ATI - Pain Module

Q (quality)

"Describe what your pain feels like"

S (severity)

"On a scale of 1-10, how would you rate your pain?" (use one of the paint scales discussed in the next section)

R (region)

"Show me the location where you are experiencing pain"

P (precipitating cause)

"What were you doing when the pain started?"

T (timing)

"When did your pain first begin? Have you experienced this pain before?"

A nurse is assisting with a staff in-service regarding pain control. Which of the following statements by a staff member indicates an understanding of the information? (Select all that apply) A. "A client's religious beliefs might affect the way they respond to pain." B. "Herbal therapies are not permitted for a client receiving prescription pain medication." C. "The client's past pain experiences are not related to their current pain and pain management." D."If a client can rate their pain using a numeric pain scale, there is no need to not nonverbal findings." E. "Pain control might be harder to achieve if the nurse and client speak different primary languages."

A. "A client's religious beliefs might affect the way they respond to pain." C. "The client's past pain experiences are not related to their current pain and pain management." E. "Pain control might be harder to achieve if the nurse and client speak different primary languages."

A nurse is discussing transcutaneous electrical nerve stimulation (TENS) treatment with a client who has chronic lower back pain. Which of the following statements should the nurse include? (Select all that apply) A. "You can be taught how to use TENS therapy at home." B. "We will insert very small sterile needles into your skin to block your pain." C. "This therapy may result in you having some temporary bruising at the site of application." D. "The TENS therapy delivers low-voltage electrical impulses to the skin over the painful areas." E. "We will adjust the intensity, pulse rate, and duration of the electrical pulses during your therapy."

A. "You can be taught how to use TENS therapy at home." D. "The TENS therapy delivers low-voltage electrical impulses to the skin over the painful areas." E. "We will adjust the intensity, pulse rate, and duration of the electrical pulses during your therapy."

A nurse is reviewing a new prescription with a client who reports difficulty managing their chronic pain. Which of the following statements should the nurse include? A. "You should write down the pain interventions you use and your pain rating before and after." B. "You should understand that it is impossible to fix everyone's pain." C. "Your provider is best at determining whether your pain treatments are effective." D. "Your care partner should manage your pain control because you are unable."

A. "You should write down the pain interventions you use and your pain rating before and after."

The FLACC Pain Scale is recommend for children from... A. 2 months - 7 years B. 0 months - 6 months C. 7 years - 17 years of age D. 8 years of age and greater

A. 2 months - 7 years

A nurse is caring for a client who has a prescription for hydromorphone 1 to 2 mg IM every 4 hr as needed for a pain rating of 4 to 6 on a 0 to 10 scale. The client has never taken hydromorphone before. Which of the following actions should the nurse plan to take? A. Administer 1 mg IM B. Request a prescription to give the medication IV instead C. Request a prescription for a different medication D. Administer 2 mg IM

A. Administer 1 mg IM

A nurse is reviewing the plan of care for several clients who are receiving treatment for pain. Which of the following actions should the nurse plan to take to evaluate the client's pain control? (Select all that apply.) A. Consider each client's cultural preferences B. Determine the effectiveness of nonpharmacological strategies C. Record the clients' subjective reports rather than the nurse's objective observation D. Recognize that older adult clients over-report their pain level E. Use a pain scale specific to each client's cognitive abilities

A. Consider each client's cultural preferences B. Determine the effectiveness of nonpharmacological strategies E. Use a pain scale specific to each client's cognitive abilities

A nurse is discussing the FLACC scale with a newly licensed nurse. Which of the following categories should the nurse include? (Select all that apply) A. Face B. Legs C. Alert D. Circulation E. Consolability

A. Face B. Legs E. Consolability

A nurse is discussing end-of-life pain management with a group of coworkers. Which of the following should the nurse include as barriers to end-of-life pain management? (Select all that apply) A. Fear of addition B. Belief that pain is expected part of their illness C. Inability to sleep D. Lack of support E. Inadequate pain assessment

A. Fear of addition B. Belief that pain is expected part of their illness E. Inadequate pain assessment

A nurse is assessing a client who is nonverbal for the presence of pain. Which of the following findings indicate an increased level of discomfort? (Select all that apply) A. Grimacing B. Restlessness C. Elevated temperature D. Increased diaphoresis E. Bradycardia

