Environment: reduce noise, dim lights, privacy. Sleep hygiene. Family involvement. Cultural considerations. Document interventions and response.
Important Notes
- Non-pharmacologic methods are complementary, not replacements — combine with appropriate pharmacologic management.
- Music therapy can reduce opioid requirements by 25-50% in surgical patients — powerful, low-cost intervention.
Clinical Tips
- Apply cold for acute injuries (first 48h), heat for chronic pain and muscle spasm.
- Teach diaphragmatic breathing to anxious patients in pain — reduces both anxiety and pain perception.
Summary
Non-pharmacological pain strategies (cold/heat, massage, CBT, mindfulness, distraction, music) are essential components of multimodal pain management.
