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Pain experienced by current or former substance abusers is a problem that continues to evoke strong judgements and responses among medical professionals. When pain among this population is not treated, tensions and mistrust often arise between patients and nurses. Behavioral issues among patients who do not trust that their pain is acknowledged and moral distress among nurses who see untreated pain is common. As previously stated, untreated pain is also a significant risk factor for addiction relapse (Prater, Zylstra, & Miller, 2002). Therefore, it is essential to address pain experienced by current and former substance users and The Gate Control Theory broadens the array of solutions to alleviate pain in this population.
At its simplest interpretation, the theory guides us to create alternative stimuli to block pain stimuli from crossing the “gate.” Alternative stimuli studied in relation to this theory include TENS, warm and cold compresses and massage. Patients with a history of substance use may have a much higher tolerance to opioid analgesics than the general population, meaning higher doses are needed to relieve their pain; using these non-pharmacologic stimuli has been shown to reduce the dose of pharmacologic intervention (McCaffery, 1990). TENS, warm and cold compresses and massage, as well as other touch stimuli, can be used as the primary analgesic, or used together with non-opioid analgesics, for former substance users who do not want opioids. These interventions can also be used alongside opioid analgesics, for severe pain, to lower the among of drug needed for relief. Finally, in addition to being useful for pain relief, touch stimuli such as massage also helps relieve secondary symptoms of pain such as anxiety and insomnia (Adams, White & Beckett, 2010).
Second, it is important to educate the patient and the nurse about these alternative methods of pain relief. Current and former substance users are accustomed to being dismissed and misled when seeking pain relief. Suggesting nonpharmacologic pain relief could be interpreted as dismissive if not explained fully or if the nurse-patient relationship is distrustful. Relationship and trust building in this population is challenging, but essential for successful use of nonpharmacologic methods. The Gate Control Theory can be distilled into a simple explanation to demonstrate why TENS, massage or other touch stimuli are being used to help block pain. Along with educating the patient, nurses must also understand nonpharmacologic methods. One study found that more nurses believe that nonpharmacologic pain relief can be effective compared to nursing students, yet more nursing student were trained in these methods compared to working nurses (Stewart & Cox-Davenport, 2014). Both training in nursing school and on the job should be implemented to help nurses become skilled in nonpharmacologic pain relief.
Third, The Gate Control Theory lends itself to new nursing research. The theory has been inspiring alternative pain management research since its introduction in the 1960s. It is also a nurse-friendly theory in that many of its applications, such as those described above, are not provider-dependent. Applying The Gate Control Theory to relieve pain in the substance-using population is still a largely untapped area of research. Expanding nursing research in this direction would be useful.
At its simplest interpretation, the theory guides us to create alternative stimuli to block pain stimuli from crossing the “gate.” Alternative stimuli studied in relation to this theory include TENS, warm and cold compresses and massage. Patients with a history of substance use may have a much higher tolerance to opioid analgesics than the general population, meaning higher doses are needed to relieve their pain; using these non-pharmacologic stimuli has been shown to reduce the dose of pharmacologic intervention (McCaffery, 1990). TENS, warm and cold compresses and massage, as well as other touch stimuli, can be used as the primary analgesic, or used together with non-opioid analgesics, for former substance users who do not want opioids. These interventions can also be used alongside opioid analgesics, for severe pain, to lower the among of drug needed for relief. Finally, in addition to being useful for pain relief, touch stimuli such as massage also helps relieve secondary symptoms of pain such as anxiety and insomnia (Adams, White & Beckett, 2010).
Second, it is important to educate the patient and the nurse about these alternative methods of pain relief. Current and former substance users are accustomed to being dismissed and misled when seeking pain relief. Suggesting nonpharmacologic pain relief could be interpreted as dismissive if not explained fully or if the nurse-patient relationship is distrustful. Relationship and trust building in this population is challenging, but essential for successful use of nonpharmacologic methods. The Gate Control Theory can be distilled into a simple explanation to demonstrate why TENS, massage or other touch stimuli are being used to help block pain. Along with educating the patient, nurses must also understand nonpharmacologic methods. One study found that more nurses believe that nonpharmacologic pain relief can be effective compared to nursing students, yet more nursing student were trained in these methods compared to working nurses (Stewart & Cox-Davenport, 2014). Both training in nursing school and on the job should be implemented to help nurses become skilled in nonpharmacologic pain relief.
Third, The Gate Control Theory lends itself to new nursing research. The theory has been inspiring alternative pain management research since its introduction in the 1960s. It is also a nurse-friendly theory in that many of its applications, such as those described above, are not provider-dependent. Applying The Gate Control Theory to relieve pain in the substance-using population is still a largely untapped area of research. Expanding nursing research in this direction would be useful.