A. Grimacing B. Restlessness D. Increased diaphoresis

A nurse is discussing the use of heat therapy with a. newly licensed nurse. The nurse should include that heat therapy is effective for which of the following conditions? (Select all that apply) A. Muscular pain B. Active bleeding C. Backache D. Menstrual discomfort E. Swollen extremity

A. Muscular pain C. Backache D. Menstrual discomfort

A nurse is caring for a client who is postoperative following abdominal surgery and has a morphine PCA pump. Which of the following medications should the nurse ensure is available in case the client develops respiratory depression? A. Naloxone B. Lidocaine C. Prednisone D. Amitriptyline

A. Naloxone

A charge nurse is reviewing factors that can affect a client's perception of pain with a newly licensed nurse. Which of the following should the charge nurse include? (Select all that apply) A. Stress B. Dietary practices C. Culture D. Social support E. Disease severity

A. Stress B. Culture C. Social support D. Disease

A nurse is caring for a client who has kidney stones. Which of the following manifestations is an objective indicator of pain? A. The client is diaphoretic B. The client is experiencing stabbing pain. C. The client is nauseated D. The client states feeling dizzy

A. The client is diaphoretic

A nurse is discussing cutaneous stimulation with a client who has back pain. Which of the following methods should the nurse include? (Select all that apply) A. Transcutaneous electronic stimulating unit (TENS unit) B. Distraction techniques C. Massage D. Acupuncture E. Cold therapy

A. Transcutaneous electronic stimulating unit (TENS unit) C. Massage D. Acupunture E. Cold therapy

Descriptive Characteristics of Pain

Aching, Throbbing, Stabbing, Pounding, Sharp, Gripping, Dull, Tearing, Radiating, Cutting, Burning, and Scalding

Wong-Baker FACES Pain Rating Scale

Appropriate pain scale for children ages 3 and older. Faces, words, and numbers.

Numeric Rating Scale (NRS)

Ask the client to rate the intensity of their pain on a scale from 0-10

The CRIES Pain Scale is recommended for children from.... A. 2 months - 7 years B. 0 months - 6 months C. 7 years - 17 years of age D. 8 years of age and greater

B. 0 months - 6 months

A nurse is caring for a client who has a prescription for heat therapy for knee pain. The nurse should apply heat therapy to the client's knee for how long? A. 60 min B. 20 min C. 30 min D. 45 min

B. 20 min

A nurse is caring for a group of clients on the pediatric unit. For which of the following clients should the nurse use the FLACC Pain Scale to determine their pain level? (Select All that apply) A. A 12 year old client who has had an appendectomy B. A 3 year old toddler who has a fractured femur C. A 6 day old infant who had a surgical repair of a heart defect B. A 3 year old toddler who has a fractured femur E. A 5 year old preschooler who is experiencing pain during a sickle cell crisis.

B. A 3 year old toddler who has a fractured femur B. A 3 year old toddler who has a fractured femur E. A 5 year old preschooler who is experiencing pain during a sickle cell crisis.

The nurse is caring for a client who has severe pain and repeatedly asks for pain medication. The nurse is busy and forgets to assess the client's pain and administer prescribed pain medication. Which of the following can the nurse be charged with? A. Malpractice B. Negligence C. Nonmaleficence D. Beneficence

B. Negligence

A nurse is evaluating a client's pain level using the PQRST mnemonic. Which of the following questions should the nurse ask to evaluate the letter "R"? A. "Can you rate your pain on a scale of 0-10, with 0 being no pain and 10 being the worst pain you can imagine?" B."Can you point to where you are having pain?" C."What does your pain feel like?" D."What were you doing when your pain started?"

B."Can you point to where you are having pain?"

A nurse is teaching staff about the ethical principle of justice and how it relates to pain management for clients. Which of the following statements should the nurse make? A."Justice allows the client the freedom of choice." B."Justice allows the client the opportunity to be treated fairly." C."Justice is causing no harm to the client." D."Justice is doing good for the client."

B."Justice allows the client the opportunity to be treated fairly."

Biopsychosocial model of pain

Biological, psychological, and social

A nurse is providing end-of-life care for a client who is unresponsive and near death. The client's family asks the nurse about managing the client's pain. Which of the following statements should the nurse make to the client's family? A. "Your family member will not require pain medication." B. "Your family member can inform the provider about their decision for pain management." C. "Your family member has the right to receive effective pain management." D. "Your family member will not be able to tolerate the effects of pain medications."

