managing severe pain in patients with opioid addiction ... · ii. opioid addiction is a national...

Running head: MANAGING SEVERE PAIN IN PATIENTS WITH OPIOID ADDICTION 1

Managing Severe Pain in Patients with Opioid Addiction

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MANAGING SEVERE PAIN IN PATIENTS WITH OPIOID ADDICTION 2

Managing Severe Pain in Patients with Opioid Addiction

1. Cover page

a. Managing Severe Pain in Patients with Opioid Addiction

b. Students Name

c. Date Submitted

d. Institutional Affiliation

2. Background/Introduction

a. Statement of the Clinical Problem

i. PICO

ii. Opioid addiction is a national epidemic. Challenges to non-opioid

treatment use include; insufficient chronic pain management programs,

lack of readily available, integrated, systematic and interdisciplinary

treatment options.

iii. Accessible and effective alternatives are also lacking

b. Overview of Opioid Addiction crisis in the US

i. Despite government pressures in devising abuse deterrent formulations,

increased use of opioid analgesics in treating non-cancer chronic pain has

led to increased opportunities for using prescription opioids illicitly (Kaye,

Jones, Kaye, Ripoll, Jones, Galan and Manchikanti, 2017).

ii. Cultural shifts in prescription habits of physicians from being phobic to

liberal when it comes to opioids due to pain under treatment, aggressive

marketing by drug companies, biased guidelines and physician ignorance


with regard to abuse has led to exponential increases in number of patients

treated with opioids.

iii. Despite widespread acknowledgement of the extent of the issue, variations

in opioid prescribing reflect a weak consensus on the appropriate use of

opioids.

iv. Surveillance programs show that abuse is heavily localized in suburban,

rural, and small urban areas with hydrocodone and oxycodone being the

most widely abused in the country.

3. Literature Synthesis

a. Applying evidence based practice (EBP) to the family, client, community and

population scenario.

i. How can patients in severe pain with a H/O opioid addiction (P) be

managed with non-opioids treatments (I) to reduce pain (C) and reduce

addiction concerns (O)?

ii. Literature Search

1. Search terms used: Opioid Addiction, non-opioid treatment, reducing

pain, addiction, pain management, chronic pain, barriers, challenges.

2. Databases used: PubMed, BMC, PLOS ONE, JAMA, CINHAL

iii. Summary of Literature

1. Despite concerns from patients regarding side effects, stigma and

addiction, they had no other options but to use opioids as the only

remedy for their pain (Penney, Ritenbaugh, DeBar, Elder and Deyo,

2016).


2. Education about realistic expectations for chronic pain management

and therapy options, as well as making A/C care more easily

accessible, might lead to more satisfaction for patients and providers,

and provide important input to policy makers.

3. Using non-opioid analgesia as a first-line treatment in short-term

moderate to severe trauma pain might contribute to reducing long-term

dependence on opioids (Swift, 2018).

4. Treatment with opioids is not superior to treatment with non-opioid

medications for improving pain-related function (Krebs, Gravely,

Nugent, Jensen, DeRonne, Goldsmith and Noorbaloochi, 2018).

An 5. opioid-sparing pain management strategy represents an effective

way to prevent excess opioids from entering the community.

6. Opioid Free Anesthesia (OFA) is especially valuable in patients at

high risk of opioid-related complications, including those with chronic

pain conditions and opioid misuse disorder.

7. Social isolation and disagreements with providers may compel patients

to place disproportionate value on opioid analgesics and to dismiss

non-pharmacologic treatments.


8. Current analysis has demonstrated the benefits of 10 kHz SCS therapy

which offers an evidence-based, non-pharmaceutical alternative to

opioid therapy and/or an adjunctive therapy to facilitate opioid dose

reduction whilst delivering significant pain relief.

9. Non-Pharmacological Treatments for pain including (1) clinician-

directed NPTs: physical therapy, transcutaneous electrical nerve

stimulation (TENS), chiropractic treatment, acupuncture, massage, and

CBT group treatments or other psychoeducational courses on pain

management were rated as helpful by those using them.

iv. Gaps in Literature

1. Further investigations are warranted on the potential of non-opioid

treatments like acupuncture and virtual reality as a replacement for

opioids in chronic pain management.

