Using Nonpharmacological Treatments in the Emergency Department to Treat Pain Complaints: A Literature Review
Abstract
Pain management in the Emergency Department (ED) is crucial for humanitarian reasons and is associated with significant morbidity. Previously, pharmacologic therapies like acetaminophen, opioids, and NSAIDs were used, but they carry risks of side effects. Non-pharmacological interventions are often used in conjunction with pharmaceutical therapies to improve pain management and reduce opioid use. This study's purpose was to describe the non-pharmacological interventions that nurses can provide in addressing pain experienced by patients in the ED. This is a literature study from several databases such as Science Direct, ProQuest, SpringerLink, and PubMed using keywords combined with Boolean. The study's selection process involved searching 769 articles using keywords, excluding 27 duplicates and 712 articles not meeting research objectives. After a full-text review of 30 selected articles, 19 were excluded, and 11 were selected for inclusion. Acupuncture therapy is the most commonly used non-pharmacological therapy, followed by warm/cold compresses, distraction, and deep breath relaxation. Non-pharmacological therapies can be given to manage pain in patients in the ED. Combining pharmacological and non-pharmacological therapies can provide more analgesia for severe pain.
References
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Bakar, A., Qomariah, S. N., Santoso, C. H., Gustomi, M. P., Syaful, Y., & Fatmawa, L. (2020). Factors the incidence of hypoglycemia in diabetes mellitus patients: A pilot study in the emergency room. Enfermería Clínica, 30, 46-49.
Bakar, A., Adriani, M., Qomariah, S. N., & Efendi, F. (2018). The Development of Islamic Caring Model to Improve Psycho-Spiritual Comfort of Coronary Disease Patients. Indian Journal of Public Health Research & Development, 9(10).
Bendall, J. C., Simpson, P. M., & Middleton, P. M. (2011). Prehospital Analgesia in New South Wales, Australia. Prehospital and Disaster Medicine, 26(6), 422–426. https://doi.org/10.1017/S1049023X12000180
Birrenbach, T., Bühlmann, F., Exadaktylos, A. K., Hautz, W. E., Müller, M., & Sauter, T. C. (2022). Virtual Reality for Pain Relief in the Emergency Room (VIPER) – a prospective, interventional feasibility study. BMC Emergency Medicine, 22, 1–13. https://doi.org/https://doi.org/10.1186/s12873-022-00671-z
Bosso, L., Espejo, T., Taffé, P., Caillet-Bois, D., Christen, T., Berna, C., & Hugli, O. (2023). Analgesic and Anxiolytic Effects of Virtual Reality During Minor Procedures in an Emergency Department: A Randomized Controlled Study. Annals of Emergency Medicine, 81(1), 84–94. https://doi.org/https://doi.org/10.1016/j.annemergmed.2022.04.015
Cohen, M. M., Smit, D. V., Andrianopoulos, N., Ben-Meir, M., Taylor, D. M. D., Parker, S. J., Xue, C. C., & Cameron, P. A. (2017). Acupuncture for analgesia in the emergency department: A multicentre, randomized, equivalence and non-inferiority trial. Medical Journal of Australia, 206(11), 494–499. https://doi.org/10.5694/mja16.00771
Els, C., Jackson, T. D., Kunyk, D., Lappi, V. G., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F., & Straube, S. (2017). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, 2018(1). https://doi.org/10.1002/14651858.CD012509.pub2
