Nursing Interventions to
Relieve Orthopedic Pain
Maricela Zarate, RN
January 22,2014
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Objective
 Cite effective non-pharmacological nursing interventions
for orthopaedic pain
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Assessment of Orthopedic Pain
“Careful assessment and evaluation to the
patient’s pain will allow the nursing staff to
determine the appropriate nursing
interventions required .The nursing
management might involve such actions as
repositioning the patient, support or
elevations of the affected limbs, application
of heat or cold, or the administration of
analgesics, sedatives, or muscle relaxants as
ordered by the physician”.
(Nursing Care Related to the Musculoskeletal System, Kindle Edition,
ISBN 978-1-78258-128-4.)
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Assessment of the Orthopedic Pain
Pain Assessment Tools
•
Pain scale, WONG-Baker FACES scale,
Verbal rating scale, etc.
•
Description of the pain
•
Duration of pain
•
What makes it worse or better
Patients with advance dementia
require behavioral observation to
determine the presence of pain.
(Wells, Passaro, and McCaffery, 2008)
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Complementary and Alternative
Medicine
“Complementary and alternative
medicine can work safely
alongside each other as long as
there is effective communication
between all practitioners as well
as between patients and
practitioners”
(Prince of Wales Foundation for Integrated Health, UK, 2003)
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Complementary and Alternative
Medicine
((Wells, Passaro, and McCaffery, 2008)
 Opioids, nonopioid, and NSAID’s
 Alternative Interventions
 Effective Communication
Gittell and Colleagues study suggested that communication, goal
setting, and patient education contributed to better pain outcome.
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Patient Education
(Wells, Passaro, and McCaffery, 2008)
 Done in the Pre-op phase
 Ensures the patient is familiar with the scale
 Alternatives to pain management
 Assess for Coping Techniques
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Coping Techniques
(Wells, Passaro, and McCaffery, 2008)
 Natural
 “Before suggesting or Instructing patients in the use of
nondrug techniques, nurses need to be aware of the
methods used effectively and preferred by the patient.”
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Non Pharmacological pain
management Techniques
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 COGNITIVE
 PHYSICAL
1.
Distraction
1.
Massage
2.
Relaxation
2.
Cold Therapy
3.
Music
3.
Repositioning
4.
Elevation, immobilizing
the effected part
Cognitive Techniques
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Distraction
•
Focusing attention away from the pain
•
Distraction is Effective
(Wells, Passaro, and McCaffery, 2008)
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Distraction
 Imagery
 Slow gentle breathing
 Music
 One study found that 19% to
28% of patients
spontaneously adopt a
distraction technique while
recovering from total hip or
total knee arthoplasty
(Pellino, Gordon, Engelke, et al.,
2005.)
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Relaxation
•
It’s safe
•
Induce sleep
•
Reduce pain
•
Calm emotions
•
Breathing and focused attention can calm
the mind and body
( NIH National Center for Complementary and Alternative
Medicine, 2013.)
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How Relaxation Techniques May
Work
( National Institutes of Health, 2013)
 Contrasts with the “fight or flight’ stress response
 Slows the heart rate
 Reduces Blood Pressure
 Reduces oxygen consumption and levels of stress
hormones
 Relaxation techniques may reduce surgery pain, as well
as abdominal pain
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Relaxation techniques benefit the
following conditions (NIH, 2013)
 Anxiety
 Irritable bowel syndrome
 Asthma
 Nausea
 Depression
 Nightmares
 Fibromyalgia
 Overactive Bladder
 Headache
 Pain
 Heart disease and heart
symptoms
 Tinnitus
 High Blood Pressure
 Insomnia
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 Smoking cessation
 Temperomandibular condition
(TMJ)
MUSIC
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(Ware,2013)
•
Can reduce stress and create a calming
environment
•
Contributes to distraction
•
Refocusing attention
Choosing Music
Sedating or soothing music is
 Instrumental
 Synthesizer
 Harp
 Piano
 Orchestra
 Slow jazz
The intervention is delivered via audiotape
and headphones. The duration is typically
20-30 minutes and may involve a single or
multiple exposures.
(Wells, Pasero, and McCaffery,2008)
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Physical Techniques
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Hand and Foot Massage
( Wells, Pasero, and McCaffery, 2008)
•
Massage. Recently investigators have
examined hand and foot massage as
an alternative to back or body
massage.
•
Reviews of the massage literature
conclude it has a beneficial effect on
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
Anxiety

