Optimizing Nurse‐Involved Non‐Pharmacological Interventions for Postoperative Pain: A Scoping Review

ABSTRACT

Aim

To identify the types of non‐pharmacological interventions, nurses' roles and outcome measures used for postoperative pain management in inpatients.

Design

A scoping review was conducted following the Joanna Briggs Institute guidelines.

Methods

Eligible studies were those involving adult surgical inpatients receiving nurse‐involved non‐pharmacological interventions, with outcome measures assessed using pain‐assessment tools. Nurses' roles were categorized into planning, implementation and evaluation.

Data Sources

PubMed, Embase, CINAHL, Cochrane Library and Web of Science were searched for studies published from January 1, 2016, to November 30, 2025.

Results

Twenty‐three studies were included, encompassing a range of surgeries such as caesarean section, episiotomy and knee replacement. Most studies involved single‐component non‐pharmacological interventions (87.0%). Interventions included cold therapy, acupressure and aromatherapy, among others. Pain intensity was most commonly assessed using the Visual Analog Scale (52.2%) and the Numeric Rating Scale (34.8%). Additional outcomes included comfort, opioid use and anxiety. Nurses were involved in planning (30.4%), implementation (87.0%) and evaluation (56.5%), with only one study including all three stages.

Conclusion

Nurse‐involved non‐pharmacological interventions are adaptable across surgical contexts. Integration into routine perioperative care, supported by standardized protocols and adequate institutional resources, is recommended. Multidimensional outcome assessment may better guide pain management and recovery.

Implications for the Profession and Patient Care

Nurses can play an active role in delivering non‐pharmacological interventions throughout perioperative care. Structured training, clear role delineation and integration of evidence‐based non‐pharmacological strategies into clinical pathways may enhance the consistency and effectiveness of postoperative pain management.

Impact

This review highlights variability in non‐pharmacological intervention delivery and outcome measurement while mapping the scope of nurse involvement. The findings provide a foundation for developing structured approaches to improve consistency in postoperative pain management.

Reporting Method

This study adheres to the PRISMA‐ScR checklist.

Patient or Public Contribution

No patient or public contribution.

Trial and Protocol Registration

Not applicable.

What Does This Paper Contribute to the Wider Global Clinical Community?

• Summarizes current evidence on nurse‐involved non‐pharmacological interventions for postoperative pain.

• Highlights variability in intervention delivery and outcome measurement, informing more structured perioperative pain care.

• Maps nurse involvement across planning, implementation and evaluation stages.

1. Introduction

Postoperative pain remains one of the most common and distressing complications following surgery, with approximately 80% of patients reporting moderate to severe pain despite advances in surgical techniques and analgesic protocols (Bekele et al. 2024; Gan 2017; Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education 2011). As surgical procedures continue to increase worldwide (Meara et al. 2015), this persistently high prevalence highlights a critical unmet need in postoperative pain. According to the International Association for the Study of Pain, pain is defined as ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’ (Raja et al. 2020). Although diverse pain management strategies are routinely implemented in clinical practice, inadequate postoperative pain control remains a sustained concern for both clinicians and patients. Poorly controlled postoperative pain is not merely a sensory experience; it is associated with delayed functional recovery and psychological distress, increased morbidity, prolonged hospitalization and greater economic burden. In addition, suboptimal pain management may negatively influence patient satisfaction and increase the risk of postoperative complications, thereby affecting both individual health outcomes and healthcare system efficiency (Jain et al. 2015; Lovich‐Sapola et al. 2015).

In 2016, a clinical practice guideline emphasized the importance of integrating non‐pharmacological interventions with pharmacological treatments to enhance postoperative pain management (Chou et al. 2016). Within this multimodal framework, non‐pharmacological strategies complement medication rather than replace it and have gained increasing attention as feasible and patient‐centered approaches to pain relief (Pain Management Best Practices Inter‐Agency Task Force 2019; Tsegaye et al. 2023). Interventions such as music, massage, cold and heat therapy, behavioural therapy, mindfulness, relaxation, and pain‐coping skills training through education are generally simple to implement and can be applied throughout the perioperative phase (Mota et al. 2021; Ruano et al. 2022; Small and Laycock 2020). Growing concerns regarding opioid‐related adverse effects and opioid stewardship have further reinforced the role of non‐pharmacological strategies in acute postoperative pain management (Small and Laycock 2020).

Nurses play a central role in postoperative pain prevention and management. As healthcare professionals who provide continuous, patient‐centered bedside care throughout the perioperative period and spend the greatest amount of time with patients, nurses are uniquely positioned to coordinate pain management efforts (Niyonkuru et al. 2025; van Veen et al. 2024). Through ongoing assessment, diagnosis, planning, implementation and evaluation of pain, nurses contribute substantially to optimizing postoperative recovery (Tsegaye et al. 2023). In clinical practice, nurses implement both pharmacological and non‐pharmacological strategies, with non‐pharmacological interventions easily delivered at the bedside and integrated into routine nursing care (van Veen et al. 2024).

