Reduction of Pain in an Adult Inpatient Medicine Unit

Colton, Stephanie L.
Barwig, Katie

Stephanie L. Colton, DNP, RN, AGACNP-BC, is Cardiac Surgery Intensive Care Nurse Practitioner, Department of Cardiac Surgery, Henry Ford Hospital, Detroit, MI. She was a Doctor of Nursing Practice student, School of Nursing, University of Michigan, Ann Arbor, MI, at the time this project was conducted.
Katie Barwig, MS, RN, is Medications Safety Manager, Department of Nursing, Michigan Medicine, Ann Arbor, MI.

MEDSURG Nursing 31(6):p 349-354, November 2022.

Movement or physical activity as a non-pharmacological intervention can reduce chronic pain. A study was conducted to determine if movement among inpatients on an adult inpatient medicine unit would decrease pain and opioid consumption, as well as improve quality of life. Findings from this study are discussed.

Clinical Question

In adult patients with pain (P), does the implementation of mobility as a non-pharmacological treatment modality in addition to medication (I) allow greater reduction in pain (O) compared to opioid administration alone (C)?

Evidence-Based Practice Model

Iowa Model for Evidence-Based Practice to Promote Quality Care ()

Patient Outcomes

Primary outcomes: Decrease pain with increased movement evaluated via a paired t test (p≤0.05); decreased opioid consumption with increased movement via milligram morphine equivalents by a paired t test (p≤0.05). Secondary outcomes: Decrease fall occurrence and pressure ulcer occurrence with increased movement via a paired t test (p≤0.05).

Search Strategy and Results

A literature search of peer-reviewed manuscripts in English between June 2014-August 2020 was conducted with filters adult and English. The following key search terms with the use of Boolean phrases of AND were used within the title and abstracts: chronic pain*, pain*, physical activity*, movement*, intervention*, and reduction*. Study selection was open to randomized controlled trials, single or double-blind, and meta-analyses. Main inclusion criteria were acute or chronic pain and the intervention of physical activity, movement, or exercise to decrease pain for adult patients. On the initial search with the combined databases, 70 articles were obtained. After removal of duplicates, 32 articles remained. During the screening of titles and abstracts, 14 articles were removed due to the articles not meeting full inclusion and exclusion criteria. Eighteen articles were identified based on title and abstract screening. Only 11 full-text articles were retained because the other seven articles focused on anxiety, posttraumatic stress disorder, or mental illness, and were not randomized controlled trials. All 11 articles were appraised with the for Randomized Controlled Trials, The Checklist for Randomized Controlled Trials, and the , Critical Appraisal Worksheet: Systematic Review.

Databases

PubMed, CINAHL

Clinical Setting/Patient Population/Average Daily Census

Project was conducted on two adult medicine units (7A, 8B) at Michigan Medicine in Ann Arbor, MI. Each unit had an average daily census of 28 patients.