Epidermólisis bullosa

Certain pains can be relieved in part without the need to use pharmacological treatment (although this is not usually the case). In most cases, the use of non-pharmacological measures can potentiate and increase the effect of medications, so the joint use of both interventions has been proved to achieve better pain control. 

Below is a list of non-pharmacological measures: 

• Providing information gives a person a sense of control and can help minimize stress.
• Distraction techniques: reading, movies and games (including video games and virtual reality) can promote relaxation and decrease the activation of the nervous system.
• Sensorial stimulation: musicotherapy, aromatherapy.
• Psychological therapies: cognitive-behavioural therapy, relaxation training (diaphragmatic breathing, muscle relaxation, guided imagery), etc. Psychological therapy will always have to be adapted to the age, cognitive level and type of disease of the patient.
• Local pain management of the wound. It is recommended to uses non-adhesive dressings to minimize the pain when taking them off, as well as spacing the dressing changes as much as possible and as much as the wound exudate lets. It is also possible to use cold gels or tepid wound cleansing solutions to minimize the pain. Regarding the bath, it can be useful to use a bathtub by immersion. In the case of using a shower, the tap can be covered or adapted so that the water pressure is gentle. In some cases, it might be useful to add salt to the water (9 grams of salt for 1 litre of water) and minimizing the number of baths a week (if possible).
• Physiotherapy, chiropody and occupational therapy. Especially when there is musculoskeletal pain, these therapies are useful to prevent contractures and treat them (Figure 6). In cases of back pain, the evaluation of the feet is essential, as it may be related to biomechanical causes (bad posture) due to blisters and calluses on the soles of the feet that force one to adopt an abnormal gait or posture. Adapted yoga can also help manage pain. It is important that it is carried out by trained professionals who know EB.
• Environment management: it is recommended to favour a calm environment, with sufficient light but not too intense (in cases of eye pain it can be very unpleasant). For the cures, it is recommended to have all materials prepared to minimize the amount of time the wounds are exposed to air, maintain a comfortable temperature, etc.