2. Multimodality pain management techniques should be assessed in

different types of settings and patients to enhance their

generalizability.


3. More studies are needed which compare opioid treatments with other

pain reduction techniques.

4. The role of the pharmaceutical industry in the opioid epidemic as it

establishes and maintains opioids as the cornerstone of pain treatment

protocols.

5. Possible side effects of non-opioid treatments for pain reduction and

whether or not they are less or more severe compared to opioid

addiction.

v. Types of evidence needed to solve the problem

1. Best evidence comes from rigorous studies with statically significant

findings.

2. Qualitative evidence can enable in-depth exploration of provider and

patient experiences with alternative approaches to opioid management

of chronic pain.

3. Evidence from randomized control trials evaluating the efficiency of

non-opioid treatments in managing chronic pain.


4. Evidence from studies that include chronic pain from various acute

injuries and the efficacy of non-opioid treatments as the first line of

intervention.

vi. Implications of research for advanced practice nursing

1. Need for sensitization and education of nurses and physicians on

alternatives to opioid treatments for chronic pain management.

2. Formulation and implementation of policies that discourage and

manage opioid use more closely by clinicians is warranted.

3. Advanced practice nurses need to consider non-opioid treatments like

acupuncture as the first line of treatment instead of only using it as

alternatives when all else fails.

4. In-depth Analysis of Clinical Problem

a. Statement of the target population and problem that is clear and explicit.

i. A patient in severe pain who has an opioid addiction.

ii. Epidemiology and prevalence of opioid addiction.

iii. Diagnosis


1. Risk Factors

2. Populations in high risk

3. Physical examination signs and symptoms.

b. Assessment and Management

i. How treatment therapies are chosen by APRNs and physicians (patient

characteristics, history of addiction, availability of treatment modalities,

pain severity or efficacy of modalities.)

ii. Monitoring should include: adherence and compliance to non-opioid

treatments, adverse and side effects, outcomes related to pain severity and

duration of relief.

c. Patient Centered care

i. Tailoring pain management prescriptions to the needs of each patient by

using individual patient characteristics to predict analgesic needs.

ii. Considering the goals and perspectives of the client , benefits and harms

according to their daily routines as well as their resources an

circumstances.


d. Disparities and social equity

i. Individuals living in rural, suburban and small urban areas are

disproportionately affected by opioid addiction.

ii. Role of insurance and pharmaceutical companies in the epidemic.

iii. Differences in terms of gender, race, socioeconomic status and age

e. Role as an advance practice nurse

i. Advocacy, scope of practice, gathering of data as a first line responder to

patients with opioid addiction.

ii. Inter-professional collaboration with other caregivers that can give

alternative non-opioid treatment such as acupuncturists.

MANAGING SEVERE PAIN IN PATIENTS WITH OPIOID ADDICTION

10

References

MANAGING SEVERE PAIN IN PATIENTS WITH OPIOID ADDICTION

11

Kaye, A. D., Jones, M. R., Kaye, A. M., Ripoll, J. G., Jones, D. E., Galan, V., & Manchikanti, L.

(2017). Prescription opioid abuse in chronic pain: an updated review of opioid abuse

predictors and strategies to curb opioid abuse (part 2). Pain physician, 20(2S), S111-

S133.

Krebs, E. E., Gravely, A., Nugent, S., Jensen, A. C., DeRonne, B., Goldsmith, E. S., ... &

Noorbaloochi, S. (2018). Effect of opioid vs nonopioid medications on pain-related

function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE

randomized clinical trial. Jama, 319(9), 872-882.

Penney, L. S., Ritenbaugh, C., DeBar, L. L., Elder, C., & Deyo, R. A. (2016). Provider and

patient perspectives on opioids and alternative treatments for managing chronic pain: a

qualitative study. BMC family practice, 17(1), 164.

Swift, A. (2018). Non-opioid analgesia is as effective as opioid management in acute pain and

supports a change in prescribing practice to help address the ‘opioid epidemic’. Evidence-

based nursing, ebnurs-2018.

managing severe pain in patients with opioid addiction ... · ii. opioid addiction is a national...

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