Nursing practices in patients with chronic pain: an integrative review

Integrative literature review, using the electronic portal SCIELO, CINAHL and PubMed Central databases, with time cut from 2008 to 2018 and data collection period between June and July 2018. The Health Science Descriptors (DeCs) and Medical Subject Heading (MeSH) were: Patients, Chronic pain, Nurse Care, Pain clinic.

Results

It was evidenced that the production analyzed is mostly on non-pharmacological nursing practices for patients with chronic pain, with reduced publications in Brazil and tended to focus on the last five years. The patient with this type of injury experiences multifactorial conditions that directly influence the health condition, and requires integral follow-up by interprofessional team, including the care network, through qualified and resolutive interventions, aiming at adaptation and/or improvement of their health condition.

Conclusion

The studies indicate benefits generated by systematized practices implemented by nurses, through instruments and tools for detection, intervention and evaluation, as well as clinical support.

Chronic pain; Nursing care; Pain clinics

Author/ Year/ Country	Design	Level of evidence	Nursing practices	Results
Freire et al, 2018 Brazil⁽¹³13. Freire ME, Sawada NO. França IS, Costa SF, Oliveira CD. Qualidade de vida relacionada? saúde de pacientes com câncer avançado: uma revisão integrativa. Rev Esc Enferm USP. 2014;48(2):357–67.⁾	Systematic review	1	Non-pharmacological interventions	Therapeutic interventions of physical, emotional and spiritual aspects that promoted the improvement of the health conditions of the patient his QoL, evidenced by means of validated measurement scales and reliable statistical power, described in the respective studies.
Oliveir, et al, 2013 Brazil⁽⁸8. Oliveira RM, da Silva LM, Pereira ML, Moura MA. Manejo da dor de pacientes com aids: análise da estrutura gerencial em hospital de referência. Rev Esc Enferm USP. 2013;47(2):456–63.⁾	Descriptive, qualitative	4	Educational practices to assess pain and Non-pharmacological interventions	The nurse can evaluate, examine and implement non-pharmacological strategies of effectiveness to the relief of pain, guaranteeing the quality of life of the patient but is not aware as a direct responsible for the care, regarding the identification of the nursing activities performed for pain management.
Thomas, et al, 2012 USA⁽¹⁴14. Thomas ML, Elliott JE, Rao SM, Fahey KF, Paul SM, Miaskowski C. A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management. Oncol Nurs Forum. 2012;39(1):39–49.⁾	Randomized Case-Control Study	1	Educational Practices	Using educational techniques, nurses help patients develop an adequate plan of care to reduce pain and other symptoms. The motivational interview technique achieves good results in this type of patient.
Baker, 2016 USA⁽¹⁵15. Baker N. Using Cognitive Behavior Therapy and Mindfulness Techniques in the Management of Chronic Pain in Primary Care. Prim Care. 2016;43(2):203–16.⁾	Experimental	2	Non-pharmacological interventions - Cognitive behavioral therapy, Mindfulness	With the understanding of how chronic pain is related to mental illness, mindfulness techniques and behavioral therapy can be used to help decrease dependence on dangerous opioid medications and help patients understand, accept and deal with their chronic pain.
Taplin,et al, 2015 USA⁽¹⁶16. Taplin SH, Weaver S, Salas E, Chollette V, Edwards MH, Bruinooge SS, et al. Reviewing cancer care team effectiveness. J Oncol Pract. 2015;11(3):239-46.⁾	Systematic review	1	Interface with team	Multidisciplinary teams for screening result in improvements in follow-up and continued compliance with the guideline; positively affect the planning and implementation of therapy, leading to better adherence and pain control.
Stapelfeld, et al, 2011 Denmark⁽¹⁷17. Stapelfeldt CM, Christiansen DH, Jensen OK, Nielsen CV, Petersen KD, Jensen C. Subgroup analyses on return to work in sick-listed employees with low back pain in a randomised trial comparing brief and multidisciplinary intervention. BMC Musculoskelet Disord. 2011;12(1):112.⁾	Randomized case-control study	1	Non-pharmacological interventions	A study performed in patients with low back pain within the study showed that multidisciplinary, non-pharmacological intervention is more effective than brief intervention in subgroups of patients with low job satisfaction, without influence on job planning and with risk of job loss due to medical leave, compared to subgroups that do not meet these criteria.
Mohammed, et al, 2016 USA⁽¹⁸18. Mohammed, et al. Creating a Patient-Centered Health Care Delivery System: A Systematic Review of Health Care Quality From the Patient Perspective. Am J Med Qual. 2016;31(1):12-21⁾	Systematic review	1	Interface with team	User satisfaction impacts on the planning and evaluation of health care delivery. The study evidenced the importance of the nurse’s communication with the team and patient.