C. "Your family member has the right to receive effective pain management."

A nurse is evaluating a group of clients who are experiencing pain. Which of the following clients should the nurse identify as experiencing neuropathic pain? A. A client who has oesteoarthritis and reports difficulty ambulating for the past 6 months. B. A clients who had surgery to report a fractured tibia and reports incisional pain. C. A client who has diabetes mellitus and reports bilateral burning foot pain without signs of injury. D. A hospice client who has prostate cancer and reports pelvic pain.

C. A client who has diabetes mellitus and reports bilateral burning foot pain without signs of injury.

A nurse is caring for a client who reports muscle pain to the lower back that has persisted for over a year after a motor-vehicle crash. In which way should the nurse categorize this client's pain? A. Cancer pain B. Acute pain C. Chronic pain D. Neuropathic pain

C. Chronic pain

A nurse is caring for an older adult client who has a cognitive impairment and is postoperative. Which of the following actions should the nurse take? A. Use the Crying, Requires Oxygen, Increases Vital Signs, Expression, Sleeplessness (CRIES) Pain scale B. Reassure family members that older adult clients have a decreased ability to sense pain. C. Evaluate the client for pain by observing their behavior. D. Assign a pain scale number based on the FACES pain scale

C. Evaluate the client for pain by observing their behavior.

A nurse is monitoring a client who is 2 hr postoperative and is receiving morphine via a PCA pump. Which of the following findings should the nurse plan to monitor to detect opioid induced ventilatory impairment (OIVI)? (Select all that apply) A. Bowel Sounds B. Deep tendon reflexes C. Respiratory rate D. Capnography E. Oxygen saturation

C. Respiratory rate D. Capnography E. Oxygen saturation

Justice

Clients to be treated equally

Nonverbal Pain Scale (NVPS) Two version of the NVPS are currently in use: The original scale and a revised version (R-NVPS)

Clients who are unable to verbalize their pain level. Originally developed for clients in burn units, but it is now also used in critical care areas where clients are unable to report pain due to the severity of their illness, sedation, or mechanical ventilation. Do not touch the client while performing an assessment with these scales as doing so may cause the results of the assessment to be skewed.

Social Factors of Pain

Cultural factors Social Environment Economic factors Social support

A nurse is reviewing discharge instructions for a client who has a prescription for morphine oral solution 10 - 20 mg every 4 hr. PRN. Which of the following statements by the client indicates an understanding of the instructions? A. "I can use the morphine as needed as long as I don't take it more than six times a day." B. "I will use my household teaspoon to measure the correct amount of morphine." C. "I will monitor for high blood pressure while taking the morphine." D. "I will keep the morphine bottle in a locked cabinet in my kitchen."

D. "I will keep the morphine bottle in a locked cabinet in my kitchen."

The NRS Pain Scale is recommended for children from.... A. 2 months - 7 years B. 0 months - 6 months D. 8 years of age and greater

D. 8 years of age and greater

The VAS Pain Scale is recommended for children from.... A. 2 months - 7 years B. 0 months - 6 months D. 8 years of age and greater

D. 8 years of age and greater

A nurse is reviewing information for several clients on the unit. The nurse should recognize that which of the following clients is at greatest risk for respiratory depression? A. A client who has chronic pain and recently started taking parozetine B. A client who has cancer and has taken oxycodone PRN for several months C. A client who has been accidentally taking twice the amount of prednisone as prescribed D. A client who has surgery 3 hr ago and is receiving IV hydromorphone PRN

D. A client who has surgery 3 hr ago and is receiving IV hydromorphone PRN

A nurse is planning to teach coworkers about the legal and ethical principles used with pain management. Which of the following examples should the nurse include as an example of autonomy? A. A nurse allows a client to wait longer for their pain medication than other clients. B. A nurse does not properly clean a vial of pain medication prior to withdrawing medication from the vial, which results in the client contracting an infection C. A nurse administers scheduled pain medication and provides therapeutic distraction techniques for a client in pain. D. A nurse provides a client with the opportunity to take an intramuscular injection or oral medication for pain relief.

