Theory Application of Therapeutic Touch and Pain Management in Palliative Care Patients, Research Paper Example

Key Words: Therapeutic touch, alternative therapy, massage, pain measurement tools, holistic approach, palliative care, sensory/affective components.

Abstract

Pain is an unpleasant sensation which has physical as well emotional components. Both components need to be handled in a holistic manner in order to provide maximum, if not total relief to the patient. Acute pain is usually handled more effectively by drugs but chronic pain, especially in young children, old and terminally ill patients cannot be handled by drugs alone. The recent emergence of touch therapy in conjunction with alternative systems of medicine has provided a new and successful approach to handle pain. Therapeutic touch involves a wholesome long term relationship between the patient and the therapeutic interventionist with components of physical touch and emotional support playing important roles in the delivery of therapy.

Introduction

Alternative therapies have proven successful in the management of pain, especially in patients suffering from chronic disorders requiring prolonged hospitalization. Patients suffering from incurable and crippling diseases require continuous palliative care which might be extended to a home setting as well. Management with drugs involves compliance which is often difficult in such patients, and is also associated with adverse effects which sometimes preclude their use. Touch and massage along with psychological and emotional support tend to mellow the suffering due to pain if not banishing it altogether. The impact of this therapeutic modality is such in some cases that it baffles the persons who believe exclusively in a cause-effect relationship of diseases and the symptoms associated with them. Pathophysiological mechanisms of pain have been researched extensively and pharmacologic interventions have been accordingly designed to tackle different kinds of pain due to various etiological backgrounds. The use of drugs such as anti inflammatory analgesics, opioid analgesics is no doubt beneficial and essential in the control of pain but they can be better utilized in combination with alternative therapies which can aid in the reduction of the dosage used and also leading to outcomes where the patient is able to consciously eliminate the pain.

Rationality of Therapeutic Touch

Therapeutic touch, which literally means a direct contact with the patient, where touching and massage are the principal components used to provide relief from chronic pain along with psychological counseling, has proven successful in most patients, particularly in pediatric and geriatric practices. Touch therapy is based upon a wholesome relationship between the sufferer and the patient where the therapist makes use of the environmental energy field around the patient and directs it towards a mutually achievable level of optimism in the patient which makes him or her oblivious of the pain sensation (Green, 1998). The therapy is based upon the existence of every individual in complete harmony with the environment, where there is a constant exchange of energy between the two (Green, 1998). The sensation of pain involves the interaction of sensory and affective components which work together in its manifestation (Piotrowski et al, 2003).  The sensory component of pain is based upon the normal physiological mechanisms which are triggered in response to injury and convey the sensation of pain to the brain through afferent and efferent neuronal pathways which in turn are based upon the conduction of signals through neurotransmitters. Sensory qualities are expressed in terms of relationship to time, intensity, location, pressure and thermal gradients (Piotrowski et al, 2003). The affective component of pain is based upon the consciousness and awareness of one’s physical assets in terms of emotional beliefs and sensations which perceive pain as an unpleasant experience. Tolerance to pain is therefore varies in individuals depending upon their fitness, health, sex and emotional stability. This is the reason that the healing process and response to discomfort is faster and better, respectively in some individuals as compared to others. Individual patients therefore need to be evaluated independently and tailor made solutions for pain management need to be prepared for them. This is especially vital in young children and old patients whose compromised cognitive status during suffering is diminished. Moreover such patients are generally found deficient in conveying their actual feelings to the therapeutic interventionists. Pain measurement tools (PMT) need to be used initially before going in for therapeutic interventions (Caraceni et al, 2002). PMT include visual analog scales, numerical rating scales and verbal rating scales which give a fair degree of assessment of pain being experienced by a patient. Intense pain, after serious injury or immediately after major surgery needs to be handled with utmost care as this is one of the most perturbing phases in a patient. Drug use is essential at this stage but emotional support and encouragement play a great role in reducing panic and the feeling of helplessness. Managing post operative pain involves the adoption of a wholesome approach and optimal therapeutic strategies have to be decided upon in individual cases.

Clinical trials have shown the definite benefits of adjunct therapy when used in association with painkillers (Piotrowski et al, 2003). Additional measures to minimize pain include routine care, focused attention as well as massage. Success of such measures have led to the planning and designing of specific protocols to be followed where touch therapy has been delivered with great success in terminally ill patients. In a study involving cancer patients it was observed that definite improvements in physical as well as psychological functioning are achievable through touch therapy (Weze, et al, 2004). Daily sessions of 40 minutes duration lasting 4-6 weeks in which non invasive touching of head, chest, arms, legs and feet along with informal conversation between the patient and the therapeutic interventionist were used resulted in better management of pain and great psychological improvement in the patients (Weze et al, 2004).

Meditation, prayer and encouragement are the essential components of adjunct therapy and sometimes can be more successful without the need of any pain medication at all. In terminally ill patients such therapy has to be delivered on a continuous basis and regularly monitored to address any immediate issues arising at different stages. As old patients are subject to gait disturbances, falls, slower rehabilitation, multiple drug use, cognitive disorders and malnutrition, the necessity of continuous observation and care is all the more essential.

Conclusion

The role of therapeutic touch has been proven in repeated clinical trials and now occupies a prominent place in the administration of palliative care. The growing figure of aged population suffering from terminal diseases necessitates the need for alternative therapy when drugs alone cannot be used. Clinical trails have proven that adjunct therapy in combination with prescription drugs is a much better method for improving the quality of life of such patients. Handling of patients with chronic pain is a routine matter at hospitals and the nursing care has to be extended to periods lasting much longer, even after discharge of such patients from the hospital. Pain management is therefore an essential component of today’s nursing practice and skills in this department need to be developed through study as well as experience.

References

Caraceni, A., Cherny, N., Fainsinger, R. et al. (2002). Pain Measurement Tools and Methods in Clinical Research in Palliative Care: Recommendations of an Expert Working Group of the European Association of Palliative Care, Journal of Pain and Symptom Management, Vol. 23 No. 3

Green, C. A. (1998). Reflection of a Therapeutic Touch experience: Case Study 2, Complementary Therapies in Nursing & Midwifery Vol. 4, 17-21

Piotrowski, M.M., Paterson, C., Mitchinson, A. et al. (2003). Massage as Adjuvant Therapy in the Management of Acute Postoperative Pain: A Preliminary Study in Men, J. Am. Coll. Surg., Vol.197, 1037-1046

Weze, C., Leathard, H.L., Grange, J. et al. (2004). Evaluation of healing by gentle touch in 35 clients with cancer, European Journal of Oncology Nursing, Vol. 8, 40–49