Despite growing interest in non‐pharmacological approaches, existing reviews have primarily focused on specific surgical procedures or distinct patient populations, such as paediatric patients or individuals with opioid tolerance (Fan and Chen 2020; Hargett et al. 2022; Llerena et al. 2024; Mota et al. 2021; Ruano et al. 2022). Consequently, evidence exploring these interventions across various surgical settings while explicitly examining nurses' roles during the perioperative period remains limited. Furthermore, given the multidimensional nature of pain, diverse outcome measures have been used to evaluate intervention effectiveness; however, these outcome measures have not been comprehensively examined in studies of nurse‐involved non‐pharmacological postoperative pain management (Scher et al. 2020).

Therefore, in this scoping review, we focused on studies published from 2016 onward, following the release of the 2016 clinical practice guideline that highlighted the importance of non‐pharmacological interventions as part of multimodal postoperative pain management (Chou et al. 2016). We aimed to provide a comprehensive overview of nurse‐involved non‐pharmacological interventions for postoperative pain management among adult inpatients in general wards and to inform their implementation in clinical practice.

2. Aims

In this scoping review, we aimed to identify and map nurse‐involved non‐pharmacological interventions for postoperative pain management in surgical inpatients. The review questions were developed using the PCC (Population, Concept and Context) framework (Peters et al. 2024).

The research questions were as follows:

1. What types of nurse‐involved non‐pharmacological interventions have been used for postoperative pain management?

2. What outcomes have been used to evaluate the effects of the interventions?

3. What roles have nurses played in the interventions?

3. Methods

3.1. Design

This study was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews (Peters et al. 2024). Reporting followed the Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) checklist (Appendix S1). A review protocol was not formally registered for this scoping review.

3.2. Search Strategy

The search was conducted across five databases: PubMed, Embase, CINAHL, Cochrane Library and Web of Science. The search strategy was structured according to the PCC framework used to define the eligibility criteria. Both controlled vocabulary and free‐text keywords were used in each database, including Medical Subject Headings (MeSH) in PubMed, Emtree in Embase and CINAHL Headings in CINAHL. The Cochrane Library was searched across all available databases using relevant keywords. The search covered studies published between January 1, 2016, and November 30, 2025. The full search strategy is detailed in Appendix S2. The PubMed search query, presented as a representative example, incorporated MeSH terms and keywords related to non‐pharmacological interventions (e.g., aromatherapy, music and relaxation), surgical timing (e.g., postoperative, postsurgical and perioperative), pain (e.g., acute pain and postoperative pain) and inpatient settings.

3.3. Inclusion and Exclusion Criteria

The eligibility criteria were determined based on the PCC framework (Peters et al. 2024). The population included adult inpatients aged 18 years and older who had undergone surgery. The concept focused on nurse‐involved non‐pharmacological interventions for managing postoperative pain across the perioperative period. The context was limited to general wards in hospital settings. Studies were included if postoperative pain was assessed using any validated or self‐reported pain assessment scale and if they were published from 2016 onward.

The exclusion criteria encompassed studies targeting outpatients and those without nurse‐involved non‐pharmacological interventions. Additionally, studies were excluded if the intervention was delivered outside general wards, such as in preoperative outpatient clinics, intensive care units, post‐anaesthesia care units or post‐discharge settings. Studies not published in English or Korean were also excluded. Reviews, editorials, dissertations, conference proceedings, case studies, continuing education unit articles, protocols and trial registry records were additionally excluded.

3.4. Study Selection

The search strategy was validated by a professional librarian. All identified records were exported to EndNote 21, and duplicates were removed. Two researchers (J.S. and S.N.) independently screened the titles and abstracts of the records according to predefined inclusion and exclusion criteria. Subsequently, full‐text articles were retrieved and independently assessed for eligibility. Any disagreements were resolved through discussion with a third reviewer (H.J.L.). Consistent with the methodological guidance for scoping reviews, no formal quality appraisal of the included studies was conducted, as the aim of this review was to map the available evidence rather than evaluate methodological quality.

3.5. Data Extraction and Charting

Three data extraction templates were developed using Microsoft Excel to capture key characteristics of the included studies. Two reviewers independently extracted data using these templates. The templates included general characteristics, intervention characteristics and the nurses' roles (Table 1). The extracted data were summarized and synthesized narratively. The findings were subsequently grouped into thematic categories based on similarities in intervention characteristics, outcome measures and nurses' roles. These thematic categories were used to organize the results of the review.

TABLE 1.

Data extraction and charting categories.

Domain	Extracted variables
General characteristics	Author(s), year, country, study design, type of surgery, sample size, outcome measures and pain scale
Intervention characteristics	Composition, type, provider, duration, experimental and control group details, and intervention device
Nurses' roles	Planning, implementation, evaluation and evaluation time point

In analysing nurses' roles, nurse involvement was operationally defined as cases in which nurses were explicitly identified as participating in any stage of the intervention (e.g., planning, implementation or evaluation). In cases where the intervention personnel were not explicitly specified, studies were included only when the intervention was clearly described as part of nursing care and the study authors were identified as nurses. This approach was adopted to minimize the misclassification of intervention involvement. In addition, the types of non‐pharmacological interventions and nurses' roles were summarized using graphical representations.

4. Results

A total of 2579 records were identified through searching across the five databases: 495 from PubMed, 1186 from Embase, 177 from CINAHL, 349 from Cochrane and 372 from Web of Science. In addition, 12 studies were identified through other sources, including hand‐searching (n = 4) and reference list screening (n = 8). After removing 601 duplicates, 1990 studies remained for title and abstract screening. The screening process was conducted by two reviewers, and 1892 records were excluded based on the predefined eligibility criteria. Ninety‐eight full‐text articles were assessed for eligibility by the same two reviewers. Following full‐text review, 75 articles were excluded due to ineligible participants (n = 2), ineligible intervention (n = 28), ineligible study design (n = 43) or absence of pain‐assessment scale (n = 2).