D. A nurse provides a client with the opportunity to take an intramuscular injection or oral medication for pain relief.

A nurse is caring for a client who has a prescription for oxycodone 5 to 10 mg PO every 4 to 6 hr as needed for pain rating 7 to 10 on a 0 to 10 scale. Fifteen minutes after receiving the dose, the client reports to the nurse their pain is still a 7 and has not changed. Which of the following actions should the nurse take? A. Administer another 5 mg does of the oral opioid now. B. Administer 10 mg of oxycodone every 2 hr C. Inform the provider that the client's pain medication is not effective D. Offer to assist the client with non pharmacological relief strategies.

D. Offer to assist the client with non pharmacological relief strategies.

Malpractice

Defined as a negligent act that has been performed by a professional or trained individual - in this case a nurse

Biological Factors of Pain

Disease severity Nociception Inflammation Brain function

Beneficence

Doing good and acting in the best interest of clients by providing care that benefits them is an act of beneficence.

R-NVPS

Eliminated Physiologic II and replaced it with a respiratory category. Do not touch the client while performing an assessment with these scales as doing so may cause the results of the assessment to be skewed.

Autonomy

Entrails granting the patient the right to self-determination.

Negligence

Failing to perform in a manner that a reasonable and prudent person would perform

Nociceptors

Found in multiple parts of the body and may be activated by chemical substance, tissue damage, and extreme temperature and pressure changes.

Except from the Nightingale Pledge from 1935 in relation to ethics and pain management

I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug.

Aromatherapy massage

Incorporating essential oils such as rosemary, geranium, lavender, eucalyptus, and chamomile. Nurse should be sure to assess for any allergies to essential oils prior to use, and should be away of the individual and combined affects of the oils.

Flowsheets: Assessment -> Pain Assessment (First following-up paint assessment Time this entry 1818)

Location of pain Pain rating Medications cause of pain relief

Flowsheets: Assessment -> Pain Assessment (Second following-up paint assessment Time this entry 1830)

Location of pain Pain rating Medications cause of pain relief

Flowsheets: Assessment -> Pain Assessment (Time this entry 1800)

Location of pain Pain rating Client's description of pain Non-pharmacologic pain interventions implemented

Psychological Factors of Pain

Mood/affect Catastrophizing Stress Coping

Clients can receive opioid medication by various routes

Mouth (PO), intramuscular (IM), injection, intravenous (IV) injections given intermittently or as continuous drips, per return (PR), and topically (TOP)

OIVI

Opioid induced ventilatory impairment - another name for respiratory depression - includes using a combination of capnography (monitoring of carbon dioxide levels) along with respiratory assessment and pulse oximetry to improve identification.

Delivered in the epidural space via an epidural pump to used for intraoperative and postoperative use in controlling pain

Opioids such as morphine, hydromorphone, and fentanyl, as well as local anesthetic medications such as lidocaine, mepivacaine, ropivacaine, and bupivacaine. The RN assists the anesthesiologist with this procedure by ensuring consent has been obtained from the client, establishing an IV line, and positioning the client, while also supporting the client during the procedure. Following placement of an epidural catheter the nurse should monitor the insertion site for any infection, ensure the dressing remains dry and intact, and carefully monitor the client's vital signs and response to the pain med.

What does the P in PQRST pain assessment stand for?

P stands for palliative or precipitating factors

NSAIDs are available in numerous forms such as...

PO, IV, IM, PR, and TOP (by patch or ointment).

Nonpharmacological Pain Intervention

Pain treatments include any interventions that are not medication related. Range from sophisticated invasive devices to simple actions the nurse can perform - positioning, cutaneous stimulation, cognitive strategies, and therapeutic touch.

PQRST mnemonic

Precipitating cause Quality Region Severity TIming

Positioning

Prevents injury and subsequent pain. Should move and be positioned off of bony prominences to avoid painful pressure injuries, and care should be taken when moving clients to about shear injuries. Reposition the client every 2 hours. Nurse should pad bony prominences such as the coccyx, sacrum, heels, and scapula to prevent skin breakdown.

What does the Q in PQRST pain assessment stand for?

Q for quality of pain, R for region or radiation of pain

What does the S in PQRST pain assessment stand for?

S for subjective descriptions of pain

SBIRT mnemonic

Screening Brief Intervention Referral to Treatment

Ethics

Study of moral principles that guide personal or group behavior.

Pain

Subjective and can be caused by stimuli that are actual or anticipated. "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."

Chronic Pain

Sudden or slow onset of any intensity and is constant or recurring without an anticipated or predictable end. Usually lasts longer than six months. Examples: Arthritis, back pain, and headaches. Can be both physically and emotionally debilitating.

