Nonpharmacologic Modalities Cognitive Behavioral and Physical Therapies for Analgesia and Anxiolysis

Traditionally, nonpharmacologic techniques of pain management in the ED are limited to application of heat or cold, and immobilization and elevation of injured extremities. Other techniques may prove to have a role in the ED and post-ED setting. Among these are cognitive-behavioral techniques, which are effective in reducing pain and anxiety, may control mild pain when used alone, and also enhance patient satisfaction. These techniques include reassurance, explanation, relaxation, music, psychoprophylaxis, biofeedback, guided imagery, hypnosis, and distraction. They are a useful adjunct to pharmacologic management of moderate to severe pain.1 Successful application of these therapies requires a cognitively intact patient and skilled personnel, but many of the techniques require only a few minutes to teach the patient.

Physical nonpharmacologic agents are becoming increasingly relevant to ED pain management. In addition to the traditional techniques noted above, the less commonly used physical modalities such as transcutaneous electrical nerve stimulation (TENS) and acupuncture, particularly the newer electroacupressure techniques,17 may have some potential role in the ED environment in the future. Although specific technical skills and equipment are required, there is no need for intravenous access, and there is no systemic effect or depression of respirations or mental status.

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