NR 505 Week 5 Research Literature Design Sampling Implementation Assignment Complete Solution
In adult patients with chronic pain, how does the
... [Show More] implementation of complementary integrative interventions, compared to traditional narcotic pain management affect patients pain levels and quality of life?
As a future family nurse practitioner (FNP) it is crucial to identify alternative ways to manage chronic pain appropriately. According to Hadi, Alldred, Briggs, Marczewski, & Closs (2017) chronic pain is one of the leading causes of disability worldwide. It is estimated that 25.3 million Americans suffer from chronic pain and individuals who report severe pain are more likely to experience poorer health overall (National Center for Complementary and Integrative Health, 2015). “About 4% of the adult US population abuses prescription opioids, and in 2015, more than 33,000 deaths were linked to overdose with licit and illicit opioids” (Skolnick, 2018). Furthermore, Dahlhamer et al., (2018) states that one of the most prevalent reasons that adults in the United States seek medical care is for the treatment and management of chronic pain. These facts present unique challenges in treating and managing chronic pain in the primary care setting.
The current treatment for patients with chronic pain is not adequate. Sufferers of chronic pain are at risk to live a cruel cycle. Chronic severe pain can lead to time off from work, sedentariness, stress, anxiety, insomnia, and depression eventually affecting relationships, and in turn affecting all aspects of one’s life (Hadi et al., 2017). Treating pain alone is not sufficient, the patient must be treated as a whole looking at all aspects of living well. Healthcare providers are hesitant to employ complementary alternative forms of treatment and interventions (Satori & Heidemann, 2017).
Research Literature Support
The following articles support the PICO question of; In adult patients with chronic pain, how does the implementation of complementary integrative interventions, compared to traditional narcotic pain management affect patients pain levels and quality of life?
Mehl-Madrona, Mainguy, & Plummer (2016) conducted a study to determine if the integration of complementary and alternative medicine in primary-care pain management could reduce opiate use for patients with chronic pain in a rural setting. The research approach used was quantitative analyzing the opiate dosages of the participants. The study showed the results of participation in group medical visits (GMV) with inclusive complementary alternative medicine (CAM) in a rural primary-care clinic where a large number of patients were receiving high doses of opiates with no non-pharmacological treatments or interventions. The participants continued to receive their opiates at the current dose with an agreement to attend GMV a minimum of twice a month and to engage in physical activity at least once a week. The 2-hour GMV consisted of a family practice physician with behavioral health training, a nurse, and a behavioral health specialist. The maximum number of participants per group was 12. No patient would be forced to reduce their opiate dose; however, no dosage increase would be made without a pain specialist recommendation. The GMV sessions started with collection of vital signs, then a talking session, physical activity such as yoga, stretching, or tai chi, and finished with guided imagery. The program lasted for a period of 6 months. The GMV group was compared to chronic pain patients within the practice that were receiving treatment as usual (TAU) at the end of the six months. Out of the 207 patient participants in the GMV 42 attended for six months with no increase in the opiate dosage, participants that left before the six months did not significantly reduce their opiate use. However, eighteen participants reduced their dosage and eight participants discontinued opiate use. On a 0 to 10 pain intensity rating scale, there was shown to be a statistically significant reduction in pain rating; as well as an improvement in the primary symptom causing pain. Improvements in activities of daily living were not largely relevant; however, reports in quality of life were statistically significant. A strength of this study is that it was utilizing participants that had previously been considered intractable by their physicians and steadily increasing their use of opiates; it proves that CAM can be successful with the most difficult of patient populations. A limitation of this study is that it was a relatively small group of participants and it took some time to quantify the data.
According to Monroe et al., (2016) in older adults the treatment of chronic low back pain is often limited due to adverse side effects of analgesic medication and further research is indicated for nonpharmacological treatment options. The purpose of their study was to determine the potential effectiveness of a mind-body program for older adults with chronic low back pain (LBP) in reducing pain while increasing function. They performed a mixed method experimental study that was designed as a randomized education-controlled clinical trial of a mind-body program on elderly patients with chronic LBP. The intervention group participated in an 8-week program on mindful meditation stress reduction program while the control group participated in an 8-week health education program called 10 Keys to Healthy Aging. Both groups received the same amount of time, attention, and support and were taught the same chair stretching techniques. [Show Less]