Ultimately, 23 studies were included in the final review. The study selection process is presented in Figure 1.

FIGURE 1.

PRISMA flow diagram. [Colour figure can be viewed at wileyonlinelibrary.com]

4.1. Study Characteristics

The characteristics of the included studies are summarized in Table 2. The studies were published between 2016 and 2025 and were conducted across six countries, with the largest number from Turkey (n = 8) and the United States (n = 7). In terms of study design, the studies comprised randomized controlled trials (n = 11), quasi‐experimental studies (n = 9), retrospective cohort studies (n = 2) and mixed‐methods designs (n = 1).

TABLE 2.

General characteristics of included studies.

Authors, year	Country	Study design	Type of surgery	Sample size	Outcome measures	Pain scale
Jeon and Park (2016)	Korea	Quasi‐experimental study	Hysterectomy	60	Pain intensity, uncertainty, anxiety and depression	VAS
Ahn and Park (2017)	Korea	Quasi‐experimental study	Caesarean section	50	Pain intensity, nausea and vomiting	VAS
Quinlan et al. (2017)	USA	RCT	Lumbar spinal fusion surgery	148	Pain intensity, analgesia use, perception of intervention benefit	NRS
Shehta et al. (2017)	Egypt	Quasi‐experimental study	Episiotomy	104	Pain intensity, mother ability to sit, move and care for newborn	VAS
El‐Saidy et al. (2018)	Egypt	Quasi‐experimental study	Episiotomy	200	Pain intensity and wound healing	NRS, SF‐MPQ
Simonelli et al. (2018)	USA	RCT	Caesarean section	165	Pain intensity, relaxation, stress, opioid and NSAID use	NRS, VAS
Akgün and Boz (2020)	Turkey	RCT	Caesarean section	132	Pain intensity and analgesic use	VAS
Hill et al. (2020)	USA	RCT	Pelvic reconstructive surgery	92	Pain intensity, patient satisfaction and perception of healing environment	VAS
Ozkan and Cavdar (2021)	Turkey	RCT	Abdominal surgery	60	Pain intensity and analgesic use	VAS
Soylu and Tekinsoy Kartın (2021)	Turkey	RCT	Cholecystectomy	53	Pain intensity, gastrointestinal functions and anxiety	NRS
Stallings Welden et al. (2021)	USA	RCT	Abdominal surgery	147	Pain intensity and medication use	VRS
Suwannalert et al. (2021)	Thailand	RCT	Caesarean section	100	Pain intensity, intravenous pain reliever use and length of stay	VAS
Burgess et al. (2022)	USA	Pilot RCT	Caesarean section	48	Pain intensity, anxiety and comfort level	NRS
Turhan Damar and Bilik (2022)	Turkey	Mixed‐methods study (quasi‐experimental with qualitative evaluation)	Total knee replacement	83	Pain intensity, stiffness, physical function and quality of life	WOMAC pain subscale (5 items)
Andujo et al. (2023)	USA	Retrospective cohort study	Hip fracture surgery	451	Pain intensity, opioid utilization, length of stay, delirium, complications and 30‐day readmission	NRS
Lindner et al. (2023)	USA	Retrospective cohort study	Pancreas transplantation	52	Pain intensity, opioid utilization, length of stay and return of bowel function	0–10 scale
Roma et al. (2023)	Egypt	Quasi‐experimental study	Episiotomy	100	Pain intensity and wound healing	VAS
Taşcı and Göktaş (2023)	Turkey	Quasi‐experimental study	Hemorrhoidectomy	64	Pain intensity	NRS
Zou et al. (2023)	China	Quasi‐experimental study	Nephrectomy	96	Pain intensity, anxiety, comfort level and hospitalization indicators	NRS
Biricik et al. (2024)	Turkey	RCT	Total knee replacement	44	Pain intensity, stiffness, physical function, quality of life and complications	WOMAC pain subscale (5 items)
Balaban and Yayla (2025)	Turkey	RCT	Bariatric surgery	90	Pain intensity, gastrointestinal functions and anxiety	VAS and VRS
Hables et al. (2025)	Egypt	Quasi‐experimental study	Caesarean section	159	Pain intensity and narcotics use	VAS
Yılmaz Güven and Bulut (2025)	Turkey	Quasi‐experimental study	Total knee arthroplasty	100	Pain intensity, anxiety and mobility	VAS

Abbreviations: NRS, Numeric Rating Scale; RCT, randomized controlled trial; SF‐MPQ, short‐form McGill Pain Questionnaire; VAS, visual analog scale; VRS, verbal rating scale; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.

The interventions were applied across various types of surgical procedures. Caesarean section (n = 6) was the most frequently represented surgery, followed by episiotomy (n = 3) and total knee replacement or arthroplasty (n = 3). Other procedures included abdominal surgery (n = 2), hysterectomy, lumbar spinal fusion, pelvic reconstructive surgery, hip fracture surgery, cholecystectomy, bariatric surgery, pancreas transplantation, hemorrhoidectomy and nephrectomy.

