Pain Management Programs & Guided

Imagery

Elise Robertson, R/TRO

West Park LTC

Agenda

Overview

Pain Management Programs

Guided Imagery

Environments & Assessment

Implementation & Facilitation

Tips

Practice

Questions

Pain Management Groups

When we think or talk about pain management groups there can be a variety of individuals we can include.

Some of the most common types of chronic pain include:

Headache, Post surgical pain, post traumatic pain, back pain, cancer pain, arthritis pain, nerve pain, psychological pain like depression.

Chronic Pain Group/Programs

• Creating specific programs or groups for individuals with pain helps to create therapeutic environments but may also help with higher participation in programs.

• Programs can be done 1:1, by the bedside or in small groups. There are also other groups that can come in to lead specific programs and therapies that help to aide in chronic pain management.

• A potential for more comfort care measures when someone becomes palliative or end of life is beneficial here to.

Pet therapy:

Has calming effects, improves mood, and can lessen depression.

Music Therapy:

Can assist in emotional release, reduce amount of pain they perceive

and promoting relaxation.

Hand Massage or RMT massage:

Relieve tension, stress and eases muscle or joint pain.

Physiotherapy Hot or Cold Packs

To reduce inflammation and swelling causing pain

Pain Management Programs

What kinds of programs are there for pain management

Pain management programs

Hypnosis: Helping the mind think differently or not at all about the pain we feel or try to reduce its intensity. Tai Chi: Slow focused movements coupled with deep breathing can support the ease of pain. Acupuncture: Specific acupoints that fine needles are inserted to release endorphins and raise body's natural pain killing chemicals. Administered by professionals

Guided Imagery ---------

Guided Imagery & Pain Management

Guided imagery is used with many chronic pain management groups; one such in particular is the Arthritis Society as it is a well- recognized and scientifically validated way to relieve pain, anxiety, and depression. It is driven by the idea that if you can envision your pain receding you can achieve it. Guided Imagery has many health benefits: Lowering blood pressure, reducing active stress hormones, reducing muscle tension and chronic pain, as well as improving mood.

What Is Guided Imagery?

• It is used in many cultures, an can be traced to the 13th century where Tibetan monks would meditate and use imagery to say that Buddha would come and cure disease or pain.

Guided imagery is a program of directed thoughts and suggestions that guide your mind toward a relaxed, focused state. You can use an instructor, tapes, or scripts to help you through this process.

Physiological Response

How it works

Essentially it is a placebo effect

Your body and mind respond as if the image is real

E.g when you watch a movie and you become tearful or cry, rationally we are aware that this is

only a movie but the physiological response (tears or laughing) and emotional response (sad

or happy) is as if it were real.

Who Is Guided Imagery For

Anyone who can benefit from a session as long as the session is geared toward a goal they wish to attain.

Some examples are:

Athletes before events picturing the game or win

Aiding in patient disease treatment like attacking an illness

Reduction of pain by changing the perception of it

Relaxation and behavior groups

Work wellness to reduce stress or refocus

Guided Imagery Types Total guided Visualizations- eyes closed and client just listens

Instructors and facilitators with scripts

CD’s

Music (hearing)

Self Scripts and self talk

Touching- the use of tactile objects to express emotion

Aromatherapy (scent) based evoking of emotion Interactive Visualizations- asks clients what they are seeing or hearing, feeling PMR- Progressive Muscle Relaxation Taste base use- involving food, tea and other items to become more present

Quick example script

Pain Groups & Visualization

Guided visualizations or Guided Imagery and pain relief is best used when the patient is not in extreme pain. Best used after pain medication has taken effect or on a day they feel comfortable.

e.g of popular scenes that help control pain

• Pool or warm healing water

• Applying a “patch” of medication of affected areas they feel pain

• Beam or laser of shining light

• A vision of a religious/spiritual entity touching affected areas

• Using colors in scenes to create a blanket or color enveloping the patient

Research Study

Paraplegic Neuropathic pain is one of the most difficult of all pains to treat.

In a pilot study patients with paraplegia, guided imagery and virtual walking therapy (encouraging patients to imagine themselves walking) led to a significant reduction in pain.

Virtual walking may be a viable treatment for pain after spinal cord injury.

Pain Groups / Palliative Care Groups

We are not going to cure pain with guided imagery but we give the individual tools to recognize it and manage it.

Palliative Care

Using Guided Imagery towards end of life may help pain but it may also help ease anxieties about their condition.

Helping individuals visualize peace, take control of pain, control of emotions and worries or distress.

Assessment & Environments • Good to know the background of the client

as you don’t want to set an aromatherapy scent that is too strong or distracting to a client.

• Also want to consider if there are aversions to things like not liking water and doing a script out at sea.

• Limit potential distractions by asking or reviewing types of environments first. And be upfront about what todays session will look like.

• No phones, no flipping pages, no pens

• Dim Lighting works good, comfortable chair

• Cognition level, use smaller length scripts for clients who may have Dementia and simplify words.

Assessment & Environments • Ask yourself what do I want my clients,

residents or myself to get out of this session.

• Is it to manage pain- look into scripts that have pain relief and coaching methods of how to accept and manage pain

• Is the goal to reduce behaviours and relax individuals- then looking at scripts with music or videos and getting to know your participants will be helpful

• Maybe you want to try and blend it with some light exercise or movements, using tactile relaxation can be beneficial to those with lower cognition.

• Once you know your goals, then you can set up the environment to make it peaceful and relaxing.

Implementation and Facilitation

• In a few minutes we will practice some scripts together to see what it looks like

• As you have set up your environment you will then move towards your scripts and goal to attain. Even though your environment is set up you have to prepare your participants.

• Getting them comfortable and focused to the task is important by starting with a few deep breaths and reminding them that is a safe space, they can move around if they are uncomfortable or open their eyes if they feel, but also to respect the space as others may be present as well.

Implementation and Facilitation • Tone of voice- soft, breathing with the individuals, not rushing, if you

fumble a word apologize and continue

• What if someone looses concentration or gets distracted. That’s ok our minds can go for a walk sometimes just reassure them that they can join back in at anytime.

• Resetting after a distraction like an alarm or behavior- refocusing everyone by either going back a step or checking in with them to see how everyone is doing and then continuing.

• Keep trying different scripts or sessions until you find the right fit. Then keep practicing.

• Remember at the end of the session to bring them back to the present. E.g open your eyes, take a few deep breaths. Don’t just close a session and say bye. Give them time to regroup to reduce falls and keep them calm.

Tips

• Music can increase effects of imagery

• Remind clients that they do not have to stay in the same position until its too painful. Change the sitting position if you need to.

• If clients fall asleep remind them they can open their eyes for a moment, change their position or check in with everyone. Ask “mary” how she is doing. Or ask the group to respond how they are feeling.

Lets Try Some Scripts- Practice Time

• Pain script – quick version

Quick Tensing and Relaxing Script for the office.

Sometimes it can get overwhelming with things that are due immediately, things that are due in the future, and what was supposed to be done.

This is a quick technique to help you take a minute to reset yourself.

• Script

• 2 minute Cooks Hookup exercise

• Script

Debrief

Ask clients how was that for you? Some people found the breathing relaxing, what about other people. Where you able to manage the pain or get some relief while in the session?

Scripts

• Each script can be tailored to your participants needs.

• Whether you are focusing on pain acceptance, or palliative comfort and control, or general relaxation there can be many facets in which it can be used as a therapeutic tool.

Thank you for participating today.

Questions