Grissa, M. H., Baccouche, H., Boubaker, H., Beltaief, K., Bzeouich, N., Fredj, N., Msolli, M. A., Boukef, R., Bouida, W., & Nouira, S. (2016). Acupuncture vs intravenous morphine in the management of acute pain in the ED. American Journal of Emergency Medicine, 34(11), 2112–2116. https://doi.org/10.1016/j.ajem.2016.07.028
Hunold, K. M., Esserman, D. A., Isaacs, C. G., Dickey, R. M., Pereira, G. F., Fillingim, R. B., Sloane, P. D., McLean, S. A., & Platts-Mills, T. F. (2013). Side Effects From Oral Opioids in Older Adults During the First Week of Treatment for Acute Musculoskeletal Pain. Academic Emergency Medicine, 20(9), 872–879. https://doi.org/10.1111/acem.12212
International Pain Summit Of The International Association For The Study Of Pain. (2011). Declaration of Montréal: Declaration That Access to Pain Management Is a Fundamental Human Right. Journal of Pain & Palliative Care Pharmacotherapy, 25(1), 29–31. https://doi.org/10.3109/15360288.2010.547560
Kassim, M. A. K., Pantazi, A. C., Nori, W., Tuta, L. A., Balasa, A. L., Mihai, C. M., Mihai, L., Frecus, C. E., Lupu, V. V., Lupu, A., Andrusca, A., Iorga, A. M., Litrin, R. M., Ion, I., Ciciu, E., Chirila, S. I., & Chisnoiu, T. (2023). Non-Pharmacological Interventions for Pain Management in Hemodialysis: A Narrative Review. Journal of Clinical Medicine, 12(16), 5390. https://doi.org/10.3390/jcm12165390
Kia, Z., Allahbakhshian, M., Ilkhani, M., Nasiri, M., & Allahbakhshian, A. (2021). Nurses’ use of non-pharmacological pain management methods in intensive care units: A descriptive cross-sectional study. Complementary Therapies in Medicine, 58(February), 102705. https://doi.org/10.1016/j.ctim.2021.102705
Leutualy, V., Madiuw, D., Tasijawa, F. A., Sumah, D. F., Manuhutu, F., & Maelissa, S. (2022). Non-pharmacology Interventions on Pain in Critically Ill Patient: A Scoping Review. Open Access Macedonian Journal of Medical Sciences, 10(F), 182–189. https://doi.org/10.3889/oamjms.2022.7985
Lipp, C., Dhaliwal, R., & Lang, E. (2013). Analgesia in the emergency department: a GRADE-based evaluation of research evidence and recommendations for practice. Critical Care, 17(2), 212. https://doi.org/10.1186/cc12521
Liu, Y. T., Chiu, C. W., Chang, C. F., Lee, T. C., Chen, C. Y., Chang, S. C., Lee, C. Y., & Lo, L. C. (2015). Efficacy and Safety of Acupuncture for Acute Low Back Pain in Emergency Department: A Pilot Cohort Study. Evidence-Based Complementary and Alternative Medicine, 2015. https://doi.org/10.1155/2015/179731
Mota, M., Santos, E., Cunha, M., Abrantes, T., Caldes, P., & Santos, M. R. (2021). Non-pharmacological interventions for acute pain management in adult trauma victims: A scoping review. JBI Evidence Synthesis, 19(7), 1555–1582. https://doi.org/10.11124/JBIES-20-00189
Papadopoulos, G. S., Tzimas, P., Liarmakopoulou, A., & Petrou, A. M. (2017). Auricular Acupuncture Analgesia in Thoracic Trauma: A Case Report. JAMS Journal of Acupuncture and Meridian Studies, 10(1), 49–52. https://doi.org/10.1016/j.jams.2016.06.003
Park, H., Park, C., Quinn, L., & Fritschi, C. (2015). Glucose control and fatigue in type 2 diabetes: the mediating roles of diabetes symptoms and distress. Journal of Advanced Nursing, 71(7), 1650–1660. https://doi.org/10.1111/jan.12632
Persatuan Perawat Nasional Indonesia. (2018). Standar Intervensi Keperawatan Indonesia Definisi dan Tindakan Keperawatan (Edisi 1). PPNI.
