MSN-6030: Intervention Plan Design

Intervention Plan Design

In the US, the number of persons experiencing chronic pain increases considerably, which some findings estimate a prevalence of 11.2 percent in the adult population. Moreover, studies indicate that chronic untreated pain is associated with significant individual and societal consequences (Ivery, 2018). The physical and mental repercussions may incorporate compromised physical functioning and immobility, sleep disturbance, fatigue, alteration in mood, depression, anxiety, anger, and irritability. Notably, chronic pain management in the veteran population has become a challenge, especially with the increasing prevalence rates of mental health and substance abuse disorders among this group. Currently, veterans experiencing chronic pain are likely to be prescribed a higher dosage of opioids and sedative-hypnotics, incorporating benzodiazepines. However, chronic pain can also be managed using nonpharmacological interventions like CAM therapy to reduce the intensity and the frequency of chronic pain the veterans experience. Therefore, this paper intends to investigate the effectiveness of nonpharmacological interventions compared to opioid therapy in the management of chronic pain in the veteran population.

Major Components of the Intervention Plan

In this intervention plan, the aim is to determine the effectiveness of nonpharmacological interventions in treating chronic pain in the veteran population versus opioid therapy. The major components in this intervention plan will therefore include pain management programs (PMPs) and multidisciplinary pain clinics. The multidisciplinary pain clinics are suited to treat comorbid pain and emotional issues, as well as addressing long-term life issues and physical functioning. Therefore, nursing practitioners must have these kills because they are relevant for attending to the healthcare needs of veterans. The two major components cab be integrated with the traditional staffing mixture of psychology, physiotherapy and occupational therapy to meet enhance healthcare outcomes for veterans. In the interventional program, the ability to assess for PTSD and alcohol abuse problems will be bital, and assessing clinicians will need the experience to know the level of comorbidity that can be treated on a PMP, or the level of comorbidity which requires prior treatment by other services, both in the health service and third sector (e.g. Combat Stress). Thus, a minimum level of psychology staffing is essential"

Impact of Cultural Needs and Characteristics

Research shows that cultural needs and characteristics can influence many pain-related factors such as how the veterans communicate pain, veteran's emotional responses to other people's pain, pain intensity and tolerance, beliefs concerning pain, and how to cope with pain well as pain catastrophizing. These factors can play a significant role in the onset and maintenance of chronic pain in the veteran population. For example, Veterans of Asian origin may tend to refrain from talking about their pain. Again, when they communicate their pain, they may be less direct when speaking with a non-Asian clinician than when they share with an individual from the same ethnicity as them (Sharma, Abbott, & Jensen, 2018). This tendency to refrain from talking about pain has considerable implications in managing chronic pain in Veterans of Asian origin, particularly when treated by a non-Asian clinician who speaks a different language (Sharma, Abbott, & Jensen, 2018). 

Again, culture plays a significant role in coping with chronic pain among the veterans. For instance, veterans who prefer coping such as passive coping responses like rest and utilization of appliances are mostly likely to experience adverse health care outcomes and further harm from such coping strategies. However, veterans need to embrace active coping like engaging inappropriate physical activity often tend to be effective in pain management.

Theoretical Nursing Models, Strategies from Other Disciplines, and Health Care Technologies

In managing chronic pain, two leading theories are considered to result in high comorbidity between PTSD and chronic pain. The first theory is shared vulnerability, which states that underlying trait-like anxiety sensitivity, that is, the fear of anxiety symptoms is dangerous, predisposes the veterans to both chronic pain and PTSD (Lewis et al., 2018). The second theory, known as the mutual maintenance model, states that pain may trigger traumatic memories, and traumatic hyperarousal may worsen chronic pain. In the second hypothesis, patients with behavioral avoidance often prefer to maintain both pain and PTSD. Moreover, the second model is supported by evidence that shows that veterans with comorbid pain and PTSD manifest higher levels of catastrophic thoughts and perceived lack of control over pain. The US military pain management guidelines have been shown to enhance chronic pain monitoring, education, and relief. The US military also instituted programs and policies to ensure proper utilization and discourage aberrant behaviors concerning opioid usage since opioid usage is considered a vital part of acute and chronic pain management schemes (Lewis et al., 2018). Therefore, the application of US pain management strategies may result in more effective chronic pain management and enhance long-term patient outcomes.