What does the T in PQRST pain assessment stand for?

T for temporal nature of pain (the time the pain occurs)

What is a PQRST pain assessment?

The mnemonic device PQRST offers one way to recall assessment: P stands for palliative or precipitating factors Q for quality of pain, R for region or radiation of pain S for subjective descriptions of pain T for temporal nature of pain (the time the pain occurs)

Cancer pain

Tumor pain, bone pain, and treatment-associated pain

Barriers to Effective Pain Management

Unwillingness to take pain medication or unwillingness to use non pharmacological pain interventions. Speaks a language other than that of their caregiver or nurse, or those with a history of substance abuse. Nurses often do not communicate effectively with older clients (age 65 or older) by considering discomfort to be different than pain and not treat it, may exclude clients from decision making regarding their pain, and do not consistently use non pharmacological interventions. Confusion in older clients is also a barrier for some nurses, especially inexperienced nurses who may not treat pain in the confused client.

Visual Analog Scale (VAS)

Vertical or horizontal single line, with one end representing no pain, and the other end representing the worst pain imaginable.

Pain scales appropriate for children

Wong-Baker FACES scale FLACC scale CRIES scale

Nonmaleficence

Working to do no harm

Adjuvant avalgesics

asset with pain relief by addressing underlying pain generators. May be used for mild pain, in conjunction with opioids to decrease the dosage of opioids needed and to manage neuropathic pain. Examples: Corticosteroids, antidepressants, botulinum toxin, and medical marijuana (minimal evidence based research and not FDA approved or legal in all states)

NSAID enhance

bleeding if given with anticoagulants or anti platelets

NVPS Contains

categories of Face, Activity, Guarding, Physiologic I (vital signs), and Physiologic II. Do not touch the client while performing an assessment with these scales as doing so may cause the results of the assessment to be skewed.

All pharmacological pain interventions require what...

client centered plan of care and frequent monitoring, including a complete baseline and ongoing assessment of res. rate, quality, and O2 levels as well as level of sedation.

Six different natural opioids include

codeine, morphine - these come directly from the opium poppy

NSAIDS reduce inflammation and fever by

complex process of inhibiting prostaglandin synthesis by blocking tow cyclooxygense enzymes (COX 1 and COX 2)

Cold therapy - ice packs, packages of frozen vegetables, or cold washcloths

decrease swelling, such as in an orthopedic injury like a sprain.

TENS unit

emits low-voltage electrical impulses to the skin over painful areas.

FLACC pain scale stands for?

face, legs, activity, cry, consolability

First ____ hours after surgery are the most problematic for clients due to the many medications given for anesthesia and pain management

four

The first ____ hours after release form the post anesthesia care unit (PACU) are the most critical

four hours, but close monitoring needs to occur for the first 24 hours following surgery.

Patient-controlled analgesia (PCA)

frequently used postoperatively. Allows the client to get small amounts of pain med. at a basal or continuous rate, prescribed by the provider, or a small bolus of medication when he client pushes a button. Only RNs should program and start the pain med. pump and verify the pump settings. Most policies instruct the nurse to have naloxone available int he client's room.

Cutaneous stimulation

heat and cold therapy, touch, message, acupuncture, acupressure, and transcutaneous electronic stimulation (TENS).

Cognitive behavioral therapy (CBT)

help clients learn how to manage negative thoughts and maladaptive behaviors by adapting to new behaviors, clients can decrease anxiety, stress, and chronic pain, and move toward an improved quality of life. Examples include distraction, relaxation, imagery, and music therapy

Semisynthetic opioids are created from the naturally occurring opiates

heroin, hydrocodone, oxycodone, and hydromorphone

Pain tolerance

how much of a stimulus the client is willing to accept

Examples of NSAIDS

ibuprofen (OTC NSAID), aspirin, diclofenac, celecoxib, keterolac, and naproxen

Nociceptive pain

includes somatic (with pain occurring in the skin, bones, joints, muscles, or connective tissues), visceral (with pain occurring in the internal organs and referring to other location of the body) and cutaneous (with pain occurring in the skin or subcutaneous tissue). Cutaneous pain may also be referred to as somatic pain. Nociceptive pain is usually localized and described as throbbing or aching. Felt in a tissue, organ, or damaged part of the body, or referred pain

Objective

indicators of pain are manifestations that the nurse can observe and measure, such as crying, sweating, restlessness, grimacing, or guarding by the client. Example: vital signs, physical assessment findings, laboratory tests and imaging reports, and any other diagnostic information

Subjective

indicators of pain that are based on the client's report or opinion example: pain scale to determine the client's view of the severity of pain

Acupuncture

inserting small sterile needles into the skin to minimize pain, both acute and chronic, as well as for complex regional pain syndrome.

