An innovative approach to pain management in critical care: therapeutic touch.

Nursing research suggests that pain in critically ill patients is inadequately controlled and has deleterious effects. The critical care nurse must depend on the patient's perception of pain and its expression in physiological and behavioural responses. Ventilatory support, fluctuating levels of consciousness, hemodynamic instability and severity of illness are often barriers to the expression and interpretation of pain. This article includes a review of the nursing literature pertaining to pain management in the critically ill patient. Existing practices are examined and alternative approaches explored. Therapeutic touch (TT), one innovative approach, is proposed as an adjunct to pharmacological intervention TT is a non-invasive, holistic practice that promotes comfort, relaxation, stress reduction and heating. Clinical studies suggest that TT prolongs the interval between analgesies. The authors highlight the 10-year clinical experience of a critical care nurse practising TT in a 30-bed critical care and trauma centre.