Justification of the Major Components of an Intervention

This project aims to determine the effectiveness of nonpharmacological interventions compared to opioid therapy in the management of chronic pain in the veteran population. Evidence shows that in the veteran population, providers' chronic pain management strategies are increasingly based on a multimodal approach that entails a combination of both pharmacological and nonpharmacological interventions to offer more comprehensive chronic pain management. The pharmacological interventions include nonopioid analgesics, opioid analgesics, and other treatments like antidepressants and anticonvulsants. On the other hand, nonpharmacological interventions include distractions, relaxation, or imagery; superficial massage; breathing techniques, music therapy; spiritual practices; environmental modifications; positioning and repositioning; heat or cold application; and transcutaneous electrical nerve stimulation as well as Complementary and alternative medicine (CAM) therapy. 

Opioid utilization for chronic pain management has been the mainstay for chronic pain management, with the adoption of nonopioid practices being considered to offer safer pain care. However, studies indicate that veterans prescribed long-term opioid therapy have more pain diagnoses, significant pain levels, and pain interferences in functioning than those in the short-term or those who are not prescribed opioid therapy (Ivery, 2018). These results show a strong correlation between opioid treatment and an increase in patients diagnosed with chronic pain. Other studies show that veterans who are prescribed long-term opioid therapy are vulnerable to overdose and accidental deaths while at the same time, they receive insignificant care to relieve their pain and enhance their physical functioning (National Academies of Sciences, Engineering, and Medicine,2017). Therefore, with increased accidental overdose deaths among the veterans, this population is affected, thereby creating an urgency to provide alternative pain management strategies like the use of nonpharmacological interventions such as CAM therapy. 

CAM therapy refers to using other medical products and practices that are not part of standard medical care. The veterans may utilize CAM therapy to help them comfort themselves and ease the worries of chronic pain and related stress (Edmond et al., 2018). For instance, the CAM therapy utilized to treat chronic pain incorporates acupuncture, aromatherapy, biofeedback, chiropractic care, energy healing, folk remedy, massage, lifestyle modifications, naturopathy, relaxation techniques, and spiritual healing by other people, and yoga (Vanneman et al. 2018). For instance, studies have shown that chiropractic treatment is the most effective treatment of lower back pain, followed by massage therapy. However, the use of the various CAM therapies remains controversial, with acupuncture being the most widely tested and proven therapy for treating chronic pain. Studies have found acupuncture to reduce chronic pain and enhance functioning (Vanneman et al., 2018).

Impact of Stakeholder Needs, Health Care Policy, Regulations, And Governing Bodies

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Impact of Stakeholders

Chronic pain is a public health challenge that has attracted various healthcare stakeholders and governing bodies. For instance, the Department of Health and Human Services (HHS) has envisioned a strategic framework on multiple chronic conditions to accomplish much of what a coordinated national initiative on pain management could do (National Academies of Sciences, Engineering, and Medicine,2017). The HHS initiative recognized the high economic cost of multiple chronic diseases, most of which incorporate significant pain components. Moreover, in chronic pain management, stakeholder support that starts with program design and progress through the evaluation is crucial to a successful Medicaid care management for veterans to manage chronic pain. All stakeholders need to be involved during each stage of the program to manage chronic pain to build support for it, offer suggestions for its design, and evaluate and continue quality improvement initiatives.  In the management of chronic pain in the veteran population, the stakeholders include Medicaid agency leadership, the military health administration, the provider community, the veteran patients and the advocacy community, the legislature, and the Centers for Medicare & Medicaid Services (CMS). These stakeholders significantly influence the choice of treatment interventions to be used on veterans.

