PAIN MANAGEMENT STRATEGIES IN HOSPITALIZED PATIENTS: A SYSTEMATIC REVIEW OF NURSING, PHARMACOLOGIC, AND NON-PHARMACOLOGIC INTERVENTIONS

Abstract Background: Hospitalized adults frequently experience moderate–severe pain despite guideline initiatives, and there is growing interest in multimodal approaches that combine pharmacologic and non-pharmacologic strategies. Objective: To synthesize comparative evidence on inpatient pain-management interventions spanning nursing-led models, medication regimens, and adjunct non-pharmacologic therapies. Methods: Following PRISMA guidance, we included randomized and comparative observational studies enrolling hospitalized adults and reporting pain or closely related outcomes. Heterogeneity in populations and interventions precluded meta-analysis; we performed structured narrative synthesis and tabulated study characteristics and effects. Results: Nine studies (2012–2025) were included: massage after cardiac surgery; guided imagery in geriatric orthopedics; music after arthroplasty; acupuncture after cesarean; virtual reality (VR) in hip arthroplasty and in hospitalized patients with cancer; nurse-led pain programs (quasi-experimental and retrospective); and a hospital PCA regimen evaluation after cesarean. Most non-pharmacologic modalities (massage, guided imagery, music, acupuncture) reduced pain or distress; VR showed mixed effects (benefit in hospitalized patients with cancer; null in hip arthroplasty). Nurse-led programs improved pain intensity, function, and/or satisfaction; a revised PCA regimen reduced re-prescription but increased complications. Conclusions: Multimodal inpatient pain care can improve pain and patient experience; effects vary by modality and setting. Standardized outcome reporting and higher-quality trials (especially for VR and nurse-led models across diverse wards) are needed to guide implementation.