4.2. Thematic Findings

The thematic findings are organized into three categories identified during the narrative synthesis and categorization process: nurse‐involved non‐pharmacological interventions, outcome measures and nurses' roles across intervention stages.

4.2.1. Nurse‐Involved Non‐Pharmacological Interventions

The characteristics of nurse‐involved non‐pharmacological interventions are presented in Table 3. Across the included studies, interventions were delivered as either single‐component (n = 20) or multiple‐component approaches (n = 3). Three studies implemented protocol‐based interventions; one was categorized as a single‐component intervention (Lindner et al. 2023), and two were categorized as multiple‐component interventions (Andujo et al. 2023; Zou et al. 2023).

TABLE 3.

Characteristics of nurse‐involved non‐pharmacological interventions.

Authors, year	Intervention composition	Types of non‐pharmacological intervention	Provider	Duration	Experimental group	Control group	Intervention device
Jeon and Park (2016)	Single	Education	Nurse	The day before surgery; educational video accessible as needed thereafter	Provided preoperative multimedia education on hysterectomy, postoperative recovery and pain management	Standard care	Video
Ahn and Park (2017)	Single	Acupressure	Nurse	Immediately after arrival in the recovery room; maintained for at least 24 h	Korean hand acupressure discs (Seoambong) applied to 12 acupressure points	Standard care	NR
Quinlan et al. (2017)	Single	Cold therapy	Nurse	Every 4 h for 20 min over 48 h	Percept Premium Cold Pack sleeve filled with crushed ice applied to the lower back in a side‐lying position	Turned and positioned to a side‐lying position without cold packs	NR
Shehta et al. (2017)	Single	Cold therapy	Nurse	Immediately after delivery; for 20 min, repeated at 2 h postpartum, and thereafter as needed	Cold gel pack applied to the episiotomy site	Standard care	NR
El‐Saidy et al. (2018)	Single	Cold therapy	Nurse	30–60 min after birth; for 20 min with a 10‐min interval before reapplication	Crushed ice gel pads, anatomically compatible with the perineum, applied to the perineal area	Standard care	NR
Simonelli et al. (2018)	Single	Massage	Nurse	Single session for 20 min	Provided head, neck and back massage	Group 2 (control): standard care Group 3 (attention control): received individualized attention	NR
Akgün and Boz (2020)	Single	Acupressure	Nurse	At 2 and 4 h postpartum; 3 min per point (1 min massage, 2 min pressure); 12 min per session	Acupressure applied manually at the P6 (wrist) and LI4 (hand) points	Control group: standard care Placebo group: superficial touch without pressure applied to the same acupressure points	NR
Hill et al. (2020)	Multiple	Environment modification: Landscape imagery, Music	Nurse, MD	Listen to music a minimum of 2 (afternoon and morning) times daily for 30 min; no maximum limit	Provided music (four playlists or personal playlists) and landscape imagery (a canvas print of a natural landscape hung on the wall near the foot of the patient bed)	Provided a standard hospital room without any changes	Bluetooth‐capable speaker
Ozkan and Cavdar (2021)	Single	Cold therapy	Nurse	At 1, 2, and 8 h postoperatively; 20 min per session, and thereafter as needed during POD 1–3	Cold gel packs applied to cover all incision and drain sites; 2–3 packs used as needed	Standard care	NR
Soylu and Tekinsoy Kartın (2021)	Single	Acupressure	Nurse, MD	At 0, 4, and 8 h postoperatively; total 12 min per session (3 min per point)	Acupressure using thumb pressure applied to ST25, CV12, TH6 and HT7 points	Light touch without pressure applied to ST25, CV12, TH6, and HT7 acupressure points	NR
Stallings Welden et al. (2021)	Single	Aromatherapy	Nurse	On each episode of surgical pain or at random, regardless of analgesic use; within 15–20 min	A drop of lavender essential oil applied to the back of neck, temple, ear, wrist or area of patient preference	Standard care	NR
Suwannalert et al. (2021)	Single	Cold therapy	Nurse, MD	2 h postoperatively; applied for 6 h	Cold gel pack applied to the surgical site with a two‐layer gauze	Standard care	NR
Burgess et al. (2022)	Single	Aromatherapy	Nurse	1–2 h	Self‐adhesive Beekley Elequil aromatabs placed on the gown at chest level	Self‐adhesive placebo tabs placed on the gown at chest level	NR
Turhan Damar and Bilik (2022)	Single	Education	Nurse	Two sessions: preoperative (1 day–1 week before surgery; 30–40 min) and postoperative (POD 3–7; 40–50 min)	Two‐phase individualized video‐based education programme (VBEP) covering perioperative pain management, surgery, recovery, rehabilitation, and home care, with interactive discussion and repetition	Standard care	Video
Andujo et al. (2023)	Multiple (protocol‐based) geriatric pain protocol (GPP)	Cold therapy, guided meditation, music, Reiki session, repositioning	Nurse, NP, MD, Pharmacist, Case Manager, Chaplaincy	Entire hospitalization period	Managed with GPP, incorporating both pharmacological and non‐pharmacological strategies (e.g., ice, music, reiki session, guided meditation and repositioning)	Standard care without GPP	NR
Lindner et al. (2023)	Single (Protocol‐based) multimodal pain‐management protocol	Education	Nurse, MD, Pharmacist	Entire hospitalization period	Provided pain‐management education, multiple medication therapy and discharge planning	Standard pre‐protocol care	NR
Roma et al. (2023)	Single	Dry‐heat application	Nurse	Twice daily (morning and evening) for 10 min over 10 consecutive days	Infrared light applied at a distance of 45 cm from the perineum after 12 h post episiotomy	Moist heat therapy involving sitting in a basin of warm water	Infrared lamp device
Taşcı and Göktaş (2023)	Single	Warm menthol‐oil sitz bath	Nurse	4th hour after the surgery, after the first defecation, and at the 18th hour for 15 min	Warm sitz bath with 5 drops of menthol oil	Warm sitz bath without menthol oil	NR
Zou et al. (2023)	Multiple (protocol‐based) cluster‐nursing methods	Angle management, Education and guided mobilization	Nurse, MD	Entire hospitalization period	Centralized preoperative education, precise angle management and early mobilization guidance	Routine urological care and nursing measures	QR Code (graphic‐foam health education)
Biricik et al. (2024)	Single	Education	Nurse, MD	Single session for 20 min preoperatively, followed by self‐directed video access	Video‐assisted patient education (VPE) delivered via tablet, covering early postoperative care, daily activities and gradual exercise	Standard care	Video
Balaban and Yayla (2025)	Single	Acupressure	Nurse	At 6, 12, and 24 h postoperatively; 16 min per session	Acupressure using finger pressure applied to ST25, CV12, SP6, HT7 and LI4 points with slow, continuous clockwise movements	Control group: Standard care Placebo group: touch‐based placebo intervention (details not fully specified)	NR
Hables et al. (2025)	Single	Cold therapy and gum chewing	Nurse	Group A (gum chewing): 2 h postoperatively; 15 min, repeated hourly Group B (Cold therapy): 2 h postoperatively; 6 h	Group A: Chewing sugar‐free xylitol gum Group B: Cold pack gel applied over the surgical wound dressing, replaced every 2 h	Standard care	NR
Yılmaz Güven and Bulut (2025)	Single	Reflexology	Nurse	6 h postoperatively; 30 min per session (20 min right, 10 min left); once every 24 h for 3 days	Foot reflexology targeting pain and anxiety applied (right foot: sympathetic regulation; left foot: parasympathetic regulation)	Standard care	NR