Pierik, J. G. J., IJzerman, M. J., Gaakeer, M. I., Berben, S. A., van Eenennaam, F. L., van Vugt, A. B., & Doggen, C. J. M. (2015). Pain Management in the Emergency Chain: The Use and Effectiveness of Pain Management in Patients with Acute Musculoskeletal Pain. Pain Medicine, 16(5), 970–984. https://doi.org/10.1111/pme.12668
Pollack, C. V., Diercks, D. B., Thomas, S. H., Shapiro, N. I., Fanikos, J., Mace, S. E., Rafique, Z., & Todd, K. H. (2016). Patient‐reported Outcomes from A National, Prospective, Observational Study of Emergency Department Acute Pain Management With an Intranasal Nonsteroidal Anti‐inflammatory Drug, Opioids, or Both. Academic Emergency Medicine, 23(3), 331–341. https://doi.org/10.1111/acem.12902
Prastika, D., Kitrungrote, L., & Damkliang, J. (2018). Pain-management strategies among hospitalized trauma patients: a preliminary study in a teaching hospital in Indonesia. Enfermería Clínica, 28, 158–161. https://doi.org/10.1016/S1130-8621(18)30058-5
Sakamoto, J. T., Ward, H. B., Vissoci, J. R. N., & Eucker, S. A. (2018). Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis. Academic Emergency Medicine, 25(8), 940–957. https://doi.org/10.1111/acem.13411
Sanjana, I. W. E., Agustini, N. L. P. I. B., Wahyunadi, N. M. D., & Yusniawati, Y. N. P. (2023). The Training Component of Knowledge Improvement about Basic Life Support in Laypersons: A literature review. Enhancing the Role of Holistic Care Approach for Better Health Status in The Clinical and Community Setting.
Sanjana, I. W. E., Widyandari, N. M. A. S., & Agustini, N. L. P. I. B. (2023). Nursing Competencies in Ambulance Needs at Prehospital: A Scoping Review. Jurnal Info Kesehatan Vol., 21(2), 212–225. https://doi.org/https://doi.org/10.31965/infokes.Vol21Iss2.960
Sanjana, I. W. E., Wihastuti, T. A., & Muslihah, N. (2022). An Analysis of Nurse Knowledge and Attitude on Pre-Hospital Ambulance Service Satisfaction in Bali, Indonesia. Babali Nursing Research, 3(3), 273–283. https://doi.org/10.37363/bnr.2022.33153
Su, S. H., Lai, P. F., Yu, H. Y., Chen, K. C., Wu, K., Huang, C. K., Tseng, W. C., Lai, C. Y., Huang, C. P., & Ho, T. J. (2022). Application of acupuncture in the emergency department for patients with ileus: A pilot prospective cohort clinical study. Medicine (United States), 101(43), E31245. https://doi.org/10.1097/MD.0000000000031245
Suroso, H., Fajriyah, N., Susila, W. D. C., & Qomariah, S. N. (2023). Education for Nurses Working in Pre-hospital Emergency Care. Synthesis Global Health Journal, 19-35.
Tu, J. F., Cao, Y., Wang, L. Q., Shi, G. X., Jia, L. C., Liu, B. L., Yao, W. H., Pei, X. L., Cao, Y., Li, H. W., Yan, S. Y., Yang, J. W., Qu, Z. C., & Liu, C. Z. (2022). Effect of Adjunctive Acupuncture on Pain Relief Among Emergency Department Patients With Acute Renal Colic Due to Urolithiasis: A Randomized Clinical Trial. JAMA Network Open, 5(8), e2225735. https://doi.org/10.1001/jamanetworkopen.2022.25735
Zhang, A. L., Parker, S. J., Smit, D. V., McD Taylor, D., & Xue, C. C. L. (2014). Acupuncture and standard emergency department care for pain and/or nausea and its impact on emergency care delivery: A feasibility study. Acupuncture in Medicine, 32(3), 250–256. https://doi.org/10.1136/acupmed-2013-010501
Zhang, T., Smit, D., Taylor, D., Parker, S., & Xue, C. (2012). P02.195. Acupuncture for acute pain management in an emergency department: an observational study. BMC Complementary and Alternative Medicine, 12(S1), 6882. https://doi.org/10.1186/1472-6882-12-s1-p251
Assiry, A. A. M., Brown, N. J., Hazelwood, S., Lyrstedt, A.-L. L., Jarugula, R., Jones, L., Chu, K., & Hughes, J. A. (2024). The use and outcomes of non-pharmacological analgesia in the adult emergency department. International Emergency Nursing, 74, 101458. https://doi.org/https://doi.org/10.1016/j.ienj.2024.101458
Bakar, A., Qomariah, S. N., Santoso, C. H., Gustomi, M. P., Syaful, Y., & Fatmawa, L. (2020). Factors the incidence of hypoglycemia in diabetes mellitus patients: A pilot study in the emergency room. Enfermería Clínica, 30, 46-49.
