Home Fundamentals of Nursing Levine’s Four Conservation Principles in the Bio-Behavioral Pain Management

Levine’s Four Conservation Principles in the Bio-Behavioral Pain Management


Myra Estrin Levine’s “The Four Conservation Principles of Nursing”. The four major assertions of this model state that nursing intervention is based on the conservation of energy, structural integrity, personal integrity and social integrity (Tomey & Alligood, 2002). Conservation of energy focused on physical, psychological/emotional and spiritual energy. Structural energy refers to the preservation of anatomical structure of the body. Conservation of personal integrity means to conserve the client’s sense of identity and self-worth. Social integrity involves the recognition and presence of human interaction (Laurente et al., 1997).

Levine’s Four Conservation Principles in the Bio-Behavioral Pain Management

Nociceptive pain and its emotional component can result in the development of a “chronic pain memory”. Neural centers involvedin sensory pain, its affective component, opioid dependence and memory overlap in the brain share common pathways. The anterior cingulate cortex, the insular cortex, and the amygdala are examples of regions implicated in both pain and memory. Relaxation techniques like psychotherapy, biofeedback, hypnosis, meditation and autogenic training induce sudden memory loss by prohibiting this process in the brain. Study showed significant pain reduction and eradication of opoid management for patients who underwent relaxation techniques. Patients reported pain relief and/or decrease in pain sensation which are attributed to memory loss (Choi et al., 2007).

The feasibility for pain reduction and safety of eight mind-body therapies such as biofeedback, progressive muscle relaxation, meditation, guided imagery, hypnosis, tai chi, qi gong, and yoga has been proven to be effective in the study for its application to older adults with chronic non-malignant pain. In an uncontrolled biofeedback trial that stratified by age group, both older and younger adults had significant reductions in pain following the intervention. Tai chi, yoga, hypnosis, and progressive muscle relaxation were significantly associated with pain reduction (Morone & Greco, 2007).

Mind-body medicine (MBM) is an exciting field of medicine that is not new; indeed it is a phenomenon inherent to clinical practice. Because of its current popularity and effectiveness for certain chronic conditions seen in primary care, MBM is especially relevant to the primary care providers. Meditation, hypnosis, guided imagery, biofeedback, and relaxation therapy are the most studied MBM techniques. A review of medical literature shows these techniques may be effective for specific indications such as chronic pain, headache, insomnia, and anxiety (Barrows & Jacobs, 2002).

In the report of Barnes and colleagues (2004), the use of Complementary and Alternative Medicine (CAM) in the United States—the 10 most commonly used CAM therapies are prayer specifically for one’s own health (43.0%), prayer by others for one’s own health (24.4%), natural products (18.9%), deep breathing exercises (11.6%), participation in prayer group for one’s own health (9.6%), meditation (7.6%), chiropractic care (7.5%), yoga (5.1%), massage (5.0%), and diet-based therapies (3.5%). Use of CAM varies by sex, race, geographic region, medical insurance status, use of cigarettes or alcohol and hospitalization. CAM was most often used to treat back pain or back problems, head or chest colds, neck pain or neck problems, joint pain or stiffness, and anxiety or depression.

Nursing Diagnosis:Acute pain related to presence of traumatized tissues secondary to surgical procedure done


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She is currently working as a medical-surgical nurse at Ministry of Health, Sultanate of Oman. A writer, blogger, researcher, correspondent and publication consultant for nursing journal and health-related educational websites. Her field of specialization focused on Intensive Care and Emergency Management. She is now taking up MAN major in Adult Health Nursing at the University of the Philippines Open University. A nursing professor for 8 years in the Philippines and served as a staff nurse at UST hospital. A caring and devoted nurse who introduced a “Pinay Nightingale” in the land of the pharaohs. A nurse by profession, an educator by devotion and a writer / researcher by passion.