Patient teaching should include procedural and sensory information, instruction to decrease treatment and activity-related pain (e.g., pain caused by deep breathing, coughing) and information about the use of relaxation. Cognitive-behavioral (e.g., relaxation, distraction, imagery) and physical interventions (e.g., heat, cold, massage) are intended to supplement, not replace, pharma-cologic interventions. Cognitive behavioral interventions include a variety of methods that help patients understand more about their pain and take an active role in pain assessment and management. Simple relaxation strategies can be effective in helping to manage pain. Patients benefit from periodic reinforcement and coaching in the use of relaxation techniques. Commonly used physical agents include applications of heat and cold, massage, movement, and rest or immobilization. Applications of heat and cold alter the pain threshold, reduce muscle spasm, and decrease local swelling. Transcutaneous electrical...
Feedback, deep breathing exercises) might facilitate mitigation of pain and accompanying psychological distress. However, the presence of an underlying delirium would certainly limit the ability of the patient to obtain any benefit from psychotherapeutic interventions. In such cases, resolution of the underlying medical condition, the addition of antipsychotics, or both, might be required to reduce the interference of any psychological interventions by a delirium.
The technology involved in biofeedback has enhanced the opportunities and approaches available in pain management. Eventually, with practice, the patient learns to attend to physical cues that signal that relaxation, deep breathing, and changes in cognitive strategies are required (e.g., sensing one's own heightened muscle tension). The patient is then able to invoke those strategies to reduce the tension without requiring the use of the biofeedback equipment. However, some practitioners question the utility of biofeedback and the necessity of all the cumbersome technology, arguing that other strategies (e.g., relaxation training) are equally efficacious (Silver and Blanchard 1978). Relaxation and imagery (R&I) has been employed in both acute and chronic pain and has been successfully implemented in the treatment of tension headache, migraine headache, temporomandibular joint pain, chronic back pain, and myofascial pain syndrome (Turner and Chapman 1982a). Progressive muscle...
VDT vibration detection threshold HBDB heart beat to deep breathing CMAP compound muscle action potential MNCV motor nerve conduction velocity MNDL motor nerve distal latency SNAP sensory nerve action potential NSC neuropathy symptoms and changes CDT coding detection threshold HP heat as pain NC nerve conduction.
There is considerable evidence that preparation for childbirth can significantly modify the pain experience. Fear, fatigue, and anxiety can all enhance pain perception, thus good antenatal education may modify the experience, but it will not lead to painless childbirth. Labor support and relaxation and breathing techniques form the basics for this technique. The continuous presence of a midwife or female support person (doula) has been shown to decrease the severity of pain reported. Relaxation techniques and or self-hypnosis can relieve anxiety and tension and thus modify the pain experience. These techniques should be encouraged for all pregnant women.
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