Tension

Depression

Stress hormones

Pain
Cold for Pain Control
 Application of cold for pain
relief and reduction of
swelling is recommended by
the American Academy of
Orthopedic Surgeons (2011).
 “Ice Compression minimize
swelling and pain”.
(Roberts,2007)
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Research on Cold Therapy
21
•
Cold Therapy has been investigated in
patients undergoing orthopedic surgeries
(primarily total knee arthoplasty) and has
been found to improve pain, range of
motion, and function.
•
However, a study by Smith and others
found that pain similar with the cryo pad
and the compression bandage applied by
the surgeon at the end of surgery; in
addition, the cold therapy increased the
cost of care and took more nursing time.
•
Thus, using cold therapy via the cryo pad
provides no benefit over compression
bandages after knee replacement and is
less cost effective.
Repositioning
 “all that may be required
is to realign the body or
reposition the affected
limb. Proper body
alignment is a key factor
in patient comfort.”
( Nursing Care Related to the
Musculoskeletal System, Kindle
Edition, ISBN 978-1-78258-128-4)
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Positioning for Better Respiratory and
GI function
(O’Plasty, 2008)
 Assess the patient’s current position in the bed.
 Note the position of the hips relative to the bed
 If the hips are moved to just above the place where the bed
bends [___x/, the patient will be able to have better lung
and abdominal excursion, thus contributing to enhanced
comfort levels.
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Positioning Tips
 Are the hips and shoulders in line?
 A slight misalignment can cause an unacceptable level of
pain
 The patient will be more comfortable with the hips and
shoulders in line and the patient’s weight distributed
equally over the body.
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Safe Repositioning
 Never pull the patient by the arm to help her/him roll
onto her side
 Always use the pad or the flat part of your hand against
the largest firm patient structure- the hip, upper thigh,
mid back between the scapula– to roll a patient to the
side.
Source: O’Plasty, A . (2008). Positioning for pain control. Retrieved
from
http://allnurses.com/geriatric-nusrses-ltc/positioning-pain-control350770.html
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Elevation and Support
 “An affected limb may
require support or
elevation on pillows in
order to reduce swelling
and reduce strain on the
associated musculature.”
( Nursing care of the
musculoskeletal system, Kindle
Edition, 2012)
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Immobilizing the Injured Part
(Roberts, 2007.)
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 Prolonged Immobilization
(more than 3 to 4
weeks) of a joint can
cause stiffness,
contractures and muscle
atrophy.
 Immobilization decreases
pain and facilitates
healing by preventing
further injury and is
helpful except for very
rapidly healing injuries.
 These complications may
develop rapidly and may
be permanent,
particularly in the elderly
 Joints proximal and distal
to the injury should be
immobilized.
Conclusion
Pain control is better attained when is managed by properly
assessing the patient’s previous experiences and how they
have managed it at home. Better outcomes are also
obtained when pain is managed using complementary and
alternative medicine.
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Questions???
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References
Nursing Care Related to the Musculoskeletal System.(2012). Kindle edition. Stanmore, New Zealand:
Powerhouse Publishing. ISBN 978-1-78258-128-4.
O’Plasty , A. (2008). Positioning for pain control. Retrieved from http://allnurses.com/geriatricnursesltc/positioning-pain-control-350770.html
Pellino, TA., Gordon, DB, Engelke, ZK, et al. (2005) Use of nonpharmacological interventions for pain
and anxiety after total hip and total knee arthoplasty. Orthopaedic Nursing, 24 (3), 182-90
Roberts, J.R. (2007). Overview of musculoskeletal injuries. Merck Manual for Healthcare Professionals.
Retrieved from
http://www.merckmanuals.com/proffesional/injuries_poisoning/fractures_dislocations_and_sprains/over
view_of_musculoskeletal_injuries_html
Ware, A. (2013). The emerging field of harp therapy and its clinical implications. Journal of the
Australasian Rehabilitation Nurses’ Association, 162(2),15-17.
Wells, N., Pasero,C., McCaffery, M. (2008). Patient safety and quality: and evidence-based handbook for
nurses, Vol. 1, Chapter 17: Improving the quality of care through pain assessment and management.
Agency for Healthcare Research and Quality.
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