Synthetic opioids

manufactured products that include fentanyl, fentanyl analogs, and tramadol

Opiods

medications most commonly prescribed for the relief of pain. Suppress pain by activating opioid receptors in the brain, spinal cord, and central nervous system. Can lead to addiction if misused, careful titration and monitoring are required. Can cause both sedation and depression of the respiratory system. Res. rate, heart rate, and b/p should be recorded and monitored in medical record. At risk for orthostatic hypotension and syncope. Slow position changes from lying to sitting, and from sitting to standing, are helpful interventions to prevent or minimize complications. Can cause nausea and committing as well as constipation, itching, rashes, and flushing.

Nonopioid analgesics

medications that are administered for pain treatment but are not opioids. Include anesthetics, nonsteroidal antiinflammatory drugs (NSAIDs), acetaminophen.

Three classes of opiods

natural, semisynthetic, and synthetic

Therapeutic touch

nurse utilizes the hands either on or near the body of the client to balance the client's energy and thereby promote healing. This treatment has been particularly noted to help alleviate or reduce pain and alleviate psychological symptoms for patients with cancer or fibromyalgia.

Crying, requires oxygen, increased vital signs, expression, sleeplessness scale (CRIES)

observation scale used for infants who were born t 38 weeks of gestation or greater. It has been found to be useful in assessing postoperative pain in neonates. Can also be used for clients who are cognitively disable and cannot report their pain. Scored 0-2 for each category. Greater than 4, further pain assessment should be completed. Analgesics should be administered for a score of 6 or higher. Total ranges from 0-10

Face, Legs, Activity, Cry, Consolability (FLACC) Scale

observational pain measurement tool designed to be used with children ages 2 mon - 7yrs, and clients who are cognitively disabled. Observes the client for 1-5 minutes (if awake) or for 5 minutes or longer (if asleep), and gives a numeric score of 0-2 for each behavior: facial expression, leg movement, bodily activity, cry or verbalization, and consolability.

Neuropathic pain

often referred to as nerve pain and arises from the somatosensory system. Examples include diabetic neuropathy, phantom limb pain, and pain associated with a spinal cord injury. Usually described as intense, shooting, or burning. Pins and needles or intense itching Nerve pain, no tissue damage.

Pain threshold

point at which a stimulus is perceived as pain

Morality

refers to an individual's sense of right and wrong or their personal values.

Pharmacological interventions

refers to medications to relieve pain, always consider the risks and benefits of the medication, client's history and comorbidities, the client's preferences, and specific characteristics of the client and the pain they are experiencing.

End of life care

refers to the support that clients receive as they are nearing death.

The relief of pain

should be available to all, regardless of age, race, background, or history

Massage and acupressure

shown to decrease pain scores in clients with various ailments, including neuropathic pain form diabetes. After, clients are asked to sit up slowly to avoid orthostatic hypotension, and are encouraged to drink water and hydrate well for the rest of the day. There are no special precautions to take after acupressure to one specific area or for essential oil usage.

Acute pain

sudden or slow onset of any intensity and an anticipated or predictable end. Pain that lasts less than six months. Examples: pain that results from tissue damage caused by trauma or injury, incisional pain from surgery, and pain from environmental factors such as head or cold If acute pain is not addressed it can become chronic.

Extracorporeal shock wave lithotripsy (ESWL)

treats soft tissue injuries by applying shock waves to the area of pain. Documented to be effective in managing common sports related injuries such as tennis elbow, achilles tendon pain, and plantar fasciitis, and other tendinopathies. Applied to clients who have not received relief from other treatments but are not ready to undergo more invasive procedures. May cause localized bruising, swelling, pain, or numbness to the area of application.

Heat therapy - Heating pad or hot water bottle

used for muscular pain relief such as back pain or menstrual pain. Should be applied for no more than 20 minutes at a time, with at least a 20 minute break after usage