Abbreviations: MD, Medical Doctor; NP, Nurse Practitioner; NR, not reported; POD, postoperative day; QR, quick response.

A range of non‐pharmacological strategies was identified across studies as summarized in Figure 2. Cold therapy was the most frequently reported intervention, followed by acupressure and education. Other single‐component interventions comprised aromatherapy, dry‐heat application, warm menthol‐oil sitz bath, massage, reflexology and gum chewing. Multiple‐component interventions combined two or more non‐pharmacological strategies, with specific components varying across studies. Education and cold therapy were used both as standalone interventions and as components within multiple‐component or protocol‐based approaches (Andujo et al. 2023; Zou et al. 2023). In several studies, interventions were delivered collaboratively with other healthcare professionals, including medical doctors (n = 7), pharmacists (n = 2) and case managers (n = 1). Six studies reported the use of intervention‐support devices, including a Bluetooth‐capable speaker (Hill et al. 2020), a Quick Response (QR) code‐based education system (Zou et al. 2023), an infrared lamp device (Roma et al. 2023) and video‐assisted education materials in three studies (Biricik et al. 2024; Jeon and Park 2016; Turhan Damar and Bilik 2022).

FIGURE 2.

Types of non‐pharmacological interventions. [Colour figure can be viewed at wileyonlinelibrary.com]

4.2.2. Outcome Measures

Outcome measures are summarized in Table 2. Pain intensity was assessed in all included studies and represented the primary outcome across the literature. The Visual Analog Scale (VAS) was the most frequently used instrument (n = 12), followed by the Numeric Rating Scale (NRS) (n = 8). Other tools including the Verbal Rating Scale (Balaban and Yayla 2025; Stallings Welden et al. 2021), the Short‐Form McGill Pain Questionnaire (SF‐MPQ) (El‐Saidy et al. 2018), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (Biricik et al. 2024; Turhan Damar and Bilik 2022) were used less frequently. In one study, a 0–10 scale was used without specifying whether it corresponded to a validated tool (Lindner et al. 2023).

Beyond pain intensity, several categories of secondary outcomes were reported. These included analgesic‐related outcomes (n = 9), such as opioid consumption; psychological outcomes (n = 7), including anxiety, depression and stress; functional outcomes (n = 7), such as mobility and physical function; and clinical indicators of postoperative recovery (n = 8), including patient comfort and length of hospital stay.

4.2.3. Nurses' Roles Across Intervention Stages

The details of nurses' roles in non‐pharmacological interventions are presented in Table 4. Across the included studies, nurses were involved in at least one stage of the intervention process, including planning, implementation or evaluation. Figure 3 illustrates the distribution of studies according to the stages of nurses' involvement.

TABLE 4.

Nurses' roles across intervention stages.