Relevant Ethical and Legal Issues

When treating chronic pain with opioid therapy, the issue of opioid overdose and misuse are critical. The healthcare providers, the communities, and government regulators must work together toward better managing chronic pain without overdosing or misusing pain medications. Healthcare providers have a moral obligation to do all they can within their limits to help their patients be free of chronic pain (Kitzmiller, 2018). Therefore, they often abide by the biomedical principles of nonmaleficence and beneficence while providing care. The nonmaleficence principle means that they should harm the patient, while the beneficence principle means that the provider must help prevent or remove harm. Therefore, not ensuring that the veteran's pain and symptoms are managed violates the healthcare professionals' Code of Ethics.

Further, failure to treat pain effectively in the veteran population can lead to legal actions taken against the healthcare provider responsible for administering pain medication. The utilization of medication intended in treating pain or relieving discomfort is legal in all states. However, underprescribing in the context of pain can potentially have serious legal repercussions, incorporating charges about negligence, elder abuse since most veterans are elderly individuals, manslaughter charges if the veteran dies due o errors in medication, and euthanasia charges. Therefore, healthcare professionals need to be aware of multiple facets of pain-related ethical and legal issues, including an appraisal of patient's decision-making capacity to void legal suits being taken against them.

Conclusion

Overall, chronic pain is increasingly becoming a healthcare problem, especially among hospitalized veterans. However, cultural needs and characteristics significantly influence chronic pain management in the veteran population. Moreover, two key models, such as the "shared vulnerability" and the "mutual maintenance," can be considered when it comes to veteran pain management. Moreover, the literature has shown that veterans' nonpharmacological chronic pain management interventions are more effective than opioid therapy. Opioid therapy is associated with deaths from overdose and misuse of opioids and little pain management compared to CAM therapies like chiropractic treatment, massage therapy, and acupuncture therapy. Further, stakeholder engagement in pain management is crucial for the success of any pain management program. Most importantly, all healthcare providers treating veterans have a moral obligation to do no harm and help to prevent or remove harm

References

Edmond, S. N., Becker, W. C., Driscoll, M. A., Decker, S. E., Higgins, D. M., Mattocks, K. M., ... & Haskell, S. G. (2018). Use of nonpharmacological pain treatment modalities among veterans with chronic pain: results from a cross-sectional survey. Journal of general internal medicine, 33(1), 54-60.

Ivery, J. D. (2018). Evidence-Based Strategies and Practices to Manage Veterans' Noncancer Pain: A Systematic Review.

Jukić, M., & Puljak, L. (2018). Legal and Ethical Aspects of Pain Management. Acta medica academica, 47(1).

Kitzmiller, K. (2018). Ethical Considerations in Pain Management. Crossroadshospice.com. Retrieved 14 March 2021, from https://www.crossroadshospice.com/hospice-palliative-care-blog/2018/may/18/ethical-considerations-in-pain-management/.

Lewis, M. J. M., Kohtz, C., Emmerling, S., Fisher, M., & Mcgarvey, J. (2018). Pain control and nonpharmacologic interventions. Nursing2020, 48(9), 65-68.

National Academies of Sciences, Engineering, and Medicine. (2017). Pain management and the opioid epidemic: balancing societal and individual benefits and risks of prescription opioid use.

Sharma, S., Abbott, J. H., & Jensen, M. P. (2018). Why clinicians should consider the role of culture in chronic pain. Brazilian journal of physical therapy, 22(5), 345–346. https://doi.org/10.1016/j.bjpt.2018.07.002

Vanneman, M. E., Larson, M. J., Chen, C., Adams, R. S., Williams, T. V., Meerwijk, E., & Harris, A. H. (2018). Treatment of Low Back Pain with Opioids and Non-pharmacologic Treatment Modalities for Army Veterans. Medical care, 56(10), 855.