Alternative and complementary postoperative pain strategies
Alternative medicine is often used by patients, although the frequency of its use in the postoperative setting is unknown.1 The following table is a summary of commonly used alternative therapies. The data review is not meant to be exhaustive, however provides a summary of higher quality or most quoted articles related to each type of intervention. From a logistical standpoint, alternative therapies are not typically covered by insurance or reimbursed, and while some interventions are simple and inexpensive, others (massage, acupuncture) require a larger input of time and resources.
| Evidence | Regimen |
| Christoffersen, Hernia, 2015.2 Small RCT (total n=56) after elective laparoscopic umbilical or epigastric hernia repair
Rothman, Danish Medical Journal, 2014.3
|
Continuous use x 7 days
Varied |
| Evidence | Regimen |
| Sun, British Journal of Anesthesia, 2008.4 Systematic review – included 15 RCTs of acupoint stimulation vs sham
Kotani, Journal of American Society of Anesthesiologists, 2001.5
|
Varied
Preoperative intradermal needles inserted to left and right of bladder meridian. Patients in intervention and control groups also received epidural catheters |
No high quality evidence in the postoperative setting.
| Evidence | Regimen |
| Watkins, JACS, 2014.6 Small RCT (total n=55) after abdominal operations with a midline incision
|
Continuous application of ice from OR to 24 hours postop |
No high quality evidence for use in the postoperative setting. Commonly used for muscular pain/arthralgia
| Evidence | Regimen |
| Habib, Anesthesia & Analgesia, 2009.7 RCT, blinded, total n= 70 after radical prostatectomy
Bai, Current Medical Research and Opinion, 2015.8
|
Patch placed in OR, left for 24 hours
Varied |
| Evidence | Regimen |
| Mitchinson, Archives of Surgery, 2007.9 RCT of patients after major abdominal operations
|
20 minute nightly back massage x 5 days |
Poor quality data. Data that does exist shows no effect.10 11
| Evidence | Regimen |
| Good, Pain, 1999.12 RCT of relaxation, music, combination and control, n=500 after abdominal surgery
Roykulcharoen, JAN, 200413
Gonzales, AANA, 2010.14
|
Recorded tape of jaw relaxation instruction, a choice of music, or both played pre and postoperatively
15 minutes of systemic relaxation in recovery
CD with guided imagery played in preop |
- Eisenberg, D. M. et al. Trends in Alternative Medicine Use in the United States, 1990-1997: Results of a Follow-up National Survey. JAMA 280, 1569–1575 (1998).
- Christoffersen, M. W., Olsen, B. H., Rosenberg, J. & Bisgaard, T. Randomized Clinical Trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair. Hernia 19, 147–153 (2015).
- Rothman, J. P., Gunnarsson, U. & Bisgaard, T. Abdominal binders may reduce pain and improve physical function after major abdominal surgery - a systematic review. Dan. Med. J. 61, A4941 (2014).
- Sun, Y., Gan, T. J., Dubose, J. W. & Habib, A. S. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. BJA Br. J. Anaesth. 101, 151–160 (2008).
- Kotani, N. et al. Preoperative Intradermal Acupuncture Reduces Postoperative Pain, Nausea and Vomiting, Analgesic Requirement, and Sympathoadrenal Responses. Anesthesiol. J. Am. Soc. Anesthesiol. 95, 349–356 (2001).
- Watkins, A. A. et al. Ice Packs Reduce Postoperative Midline Incision Pain and Narcotic Use: A Randomized Controlled Trial. J. Am. Coll. Surg. 219, 511–517 (2014).
- Habib, A. S. et al. Lidocaine Patch for Postoperative Analgesia After Radical Retropubic Prostatectomy. Anesth. Analg. 108, 1950 (2009).
- Bai, Y., Miller, T., Tan, M., Law, L. S.-C. & Gan, T. J. Lidocaine patch for acute pain management: a meta-analysis of prospective controlled trials. Curr. Med. Res. Opin. 31, 575–581 (2015).
- Mitchinson, A. R. et al. Acute Postoperative Pain Management Using Massage as an Adjuvant Therapy: A Randomized Trial. Arch. Surg. 142, 1158–1167 (2007).
- vanderVaart, S. et al. The effect of distant reiki on pain in women after elective Caesarean section: a double-blinded randomised controlled trial. BMJ Open 1, e000021 (2011).
- vanderVaart, S., Gijsen, V. M. G. J., de Wildt, S. N. & Koren, G. A Systematic Review of the Therapeutic Effects of Reiki. J. Altern. Complement. Med. 15, 1157–1169 (2009).
- Good, M. et al. Relief of postoperative pain with jaw relaxation, music and their combination. Pain 81, 163–172 (1999).
- Roykulcharoen, V. & Good, M. Systematic relaxation to relieve postoperative pain. J. Adv. Nurs. 48, 140–148 (2004).
- Gonzales, E. A. et al. Effects of guided imagery on postoperative outcomes in patients undergoing same-day surgical procedures: a randomized, single-blind study. AANA J. 78, 181–188 (2010).