Authors, year	Types of non‐pharmacological intervention	Nurses' role in planning	Nurses' role in implementation	Nurses' role in evaluation	Evaluation time point
Jeon and Park (2016)	Education	Design video, including content selection, audiovisual planning, and development of pain‐related education (postoperative care, PCA use, analgesic benefits and additional pain control strategies)	Deliver and facilitate educational video viewing, confirm completion, address post‐viewing questions and inform re‐accessibility of content	NR	1, 24 and 48 h postoperatively
Ahn and Park (2017)	Acupressure	Select 12 acupressure sites based on established guidelines and conducted a feasibility study to determine the effect of Korean hand acupressure	Administer the Korean hand acupressure by a certified obstetric nursing specialist	NR	Before and after (0.5, 1, 2 and 24 h) the Korean hand acupressure
Quinlan et al. (2017)	Cold therapy	NR	Position patients to side‐lying, apply ice pack to the lower back and remove the pack after 20 min	Ask patients to rate their pain level and evaluate whether the intervention reduced pain	Every 4 h for 48 h after surgery, until discharge
Shehta et al. (2017)	Cold therapy	NR	Apply cold gel pack to the episiotomy site, repeat application, instruct and verify technique and encourage use as needed	Assess pain	Baseline, 0, 2, and 4 h postpartum (in hospital); follow‐up home visit on postpartum Day 2
El‐Saidy et al. (2018)	Cold therapy	NR	Provide written and oral instructions on crushed ice gel application, including timing, duration, infection prevention, pain assessment and perineal self‐care	Assess pain on postpartum day 1 and 7	2 h post‐initial application; postpartum days 1, 3 (self‐assessment) and 7
Simonelli et al. (2018)	Massage	NR	Provide massage by a nurse licensed in massage therapy	Assess pain	POD 1 (baseline, 24–48 h postpartum), 60 min post‐intervention, and average pain scores on POD 1–4
Akgün and Boz (2020)	Acupressure	NR	Manually administer acupressure by a nurse licensed in acupressure	NR	Before and after each session; four times in total
Hill et al. (2020)	Environment modification: landscape imagery, music	NR	Instruct patients how to use the speaker, turn on the music, and ensure they listen to music for 30 min	Assess pain using nursing pain score	POD 1 breakfast, POD 1 before discharge, 2‐week postoperative visit
Ozkan and Cavdar (2021)	Cold therapy	NR	Instruct patients to self‐apply cold therapy when pain occurred and to report application timing and intervals after POD 1	Assess pain	Before and after cold therapy application on the day of surgery
Soylu and Tekinsoy Kartın (2021)	Acupressure	NR	Apply acupressure, monitor patient tolerance and adjust pressure during the procedure	NR	Before acupressure, and 0, 4 and 8 h postoperatively
Stallings Welden et al. (2021)	Aromatherapy	NR	Administer lavender aromatherapy and monitor for adverse reactions	Conduct pain evaluation using patient self‐rated pain scores following nurse instruction	On admission (baseline) and during each reported pain episode
Suwannalert et al. (2021)	Cold therapy	NR	Renew cold gel packs every 2 h to maintain temperature and monitor cold‐related complications every 30 min during the first hour	Assess pain	0, 2, 4, 6, 8, 12 and 24 h postoperatively
Burgess et al. (2022)	Aromatherapy	Choose to explore the use of Elequil lavender aromatabs rather than essential oil drops or diffusers for staff and patient safety	NR	Ask patients to self‐assess pain	1–2 h post‐intervention
Turhan Damar and Bilik (2022)	Education	Plan and develop the programme using expert consultation, content validation, pilot testing with patients and subsequent revision	Deliver a two‐phase programme individually, including video presentations, interactive discussions, question and answer and repetition of unclear content	Assess pain through face‐to‐face interviews	Baseline (preoperatively), postoperative week 6, and postoperative month 3
Andujo et al. (2023)	Cold therapy, guided meditation, music, reiki session and repositioning	Confirm protocol meets functional pain‐management requirements	Provide strategies, such as ice, distraction, and repositioning, and respond to patient requests	Nr	POD 1 and POD 2
Lindner et al. (2023)	Education	NR	Provide education on pain‐management therapies, pain goals, and functional tasks on the transplant floor and upon discharge	NR	POD 1, POD 3, POD 7 and discharge day
Roma et al. (2023)	Dry‐heat application	NR	Demonstrate the use of infrared lamp, facilitate redemonstration and discussion, provide health education, and encourage adherence through daily phone calls	Assess pain	5th and 10th days after the interventions at the outpatient clinic
Taşcı and Göktaş (2023)	Warm menthol‐oil sitz bath	NR	NR	Assess pain	15 min after the bath, before enema and after defecation at 9–10 h
Zou et al. (2023)	Angle management, education and guided mobilization	Develop care‐intervention bundles	Provide education, guide postural management and early mobilization, and monitor implementation quality using graphic‐foam health education	NR	POD 1, POD 3 and POD 5
Biricik et al. (2024)	Education	Develop and pilot‐test the intervention to assess intelligibility and feasibility, and refine the intervention based on patient engagement and ability to perform	NR	NR	Baseline and postoperative months 1 and 3
Balaban and Yayla (2025)	Acupressure	NR	Apply acupressure using finger cun method	NR	24 h postoperatively
Hables et al. (2025)	Cold therapy and gum chewing	NR	Deliver and supervise gum chewing and cold pack gel intervention	NR	0, 4, 8, 12 and 24 h postoperatively
Yılmaz Güven and Bulut (2025)	Reflexology	NR	Apply foot reflexology by a nurse who received the diploma of Expert Reflexologist	Assess pain	Before and after each reflexology application

Abbreviations: NR, not reported; PCA, patient controlled analgesia; POD, postoperative day.

