PAIN MANAGEMENT

Relaxation, Imagery, and Distraction
By Marion E. Broome, RN, PHD, FAAN

It is very difficult to be in pain. However, there are many medicines you can take to reduce the pain. So, talk to your doctor about pain medications. There are also some other things you can do to manage the pain, in addition to taking medication. Three of these are:

1.) Relaxing tense muscles.

2.) Distracting yourself during a painful procedure.

3.) Using your imagination to think of pleasant things when in pain.


Relaxation

Learning how to relax will be most effective if you practice the techniques each night for 1 week after you are taught them. This practice should take no more than 15 to 20 minutes per day. If you’re scheduled for a painful procedure, then practice 3 nights before the procedure. When you begin, try to arrange 15 to 30 minutes of quiet time prior to practice. You may want to take a bath, read a book or do any other slow-paced activity. Relaxation is best learned in a room or area that is somewhat quiet, with soft lights, and one that is not too cold or too warm. You should be in a comfortable position.

The relaxation tape is about 15 minutes long and consists of instructions to contract (tense) and then release (relax) different muscle groups, starting at the head and ending at the toes. You will find you can relax more and larger groups of muscles at the same time as you continue to practice the first week.


Breathing

The benefits of using breathing patterns are primarily distraction and increased relaxation. You must concentrate in order to do the breathing and will have less attention available to think about the pain. You may need an adult to demonstrate the techniques for you. Sometimes you may become anxious and need help to remember the techniques, when you are experiencing pain.

There are 2 types of breathing you need to practice and use when undergoing a painful procedure. One is a rhythmic deep chest breathing and one is a patterned, more shallow breathing technique. Once again, practice these every night for 1 week until you know the techniques and then practice them 3 nights before the procedure.

Rhythmic Deep Chest Breathing - This breathing will be used during the relaxation and imagery exercises. It consists of taking slow, long, deep breaths in through the nose (or mouth if you are young or have a cold) and out through the mouth. This breathing is meant to be relaxing so make sure you don’t hold your breath, breathe too deep for comfort, or blow the breath out rapidly. Every time you let a breath out, remember to relax and push “all the tenseness” out. For younger children, it might be better to associate the breathing with “blowing out candles,” and “taking in enough air to make you float away.”

Some parents find that they can keep their child’s attention better during practice if they use their hand as a wand to help the child breathe. For instance, raise your hand slowly when you want your child to breathe in and lower it to signal to breathe out.

Patterned, Shallow Breathing - For children under 7 years of age, you may want to use your hand as a wand, or a puppet who “breathes” with them, or a “picture of the breathing” they can hold in their mind for instance: Toot--Toot--Toot--Toot (looks like a train -- each time a “blow” breath comes the Conductor says “Toot”).

This breathing consists of 2 short, shallow breaths, in the nose and out the mouth, and on the second the child breathes out and says “Toot.” This technique is used for distraction during a part of the procedure that is uncomfortable or painful. The pattern and noise makes it more complex and requires more attention from the child, leaving him/her less attention for the pain.


Imagery

The purpose of imagery is to provide additional relaxation and a sense of security using your child’s imagination. Your child consciously brings a pleasant scene into mind and uses hearing, vision, smell, and touch senses to make the image more vivid. Each child will have a unique, special scene. Some common ones are: parks, beaches, mountains, etc. Energy will be used to maintain the pleasant image when a child is in pain. You, as a parent, can be especially helpful to your child. You may have to talk with your child to remind him/her about what the image sounds like, smells like, and feels like, especially when your child becomes somewhat tense during a procedure. Listen to the instruction tape to learn how to use imagery.


Heat, Positioning, Massage and Physical Therapy

These modalities of pain relief work by identifying and reducing biological and physical factors that perpetuate pain. Patients who use them also learn more about correct posture and body mechanics to reduce pain. These strategies are thought to be associated with the release of endorphins, which are hormones that help stimulate brain pathways and feelings of well being.

In summary, pain is an emerging problem in CF patients. With better and more advanced medical care available for CF patients, pain will no longer be a major cause of morbidity. Effective use of both pharmacological and nonpharmacological modalities will help patients cope better with the pain associated with CF.

Good luck! You can do it!!!

Marion Broome is the Dean of the Indiana University School of Nursing. She has a doctorate degree in child and family development from the University of Georgia and is a fellow of the American Academy of Nursing (AAN), for whom she is serving as editor-in-chief of Nursing Outlook, the official journal of the AAN. She is widely regarded as an expert and leader in pediatric nursing research and practice. Her research in pediatric pain has been sponsored since 1991 by the American Cancer Society and the NIH.

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