Non-Pharmacological Pain Self-Management in an Inpatient Rehabilitation Setting: An Exploratory Quality Improvement Study

Background: Pain neuroscience education (PNE) is well-studied and described in outpatient clinical settings but not inpatient clinical environments. Objective: To assess if PNE nursing education in an inpatient rehabilitation setting would yield positives shifts in patient choices for non-pharmacological treatment choices for pain and increase self-efficacy and self-management of pain. Design: Quality improvement study Methods: Nursing staff at an inpatient rehabilitation facility underwent training in PNE, non-pharmacological approaches to pain and emotional/spiritual support, guided imagery/relaxation techniques and therapeutic presence/touch. Prior to implementation of the training, and following training, a convenience sample of 25 patients (50 total) charts were reviewed to determine if patients received a Pain Control and Comfort menu showcasing various non-pharmacological and self- management strategies for their pain. Additionally, patients' beliefs and self-efficacy was measured at the time of admission and discharge to determine if exposure to trained nurses altered their self-efficacy during the course of inpatient care. Results: Following training there was a 50.2% increase in non-pharmacological choices to manage pain and specific to the nursing education, there was a 347% increase in utilization of emotional/spiritual support, guided imagery/relaxation techniques, and therapeutic presence/touch to self-manage pain. For pain self-efficacy for dressing, bathing and ability to go to the bathroom, during the pre-improvement period, the mean score at admission for these tasks was at 7.27 and at discharge 9.16, showcasing a 26% positive shift. In the post-improvement period, the mean at-admission score for the 3 functional tasks was 5.69 points but at discharge increased to 9.11 points (61% increase). Conclusion: PNE training to nurses in an inpatient rehabilitation setting yield various positive changes including increased exposure to and use of a pain menu designed to foster increased use of non-pharmacological treatments for pain and foster increased self-efficacy and self-management by the patients.