FIGURE 3.

Distribution of nurses' roles across intervention stages. [Colour figure can be viewed at wileyonlinelibrary.com]

Nurses most frequently participated in the implementation stage (n = 20). During this stage, nurses delivered the interventions and guided patients in performing the intervention procedures. Nurses were also involved in the evaluation stage (n = 13), where they assessed pain using standardized tools or facilitated patient self‐report. Nurses were less frequently involved in the planning stage (n = 7). In these studies, nurses participated in organizing the intervention process or preparing intervention components. Only one study reported nurses' involvement across all three stages of the intervention process (Turhan Damar and Bilik 2022).

Evaluation time points were primarily short‐term, with the most studies assessing outcomes during the immediate postoperative period or during hospitalization.

5. Discussion

This review provides an overview of nurse‐involved non‐pharmacological interventions for postoperative pain management across diverse surgical populations. Three key findings emerged from the included studies. First, a wide range of non‐pharmacological interventions was identified, with simple single‐component strategies being most frequently implemented in clinical settings. Second, nurses were primarily involved in the implementation and evaluation stages of interventions, while their participation in the planning stage remained limited. Third, outcome evaluation predominantly focused on pain intensity, with relatively fewer studies examining broader recovery‐related outcomes.

A notable proportion of included studies focused on obstetric procedures, particularly caesarean section and episiotomy. Previous research has similarly reported that non‐pharmacological pain management strategies are frequently investigated in obstetric populations, partly due to the high prevalence of postoperative discomfort and the emphasis on minimizing pharmacological exposure during the postpartum period (Dantas Varella Dutra et al. 2019; Gondim et al. 2025). This concentration suggests that the current evidence base may be more applicable to obstetric populations than to other surgical groups, highlighting the need for future research across a broader range of surgical contexts.

The included interventions varied in their structure, ranging from single‐component to multiple‐component approaches, with single‐component interventions being more frequently applied in postoperative pain management. Single‐component interventions may be more feasible within routine clinical workflows and may therefore be more readily adopted in nursing practice. Previous research has similarly suggested that interventions requiring minimal resources and training are more likely to be implemented consistently in busy clinical environments (Rogers et al. 2021; Zhou et al. 2023). In contrast, multiple‐component interventions may provide broader benefits by addressing multiple aspects of pain and recovery simultaneously (Kasicki et al. 2025; Skivington et al. 2021). These findings highlight the importance of considering both feasibility and comprehensiveness when integrating non‐pharmacological interventions into clinical practice.

In addition, protocol‐based interventions were identified across both single‐ and multiple‐component approaches. In this context, protocolization appears to function as a structured framework that supports consistent and systematic delivery of non‐pharmacological interventions rather than representing a specific therapeutic modality. Standardized protocols may therefore facilitate the integration of non‐pharmacological strategies into routine clinical care and help ensure greater consistency in intervention delivery across healthcare settings (Department of Health (Ireland) 2025).

Several studies also incorporated digital tools, such as QR code‐based educational materials and video modules, to support the delivery of non‐pharmacological interventions. The integration of technology‐mediated approaches may facilitate standardized patient education while allowing patients to access information repeatedly at their own pace. Such approaches may also support patient engagement and improve the efficiency of nursing interventions within busy clinical environments.

Pain, as a subjective and multidimensional experience, requires accurate and comprehensive assessment to guide clinical decision‐making and evaluate the effectiveness of pain management strategies (Raja et al. 2020). In the included studies, pain intensity was consistently assessed, most commonly using validated unidimensional instruments such as the VAS and NRS. While these tools are widely recommended and predominantly used in clinical practice (Crisman et al. 2024), they primarily capture a single dimension of pain. Given the complex nature of postoperative pain, incorporating multidimensional assessment tools may provide a more comprehensive understanding of patients' pain experiences (Crisman et al. 2024; van Boekel et al. 2017). However, only a limited number of studies used instruments that captured broader aspects of pain, such as the SF‐MPQ, or functional or condition‐specific measures including the WOMAC pain subscale. This pattern highlights that the sensory, affective and evaluative dimensions of pain may remain underrepresented in current research. Future studies may therefore benefit from incorporating multidimensional pain assessment approaches to better capture the complexity of postoperative pain experiences.

In addition to pain intensity, several studies evaluated broader outcomes including psychological, functional and clinical indicators of recovery. These findings suggest a growing recognition that postoperative recovery extends beyond pain reduction alone and encompasses multidimensional aspects of patient well‐being (Giordano et al. 2023; Rajabiyazdi et al. 2021). Expanding outcome frameworks to include diverse recovery indicators may therefore support a more comprehensive evaluation of non‐pharmacological pain management strategies.

Another important observation was that evaluation time points in the included studies were predominantly short‐term, focusing on the immediate postoperative period or during hospitalization. Only a limited number of studies extended follow‐up beyond discharge, with assessments conducted at varying time points up to several months postoperatively. While these timeframes provide insights into early postoperative recovery, they may not fully capture the longer term effects of non‐pharmacological interventions, including their potential influence on persistent postoperative pain or long‐term quality of life. Consistently, previous research has highlighted the importance of assessing pain at specific time points and monitoring changes over time to better understand intervention effects (Choi et al. 2024).

