EVALUATION OF NON-PHARMACOLOGICAL PAIN MANAGEMENT PRACTICES AND ASSOCIATED BARRIERS

Abstract

Background: Chronic pain constitutes a significant global public health burden and necessitates a comprehensive multimodal management approach that extends beyond pharmacological interventions. International clinical guidelines strongly advocate incorporating non-pharmacological pain management strategies as integral components of holistic pain care. Despite robust evidence supporting their effectiveness, these approaches remain inadequately implemented in routine nursing practice, particularly in resource-constrained healthcare systems such as Pakistan. Objective: To assess the current practices of non-pharmacological pain management among registered nurses and to identify professional and systemic barriers influencing their implementation in a tertiary care hospital. Study Design: Descriptive cross-sectional study. Settings: The study was conducted at a tertiary care hospital in Pakistan. Duration of Study: January 2025 to July 2025. Methods: A total of 90 registered nurses with a minimum of six months of clinical experience were enrolled using non-probability convenience sampling. Data were collected using a structured, validated, self-administered questionnaire that included demographic characteristics, frequency of non-pharmacological pain management practices, and perceived barriers to implementation. Practice levels were categorized as good, moderate, or poor based on predefined scoring criteria. Data analysis was performed using SPSS version 25. Descriptive statistics were used to summarize variables, while chi-square tests and multivariable logistic regression analysis were applied to identify factors associated with good practice. Statistical significance was set at p < 0.05. Results: The mean age of participants was 36.8 ± 9.7 years, with a median clinical experience of seven years. Only 34.4% of nurses reported receiving formal pain management training within the preceding two years. The mean overall practice score was 42.6 ± 11.8, with 30.0% of participants demonstrating good practice, 53.3% moderate practice, and 16.7% poor practice. Frequently used interventions included comfort measures, patient reassurance, and therapeutic positioning, whereas cognitive and complementary techniques, such as guided imagery and music therapy, were infrequently employed. Major reported barriers were high patient to nurse ratios (80.0%), time constraints (76.7%), lack of structured training (64.4%), and absence of unit based clinical protocols (60.0%). Multivariable logistic regression revealed that recent pain management training (adjusted odds ratio 3.12, 95% confidence interval 1.24–7.86) and the availability of unit-specific protocols (adjusted odds ratio 2.74, 95% confidence interval 1.12–6.70) were independent predictors of good practice. Conclusion: Non-pharmacological pain management practices among nurses were inconsistently implemented and were significantly influenced by institutional constraints and training deficiencies. The findings underscore the critical need for structured educational programs and standardized clinical protocols to enhance evidence-based pain management. Addressing systemic barriers is essential for optimizing nursing contributions to comprehensive pain care in tertiary healthcare settings.