Bakar, A., Adriani, M., Qomariah, S. N., & Efendi, F. (2018). The Development of Islamic Caring Model to Improve Psycho-Spiritual Comfort of Coronary Disease Patients. Indian Journal of Public Health Research & Development, 9(10).
Bendall, J. C., Simpson, P. M., & Middleton, P. M. (2011). Prehospital Analgesia in New South Wales, Australia. Prehospital and Disaster Medicine, 26(6), 422–426. https://doi.org/10.1017/S1049023X12000180
Birrenbach, T., Bühlmann, F., Exadaktylos, A. K., Hautz, W. E., Müller, M., & Sauter, T. C. (2022). Virtual Reality for Pain Relief in the Emergency Room (VIPER) – a prospective, interventional feasibility study. BMC Emergency Medicine, 22, 1–13. https://doi.org/https://doi.org/10.1186/s12873-022-00671-z
Bosso, L., Espejo, T., Taffé, P., Caillet-Bois, D., Christen, T., Berna, C., & Hugli, O. (2023). Analgesic and Anxiolytic Effects of Virtual Reality During Minor Procedures in an Emergency Department: A Randomized Controlled Study. Annals of Emergency Medicine, 81(1), 84–94. https://doi.org/https://doi.org/10.1016/j.annemergmed.2022.04.015
Cohen, M. M., Smit, D. V., Andrianopoulos, N., Ben-Meir, M., Taylor, D. M. D., Parker, S. J., Xue, C. C., & Cameron, P. A. (2017). Acupuncture for analgesia in the emergency department: A multicentre, randomized, equivalence and non-inferiority trial. Medical Journal of Australia, 206(11), 494–499. https://doi.org/10.5694/mja16.00771
Els, C., Jackson, T. D., Kunyk, D., Lappi, V. G., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F., & Straube, S. (2017). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, 2018(1). https://doi.org/10.1002/14651858.CD012509.pub2
Grissa, M. H., Baccouche, H., Boubaker, H., Beltaief, K., Bzeouich, N., Fredj, N., Msolli, M. A., Boukef, R., Bouida, W., & Nouira, S. (2016). Acupuncture vs intravenous morphine in the management of acute pain in the ED. American Journal of Emergency Medicine, 34(11), 2112–2116. https://doi.org/10.1016/j.ajem.2016.07.028
Hunold, K. M., Esserman, D. A., Isaacs, C. G., Dickey, R. M., Pereira, G. F., Fillingim, R. B., Sloane, P. D., McLean, S. A., & Platts-Mills, T. F. (2013). Side Effects From Oral Opioids in Older Adults During the First Week of Treatment for Acute Musculoskeletal Pain. Academic Emergency Medicine, 20(9), 872–879. https://doi.org/10.1111/acem.12212
International Pain Summit Of The International Association For The Study Of Pain. (2011). Declaration of Montréal: Declaration That Access to Pain Management Is a Fundamental Human Right. Journal of Pain & Palliative Care Pharmacotherapy, 25(1), 29–31. https://doi.org/10.3109/15360288.2010.547560
Kassim, M. A. K., Pantazi, A. C., Nori, W., Tuta, L. A., Balasa, A. L., Mihai, C. M., Mihai, L., Frecus, C. E., Lupu, V. V., Lupu, A., Andrusca, A., Iorga, A. M., Litrin, R. M., Ion, I., Ciciu, E., Chirila, S. I., & Chisnoiu, T. (2023). Non-Pharmacological Interventions for Pain Management in Hemodialysis: A Narrative Review. Journal of Clinical Medicine, 12(16), 5390. https://doi.org/10.3390/jcm12165390
Kia, Z., Allahbakhshian, M., Ilkhani, M., Nasiri, M., & Allahbakhshian, A. (2021). Nurses’ use of non-pharmacological pain management methods in intensive care units: A descriptive cross-sectional study. Complementary Therapies in Medicine, 58(February), 102705. https://doi.org/10.1016/j.ctim.2021.102705
