Page 33 Acute Pain Management

8. NON-PHARMACOLOGICAL TECHNIQUES

Psychological interventions
1. Listening to music produces a small reduction in postoperative pain and opioid
requirement (N) (Level I [Cochrane Review]).
2. The evidence that information is effective in reducing procedure‐related pain is
tentatively supportive and not sufficient to make recommendations (Q) (Level I).
3. Distraction is effective in procedure‐related pain in children (N) (Level I).
4. Training in coping methods or behavioural instruction prior to surgery reduces pain,
negative affect and analgesic use (U) (Level I).
5. Evidence of benefit of hypnosis in the management of acute pain is inconsistent (W)
(Level I). SUMMARY
6. Immersive virtual reality distraction is effective in reducing pain in some clinical
situations (N) (Level III‐2).
7. Evidence for any benefit of relaxation techniques in the treatment of acute pain is weak
and inconsistent (N) (Level IV).
Transcutaneous electrical nerve stimulation
1. Overall, there is no evidence that TENS is effective for the treatment of pain during
labour (N) (Level I [Cochrane Review]).
2. Certain stimulation patterns of TENS are effective in some acute pain settings (S)
(Level I).

Acupuncture
1. Acupuncture reduces postoperative pain as well as opioid‐related adverse effects (N)
(Level I).
2. Acupuncture may be effective in some other acute pain settings (U) (Level I).

9. SPECIFIC CLINICAL SITUATIONS

Postoperative pain
Risks of acute postoperative neuropathic pain
1. Acute neuropathic pain occurs after trauma and surgery (U) (Level IV).

 Diagnosis and subsequent appropriate treatment of acute neuropathic pain might
prevent development of chronic pain (U).
Acute postamputation pain syndromes
1. Continuous regional blockade via nerve sheath catheters provides effective postoperative
analgesia after amputation, but has no preventive effect on phantom limb pain (U)
(Level II).
2. Calcitonin, morphine, ketamine, gabapentin, amitriptyline and tramadol reduce phantom
limb pain (S) (Level II).
3. Sensory discrimination training and motor imagery reduce chronic phantom limb pain (S)
(Level II).

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