Few Try Evidence-based Nonpharmacologic Alternatives, Such as Yoga or Massage

Heart failure patients rarely use evidence-based alternative treatments for comorbid chronic pain, often resorting to opioids or contraindicated NSAIDs, according to a small, single-center study published in Heart & Lung: The Journal of Acute and Critical Care.¹

Polling 25 patients hospitalized for heart failure who used at least 1 alternative pain treatment for chronic non-cardiac pain, researchers found that 18 (72%) were currently taking an analgesic or co-analgesic for their chronic pain.

Although these findings are concerning, the surprising aspect was that few patients had tried evidence-based alternative pain therapies that might also provide cardiovascular benefit, such as yoga for chronic low back pain and fibromyalgia.

“We expected participants to have more alternative pain management treatments,” lead author Deborah McDonald, PhD, from the University of Connecticut School of Nursing, told Clinical Pain Advisor.

According to Dr. McDonald, the preliminary study was prompted by nursing staff at Saint Francis Hospital and Medical Center in Hartford, Connecticut, who raised concerns about the therapeutic choices of inpatient heart failure patients admitted to the hospital with comorbid pain.

“Many alternative or complementary pain treatments are within the scope of nursing practice, and therefore nurses can support patients with safe alternative pain treatments and perhaps reduce the symptom burden for patients,”Dr. McDonald pointed out.

Alternative Treatments Rarely Used

For the study, nursing staff invited patients in the heart failure unit to participate in a brief research study during their hospital stay. Patients were screened within 24 hours of admission; inclusion criteria included having pain of at least 3 months’ duration experienced during the majority of days in the previous month, and current use of at least 1 alternative non-nutraceutical pain management strategy at home on a regular basis.

Mean patient age was 65.5 ± 15.42 years, and mean pain duration was 17.3 ± 21.06 years. The most common pain syndromes were back pain (44.0%), osteoarthritis (24.0%), fibromyalgia (16.0%), and neuropathic pain (16.0%).

Of 25 study patients, 9 (36%) were currently taking acetaminophen, 11 were on opioid therapy (44%), and 3 (12%) took NSAIDs. Eight patients (32%) limited their use of analgesics or co-analgesics to 1 agent; 1 patient was taking 5 different medications.