Effectiveness of nursing intervention for adult patients experiencing chronic pain: a systematic review

Objectives To determine the best available evidence regarding the effectiveness of nursing interventions for adult patients experiencing chronic pain. Types of studies Randomized Controlled Trials (RCT) and Quasi-Randomized Controlled Trials. Types of participants Participants were adults, aged at least 18 years, suffering from chronic pain (lasting for longer than six months). Pain of oncological origin and patients admitted in a hospital, were excluded. Types of interventions Non pharmacological nursing interventions for chronic pain. Types of outcome measures The primary outcome measure was chronic pain, and secondary outcome measures were: disability, depression, dependence and health related quality of life. Search strategy All studies, published and unpublished, in English and Spanish, carried out between January 1997 and December 2007 were retrieved.. Selection of studies The methodological quality of included articles was assessed by two independent reviewers using appropriate critical appraisal tools from the Joanna Briggs Institute. Data extraction and analysis Data were independently extracted by two reviewers, using the standardised data extraction tool from the Joanna Briggs Institute. A meta-analysis was not possible as the trials were heterogeneous in their interventions, characteristics of the populations, intervention duration measurement instruments and outcomes measures. Results 1,666 references were identified that fit the aim of the review. 92 articles were retrieved, of which 13 were chosen to be critically appraised for their methodological quality. In the end, eight controlled trials were included. The main results were: Cognitive-behavioural and sensorial stimulation programs reduce perceived chronic pain. Interventions based on psycho-education and music therapy programs reduce osteoarticular pain. Magnetic therapy and guided imagery are interventions that may relieve chronic headache. An intervention including a physical exercise program in incontinent elderly increases mobility but does not relieve pain, and may even worsen it. Other outcome measures showed an improvement in the quality of life (sensorial stimulation and guided imagery), in depression, disability and empowerment (music therapy) and physical functioning (program of psycho-education). The main limitations of this review were: excluding studies were the professional performing the interventions were not detailed or the intervention was not carried out by a nurse and that the search strategy was limited up to 2007. Implications for practice Listening to music, a cognitive-behavioural treatment programme, magnetic therapy, sensorial stimulation, a psychoeducation programme and guided imagery are nursing interventions that helps to reduce the chronic pain in adults and may be used as contributory to the pharmacological treatment. Short exercises for increasing endurance does not reduce pain. Implications for research For future reviews we do not recommend the inclusion of different interventions for the reduction of chronic pain, due to the great number and variability of intervention, but the development of a SR on specific interventions.