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.
|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
|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
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.
|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
|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
|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
|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).