By creating trusting relationships with patients, nurses are instrumental in reducing anxiety and helping patients to cope with pain. Establishing rapport with patients and helping them to find a degree of acceptance of pain is often the first step (Schug et al. [166]). Nurses may underestimate the benefits and comfort they bring by staying with a patient who is experiencing pain. Nurses can help to create a trusting relationship by:

Several mechanisms have been postulated to explain the association between humour and mental and physical health. Evidence supports numerous positive physiological effects of humour on several bodily systems, including the musculoskeletal, respiratory, cardiovascular, endocrine, immune and nervous systems. Positive humour has been shown to decrease negative and increase positive emotions and coping (DeKeyser Ganz and Jacobs [47]). Humour has also been found to be significantly associated with social support and self‐efficacy (DeKeyser Ganz and Jacobs [47]). Tse et al. ([181]) report that many older patients find gentle humour to be an effective way of reducing pain; they also found that it reduced patients’ perception of loneliness and that patients reported significant increases in happiness and life satisfaction. DeKeyser Ganz and Jacobs ([47]) report that attendance at a humour therapy workshop was associated with positive effects upon subsequent depression, anxiety and general wellbeing. Humour may be particularly helpful prior to a painful procedure as it can have a lasting effect. In the clinical setting, humorous recordings and books can be made available for patient use.

Patient information and education can make all the difference between effective and ineffective pain relief. Information and education help to reduce anxiety (Macintyre and Schug [99], Schug et al. [166]) and enable patients to make informed decisions about their care. Patients should be given specific information about why pain control is important, what to expect in terms of pain relief, how they can participate in their management and what to do if pain is not controlled. Some caution is required, however, because not all patients respond positively to the same level of information. Patients with high levels of anxiety may find that detailed information can increase their anxiety and negatively influence their pain control.

While scientific evidence for the effectiveness of relaxation techniques is limited for acute pain management, a number of studies have shown benefits for patients experiencing chronic pain (El Geziry et al. [52]). Techniques can range from simple breathing techniques to progressive muscle relaxation (PMR) and more complex techniques. PMR is a technique where the patient tightens and relaxes different muscle groups throughout the body in a progressive manner, provoking a sense of relaxation and comfort (El Geziry et al. [52]).

Music therapy employs specific musical elements to encourage or facilitate movement, positive interactions, and/or improved emotional or cognitive states (Bernatzky et al. [12]). The use of music in the healthcare setting can provide relaxation and distraction from pain. Theories suggest that music works by influencing the physical and psychological factors of pain. Cognitive activities such as listening to music affect the perceived intensity and unpleasantness of pain, enabling the sensation of pain to be reduced. Another mechanism by which music therapy is advantageous is reducing autonomic nervous system activity, such as reducing heart and respiratory rates and decreasing blood pressure (Hole et al. [80]). Setting up a library of music (e.g. easy listening, classical) and having personal listening devices available for patient use is a simple way to provide patients with relaxing music. Vaajoki et al. ([183]) reported significantly lower pain intensity and pain distress on the second post‐operative day in a music‐listening group compared with a control group after elective abdominal surgery. Hole et al. ([80]) suggest that music played in the peri‐operative period can reduce post‐operative pain, anxiety and analgesia needs, and improve patient satisfaction.

Art therapy is a form of psychotherapy that combines visual art‐making and psychotherapy to promote self‐exploration and understanding (Angheluta and Lee [4]). It can be used in chronic pain management, where a biopsychosocial approach is needed to address the impact of living with chronic pain. Art therapies can assist patients in moving the focus of their attention away from the physical sensation of pain; it can also resolve conflicts and problems, develop interpersonal skills, manage behaviour, reduce stress, increase self‐esteem and self‐awareness, and achieve insight (American Art Therapy Association [3]). The skills of an art therapist are required to ensure the successful use of this intervention through active art‐making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship. A key component of this form of psychotherapy is the development of a strong working relationship between client and therapist (Angheluta and Lee [4]).