The findings of this review revealed an uneven distribution of nurses' roles across intervention stages. Although nurses were involved in planning, implementation and evaluation stages, their participation was predominantly concentrated in implementation and evaluation. This pattern may reflect existing clinical structures in which nurses are more commonly positioned as implementers of predefined protocols rather than active contributors to intervention design. Institutional factors such as workload, time constraints and hierarchical decision‐making processes may also influence nurses' opportunities to participate in planning activities. However, effective postoperative pain management requires nurses to engage across all stages of care, including planning, implementation, and evaluation, in order to deliver individualized and patient‐centered interventions (Taşcı and Göktaş 2023; Yaban 2019). Limited involvement in the planning stage may reduce opportunities to incorporate bedside insights into intervention design and may hinder alignment across intervention stages. Strengthening nurses' participation in planning processes may therefore contribute to more integrated and patient‐centered postoperative pain management strategies.

6. Practice Implications

The findings of this review have several implications for clinical practice, healthcare policy and nursing education. First, healthcare organizations should develop standardized protocols or clinical roadmaps to guide the implementation of non‐pharmacological interventions in postoperative care. Such structured approaches may reduce unwarranted variability in nursing practice and facilitate the integration of non‐pharmacological strategies into existing clinical workflows, thereby improving both nurse adherence and patient outcomes (Harrison et al. 2019). At the healthcare policy level, institutional support is required to formally recognize nurse‐involved non‐pharmacological interventions as an integral component of postoperative pain management. This includes adequate staffing, resource allocation, and the incorporation of these interventions into pain management guidelines and care standards. Policy‐level support may ensure that non‐pharmacological strategies are implemented as routine elements of care rather than perceived as additional nursing tasks. Within clinical pathways, non‐pharmacological interventions can be systematically incorporated into perioperative care processes. Clearly defining nurses' roles across planning, implementation and evaluation stages may enhance continuity of care and promote more coordinated pain management strategies. Finally, nursing education should emphasize the development of competencies related to non‐pharmacological pain management, including intervention planning, implementation and outcome evaluation. Strengthening these competencies may support nurses' active participation across all stages of care and promote the consistent application of evidence‐based non‐pharmacological interventions in clinical practice.

7. Limitations

This study has some limitations that should be considered. First, this review followed established methodological guidance for scoping reviews; however, no formal review protocol was registered prior to conducting the study. This may limit the transparency regarding prospectively defined methodological decisions. Second, the search was restricted to peer‐reviewed journal articles, excluding grey literature such as dissertations and conference proceedings. While this ensured the methodological quality of the evidence included, it may have introduced publication bias. Third, identifying nurse involvement was challenging in some studies that lacked explicit descriptions of personnel. In such cases, roles were inferred based on the study context and author information, which may have introduced potential for misclassification bias in categorizing nurses' roles. Fourth, this review focused on mapping the characteristics of non‐pharmacological interventions and nurse involvement rather than evaluating their effectiveness. Therefore, the findings provide an overview of the existing evidence rather than definitive conclusions regarding the effectiveness of these interventions. Fifth, most included studies evaluated outcomes during the immediate postoperative period or during hospitalization. The limited follow‐up periods restrict understanding the long‐term effects of nurse‐involved non‐pharmacological interventions on postoperative recovery. Finally, the included studies were geographically concentrated in a limited number of countries, particularly Turkey and the United States, which may restrict the global applicability of the findings. Differences in healthcare systems, clinical practices and nursing roles across regions should therefore be considered when interpreting the results.

8. Conclusions

This scoping review highlights the diversity and clinical relevance of nurse‐involved non‐pharmacological interventions for postoperative pain management across surgical settings. To strengthen clinical practice, these interventions should be systematically integrated into routine perioperative care through standardized protocols. Clear delineation of nurses' roles across planning, implementation and evaluation stages, supported by adequate institutional resources, may further facilitate their effective implementation. In addition, the use of multidimensional pain assessment tools should be encouraged to better capture the complexity of postoperative pain and recovery.

Future research should expand the evidence across diverse surgical populations and healthcare settings, strengthen nurses' involvement across all stages of intervention development and delivery, and incorporate longer follow‐up periods to better understand sustained outcomes. Furthermore, the use of multidimensional outcome measures should be advanced to reflect the comprehensive impact of non‐pharmacological interventions. By addressing these priorities, nurse‐involved non‐pharmacological interventions have the potential to contribute to more integrated, patient‐centered, and sustainable perioperative care models, ultimately improving postoperative recovery and supporting the global advancement of postoperative pain management.

Author Contributions

Jihyung Son conceptualized the study, conducted the investigation, curated the data, prepared visualizations and drafted the original manuscript. Sunghwa Na contributed to the investigation and data curation, and participated in reviewing and editing the manuscript. Hyun Joo Lee supervised the study and contributed to manuscript review and editing. All authors reviewed and approved the final version of the manuscript.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Appendix S1: Preferred Reporting Items for Systematic reviews and meta‐analyses extension for scoping reviews (PRISMA‐ScR) checklist.

Appendix S2: Full data search strategy used for the review.

Data Availability Statement

Data sharing was not applicable to this article as no datasets were generated or analysed during this study.