Leutualy, V., Madiuw, D., Tasijawa, F. A., Sumah, D. F., Manuhutu, F., & Maelissa, S. (2022). Non-pharmacology Interventions on Pain in Critically Ill Patient: A Scoping Review. Open Access Macedonian Journal of Medical Sciences, 10(F), 182–189. https://doi.org/10.3889/oamjms.2022.7985
Lipp, C., Dhaliwal, R., & Lang, E. (2013). Analgesia in the emergency department: a GRADE-based evaluation of research evidence and recommendations for practice. Critical Care, 17(2), 212. https://doi.org/10.1186/cc12521
Liu, Y. T., Chiu, C. W., Chang, C. F., Lee, T. C., Chen, C. Y., Chang, S. C., Lee, C. Y., & Lo, L. C. (2015). Efficacy and Safety of Acupuncture for Acute Low Back Pain in Emergency Department: A Pilot Cohort Study. Evidence-Based Complementary and Alternative Medicine, 2015. https://doi.org/10.1155/2015/179731
Mota, M., Santos, E., Cunha, M., Abrantes, T., Caldes, P., & Santos, M. R. (2021). Non-pharmacological interventions for acute pain management in adult trauma victims: A scoping review. JBI Evidence Synthesis, 19(7), 1555–1582. https://doi.org/10.11124/JBIES-20-00189
Papadopoulos, G. S., Tzimas, P., Liarmakopoulou, A., & Petrou, A. M. (2017). Auricular Acupuncture Analgesia in Thoracic Trauma: A Case Report. JAMS Journal of Acupuncture and Meridian Studies, 10(1), 49–52. https://doi.org/10.1016/j.jams.2016.06.003
Park, H., Park, C., Quinn, L., & Fritschi, C. (2015). Glucose control and fatigue in type 2 diabetes: the mediating roles of diabetes symptoms and distress. Journal of Advanced Nursing, 71(7), 1650–1660. https://doi.org/10.1111/jan.12632
Persatuan Perawat Nasional Indonesia. (2018). Standar Intervensi Keperawatan Indonesia Definisi dan Tindakan Keperawatan (Edisi 1). PPNI.
Pierik, J. G. J., IJzerman, M. J., Gaakeer, M. I., Berben, S. A., van Eenennaam, F. L., van Vugt, A. B., & Doggen, C. J. M. (2015). Pain Management in the Emergency Chain: The Use and Effectiveness of Pain Management in Patients with Acute Musculoskeletal Pain. Pain Medicine, 16(5), 970–984. https://doi.org/10.1111/pme.12668
Pollack, C. V., Diercks, D. B., Thomas, S. H., Shapiro, N. I., Fanikos, J., Mace, S. E., Rafique, Z., & Todd, K. H. (2016). Patient‐reported Outcomes from A National, Prospective, Observational Study of Emergency Department Acute Pain Management With an Intranasal Nonsteroidal Anti‐inflammatory Drug, Opioids, or Both. Academic Emergency Medicine, 23(3), 331–341. https://doi.org/10.1111/acem.12902
Prastika, D., Kitrungrote, L., & Damkliang, J. (2018). Pain-management strategies among hospitalized trauma patients: a preliminary study in a teaching hospital in Indonesia. Enfermería Clínica, 28, 158–161. https://doi.org/10.1016/S1130-8621(18)30058-5
Sakamoto, J. T., Ward, H. B., Vissoci, J. R. N., & Eucker, S. A. (2018). Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis. Academic Emergency Medicine, 25(8), 940–957. https://doi.org/10.1111/acem.13411
Sanjana, I. W. E., Agustini, N. L. P. I. B., Wahyunadi, N. M. D., & Yusniawati, Y. N. P. (2023). The Training Component of Knowledge Improvement about Basic Life Support in Laypersons: A literature review. Enhancing the Role of Holistic Care Approach for Better Health Status in The Clinical and Community Setting.
