Nonpharmacologic Measures

Applications of cold (to reduce inflammation) or heat (to reduce spasms) to muscles or joints are commonly employed techniques but evidence for an analgesic benefit is mixed. Hypnosis has been shown to reduce pain associated with medical procedures; however, it requires specific training and time to administer. Transcutaneous electrical nerve stimulation (TENS) has shown conflicting results in terms of an analgesic benefit in the acute setting, but it has been shown to reduce the need for pharmacologic analgesics. There is limited evidence of benefit in the acute setting from relaxation and guided imagery. Acupuncture and electro-acupuncture have been shown to be of benefit in the acute setting both to improve pain and to reduce common opioid side effects; however, they require specific training and time to administer.

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