A home care nurse is planning to use nonpharmacological pain relief measures for an older adult who has severe chronic back pain. Which of the following guidelines should the nurse use?

Rationale: A. Discontinue opioids before trying nonpharmacological methods of pain relief: It is not necessary to stop opioid therapy before using nonpharmacological interventions. Combining pharmacologic and nonpharmacologic strategies can provide synergistic pain relief and improve overall comfort, especially in older adults with chronic pain. B. Pain relief from the use of heat and cold continues for several hours after removal of the stimulus: The analgesic effect of heat or cold is usually temporary and generally lasts only during application and shortly afterward. It does not provide prolonged pain relief for several hours, so ongoing assessment and adjunct interventions are needed. C. Use imagery with clients who have difficulty with focus and concentration: Imagery requires the ability to concentrate and visualize; clients with impaired focus may struggle to benefit from this technique. Alternative nonpharmacological strategies that require less cognitive effort, such as gentle massage or music therapy, may be more effective for these individuals. D. Distraction changes the client’s perception of pain, but does not affect the cause: Distraction techniques, such as listening to music, conversation, or engaging in activities, work by diverting attention away from the pain stimulus. While they do not treat the underlying pathology, they effectively reduce perceived pain intensity and improve coping.