Yıldırım e Kanan, 2016 Turkey⁽¹⁹19. Yıldırım M, Kanan N. The effect of mirror therapy on the management of phantom limb pain. Agri. 2016;28(3):127–34.⁾	Quasi-experimental study	3	Nursing care plan - non-pharmacological therapy	Mirror therapy practiced for 4 weeks provided a significant decrease in the severity of phantom limb pain and patients who were not using prosthesis had greater benefit from mirror therapy.
Griffith, et al, 2010 USA⁽²⁰20. Griffith J, Lyman JA, Blackhall LJ. Providing palliative care in the ambulatory care setting. Clin J Oncol Nurs. 2010;14(2):171–5.⁾	Experience report	5	Telenovation consultation	The implantation of early palliative care helps to control pain, especially with an interdisciplinary approach, as well as insertion of the family into the care plan. The palliative care nurse often communicates with patients and family members over the phone to ensure that the recommended interventions are effective in controlling pain and symptoms without causing costly side effects.
Potássio, et al, 2009 USA⁽²¹21. Potash MN, West JA, Corrigan S, Keyes MD. Pain management after Hurricane Katrina: outcomes of veterans enrolled in a New Orleans VA pain management program. Pain Med. 2009;10(3):440–6.⁾	Literature review	5	Nursing Registration	Identified the main impediments and facilitating factors in the provision of service in pain management, due to the professionals’ records in the electronic system, being an important factor in the continuity of services after a regional disaster.
Ramelet, et al, 2014 France⁽²²22. Ramelet AS, Fonjallaz B, Rapin J, Gueniat C, Hofer M. Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol. BMC Pediatr. 2014;14(1):151.⁾	Cross-over randomized study	1	Telenovation consultation	The telenovation consultation happens at least once a month, by a qualified and experienced nurse. It aims to provide affective support, health information and decision support. It allows individualized and frequent care, with patient satisfaction, adherence to treatment and use of tele-research service and cost.
Antony e Merghani, 2016 India⁽²³23. Antony T, Merghani TH. The influence of demographic and psychosocial factors on the intensity of pain among chronic patients receiving home-based nursing care. Indian J Palliat Care. 2016;22(3):362–5.⁾	Cross-sectional and descriptive	4	Home Visits	The results of this study showed that certain demographic and psychosocial factors influence the manifestation of pain and its intensity among chronic patients. Therefore, improvements in education, economic status and psychosocial support should be considered for the management of chronic patients.
Morales, et al,2016 Spain⁽²⁴24. Morales-Fernandez A, Morales-Asencio JM, Canca-Sanchez JC, Moreno-Martin G, Vergara-Romero M; Group for pain management Hospital Costa del Sol Members. Impact on quality of life of a nursing intervention programme for patients with chronic non-cancer pain: an open, randomized controlled parallel study protocol. J Adv Nurs. 2016;72(5):1182-90.⁾	Randomized controlled study	1	Educational Interventions	Nurses can play a vital role in treating pain by using best practices in assessing and managing pain under a holistic approach where the patient plays a proactive role in approaching the disease process. Educational interventions on self-esteem, pain awareness, communication and relaxation techniques will be performed.
Costello, et al 2013 USA⁽²⁵25. Costello M, Greenberg H, Bell C, Trowers-Smith J. Management of the hospitalized patient experiencing acute on chronic pain: a case study. Pain Manag Nurs. 2013;14(4):e268-e273.⁾	Case-study	5	Pain Evaluation	The ability to balance the level of patient comfort by minimizing adverse outcomes related to opioid overdose is key to providing excellent postoperative care for the patient with chronic pain.
Sørensen e Frich, 2008 Denmark ⁽²⁶26. Sørensen J, Frich L. Home visits by specially trained nurses after discharge from multi-disciplinary pain care: a cost consequence analysis based on a randomised controlled trial. Eur J Pain. 2008;12(2):164–71.⁾	Randomized controlled study	1	Home visits	Patients in the nursing intervention group used fewer health care resources at lower costs.
Stenner e Courtenay, 2008 England⁽²⁷27. Stenner K, Courtenay M. Benefits of nurse prescribing for patients in pain: nurses’ views. J Adv Nurs. 2008;63(1):27–35.⁾	Qualitative, descriptive study	4	Nursing Prescription	The nurse’s prescription is beneficial for patients and for the health service in general. Faster access to treatment, better quality of care, greater security, better relationship and communication with patients, greater efficiency and cost-effectiveness.

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[1] Corresponding author. Juliane de Macedo Antunes https://orcid.org/0000-0002-9763-8291 E-mail: julianedemacedoantunes@hotmail.com