Sanjana, I. W. E., Widyandari, N. M. A. S., & Agustini, N. L. P. I. B. (2023). Nursing Competencies in Ambulance Needs at Prehospital: A Scoping Review. Jurnal Info Kesehatan Vol., 21(2), 212–225. https://doi.org/https://doi.org/10.31965/infokes.Vol21Iss2.960
Sanjana, I. W. E., Wihastuti, T. A., & Muslihah, N. (2022). An Analysis of Nurse Knowledge and Attitude on Pre-Hospital Ambulance Service Satisfaction in Bali, Indonesia. Babali Nursing Research, 3(3), 273–283. https://doi.org/10.37363/bnr.2022.33153
Su, S. H., Lai, P. F., Yu, H. Y., Chen, K. C., Wu, K., Huang, C. K., Tseng, W. C., Lai, C. Y., Huang, C. P., & Ho, T. J. (2022). Application of acupuncture in the emergency department for patients with ileus: A pilot prospective cohort clinical study. Medicine (United States), 101(43), E31245. https://doi.org/10.1097/MD.0000000000031245
Suroso, H., Fajriyah, N., Susila, W. D. C., & Qomariah, S. N. (2023). Education for Nurses Working in Pre-hospital Emergency Care. Synthesis Global Health Journal, 19-35.
Tu, J. F., Cao, Y., Wang, L. Q., Shi, G. X., Jia, L. C., Liu, B. L., Yao, W. H., Pei, X. L., Cao, Y., Li, H. W., Yan, S. Y., Yang, J. W., Qu, Z. C., & Liu, C. Z. (2022). Effect of Adjunctive Acupuncture on Pain Relief Among Emergency Department Patients With Acute Renal Colic Due to Urolithiasis: A Randomized Clinical Trial. JAMA Network Open, 5(8), e2225735. https://doi.org/10.1001/jamanetworkopen.2022.25735
Zhang, A. L., Parker, S. J., Smit, D. V., McD Taylor, D., & Xue, C. C. L. (2014). Acupuncture and standard emergency department care for pain and/or nausea and its impact on emergency care delivery: A feasibility study. Acupuncture in Medicine, 32(3), 250–256. https://doi.org/10.1136/acupmed-2013-010501
Zhang, T., Smit, D., Taylor, D., Parker, S., & Xue, C. (2012). P02.195. Acupuncture for acute pain management in an emergency department: an observational study. BMC Complementary and Alternative Medicine, 12(S1), 6882. https://doi.org/10.1186/1472-6882-12-s1-p251
Published
2024-05-30
How to Cite
SANJANA, I Wayan et al.
Using Nonpharmacological Treatments in the Emergency Department to Treat Pain Complaints: A Literature Review.
Adi Husada Nursing Journal, [S.l.], v. 10, n. 1, p. 37-47, may 2024.
ISSN 2502-2083.
Available at: <https://adihusada.ac.id/jurnal/index.php/AHNJ/article/view/533>. Date accessed: 28 sep. 2025.
doi: https://doi.org/10.37036/ahnj.v10i1.533.
Section
Articles
Keywords
Acupuncture, Analgesic, Emergency Department, Non-pharmacologic, Pain Management
This work is licensed under a Creative Commons Attribution 4.0 International License.
