Managing Pain Without Medicine

Techniques for managing pain

Pediatric cancer centers offer many therapies for pain that don’t involve medication. These strategies focus on helping children and teens control their body and mind’s response to pain.  

Pain can be a complicated condition to manage, and different approaches or combination of approaches may be attempted before an effective one is found. As appropriate, patients may be referred to specialists in child life, physical therapy, occupational therapy, psychology or nursing to learn pain management techniques. Chaplains or social workers may be consulted for spiritual or family support needs.

Some pain management techniques may be available at places other than the pediatric cancer center. However, patient families should consult their medical team before using other providers or attempting to apply methods on their own.

Commonly used techniques include:  

• Distraction: This strategy encourages patients to focus on something else to take their mind off their discomfort. 
  • Sometimes that may be counting, singing or playing with a toy during a short procedure such as a needle stick. 
  • Or when the patient is experiencing longer episodes of pain, it may mean participating in a favorite activity such as watching a movie, talking with family and friends, or playing video or board games.
• Relaxation: This approach may involve deep breathing, meditation, or soothing music or sounds. It can relieve anxiety and reduce muscle tightness.
• Modeling: Someone models or demonstrates helpful ways to cope with pain. This approach may involve the patient observing another patient or a caregiver. The approach works best when the “modeler” shows some distress about a procedure and then demonstrates or explains how they coped with it. The idea is that the patient will see the response and then be able to use that strategy to help.
• Cold/heat:
  • Cold can help pain from inflammation, swelling, injury or pain from a certain procedure. Ice packs or crushed ice in a towel are common ways to apply cold to a painful area.
  • Heat can help relieve pain because it increases blood flow. Taking a warm bath or applying warm towels can be effective. Talk to a physician before using a heating pad.
• Exercise: Exercise such as walking, biking, or yoga can help by strengthening muscles, loosening stiff joints, and increasing blood flow.
  • Activity Pacing: It is important to have a good balance between rest and activity. A pacing plan helps people set activity levels based on pre-determined goals so that they can increase your activity levels, slowly and safely.
• Visualization/guided imagery: This approach teaches patients to concentrate on or imagine pleasant sights, sounds, tastes, smells, or other sensations. It is most effective if patients use all five senses.
• Massage: Massage uses gentle pressure to increase the flow of body fluids, stretch tissue, and relax the body.
• Biofeedback: Biofeedback is a technique used to train the mind to control the way the body responds to stressors such as pain.
  • In biofeedback, sensors are attached to the skin to measure the patient’s response to stress by tracking indicators such as heart rate. As patients use strategies such as deep breathing or visualization, they can watch on computer screen to see if the strategy causes the heart rate to decrease. Patients can see which approaches are the most effective and can learn to use them to control the body’s response to pain. 
• Medical hypnosis: Hypnosis is a set of techniques designed to enhance concentration, minimize distractions, and heighten awareness to influence thoughts, feelings and behavior regarding pain.
• Cognitive-Behavioral Therapy (CBT): CBT can include many techniques, such as reframing or restructuring of thoughts. These strategies teach the patient to monitor and evaluate negative or illogical thoughts and attitudes and replace them with more positive ones.
• Acupuncture: The practice of acupuncture helps control how nerves work in the body. A trained acupuncturist inserts thin needles into the skin or muscle at specific points (acupoints) that lie along nerves. Treatments may help relieve symptoms such as nausea, vomiting, pain, and fatigue.    

The pain management team may also suggest keeping a pain journal to help determine the best ways to manage pain.