MSN-FP6030 Assessment 1

Need Statement

The study emphases on the treatment of lasting pain among veterans. Research has been conducted to determine whether the non-pharmaceutical treatment of chronic ache in veterans is more efficient than opioid therapy. The clinical question that forms the foundation of the project focuses on the chronic pain management by the opioid therapy option in a veteran home. The purpose of the research is to explore whether opioid therapy is better than non-pharmaceutical therapy. 

Literature on the use of opioid identifies that it is tied to critical issues such as addiction and abuse, and risks of overdose. The target population, veterans, are more at risk of overdose than the general population. Most veterans, especially those in the combat zones, need medical attention for both the physician and psychological pain (Finley et al., 2020). Mental health patients are prone to the abuse of opioid due to their psychological stress than impairs their normal thinking. Veterans with PTSD issues are more likely to get a higher prescription of the drug and sedative-hypnotics. It is a drug combination that increases the risks of overdose in the users. The veterans who use the high dosages have a high probability of committing suicide compared to the non-veterans. 

Target and setting

The target population for the project is the veteran population residing in a long-term home care environment. Research identifies that almost 50% of the veterans in the Veteran Health Administration are vulnerable to chronic pain issues. The literature further shows that veterans also have high rates of pain. They also determine that there are increased rates of severe pain compared to the non-veterans. The available evidence discloses that the severe pain among the veteran population results from the distress and long-term use of opioids. This, an alternative and integrated treatment alternative is recommended to improve pain management among the population. 

Chronic pain is a persistent issue in the veteran population than in the general population. Co-existing mental health outcomes usually accompany it. When the persistent pain goes unrelieved, it can result in depression, anxiety, poor sleep patterns, and a decline in the quality of life, among other issues. The costs of chronic pain comprise loss of efficiency at work, incapacity, and augmented health care costs. As a result, most veteran homes resort to using opioid therapy to counter such extreme pains in the patients to prevent their breakdown into the identified risks. 

Intervention Overview

The use of opioids among veterans addresses most chronic pain incidences. Many physicians do not recommend opioid as a first line intervention for severe pain. The side effects and the risks associated with the medicine influence the judgement of these physicians. Moreover, evidence points that the use of opioid for long-term pain management is ineffective. The use of alternative therapies is recommended to help improve the outcomes. Global health entities, including the Center for Disease Control and Prevention (CDC), identified that more than 50 million adults in the United States endure chronic pain (Gudin, Kaufman & Datta, 2020). The condition is prevalent and has a high intensity in the veterans than in the general citizen population and is often associated with co-existing mental health issues. There is joint and back pain and other muscular ailments categorized as the most common diseases among veterans from the battlefield. The National Institute of Health (NIH) conducted a study in 2017 and identified that 65% of the veterans in America have pain long before they are surveyed (Hadland et al., 2020). The report further identifies that 9.1% categorized as having chronic pain, and it was 40% higher in Veterans than in the non-veterans among individuals who worked in combat in recent conflicts. 

Literature Review

According to White, Lazo, Lidia & Xuezhao (2017), pain management for the veteran population is a current challenge managed through medications. The research also notes that opioids are the most widespread medical approach used to manage intense pain. For the Veteran Affairs Healthcare System (VA HCS) populace, pain is a common sign described among primary care patients. While opioids are determined as effective in managing pain among affected role with cancer and in clinic care, the medication's chronic use presents severe risks for the patients (Hagedornet al., 2018). The body tends to develop a tolerance to the drug, and the same amount of medication becomes inefficient in managing the pain. As a result, it leads to addictive actions and rises the death rates from opioid-related overdoes (Pergolizzi, Varrassi, Paladini & LeQuang, 2019). As a result, harmonizing and consolidative medicine expands within the VA HCS to alleviate the opioid disaster. It then provides a substitute to pharmacological pain-management choices. 

Battlefield Acupuncture (BFA), advanced in 2001, is recommended as an alternative to opioids in the armed and VA HCS amenities. The BFA is recommended as a safe, simple, and fast-acting, and cost-efficient substitute to opioid medicines for the management of chronic pain (Minegishi, Garrido, Pizer & Frakt, 2018). During the treatment using BFA, the clinician homes up to 5 auricular semi-permanent sterile needles in each ear. The technique delivers substantial reduction of the pain instantly. It stimulates the central nervous system, involves the hypothalamus, cingulate gyrus, and cerebral cortex (Godsi et al., 2011). These are the organs thought to constrain the neurotransmitters and provocative markers and eject endogenous opioids. Various studies used practical magnetic character imagination and positive electronic tomography. They showed that the brain's areas relating to the pain feeling are reserved when the auricular acupuncture indicators are in place.  

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Integrative care is recommended as a safer substitute to the use of opioids with less or almost no hostile effects in treating severe pain. It has as well been showed to be an active nonpharmaceutical handling for chronic pain (Wandner et al., 2020). Past studies on the BFA or the auricular acupuncture on the probable for decreasing drug opioid is negligible. Among the literature, there are no randomized controlled trials (RCT) associating to the properties of BFA and opioid use as a key outcome quantity. The prescription of medication used for pain management after the ER treatment was assessed as a secondary result. 

According to Bennett, Golub & Elliott (2017), chronic pain is the reason many Americans seek medical attention. Most of the citizens suffer from joint and back pain especially in the veteran population. A report by the National Institute of Health in 2017 exhibited that the chronic pain in veterans is 40% more than the general population (Rice et al., 2020). When the pain is untreated, the patient develops psychological issues including depression and anxiety. Opioid is the most administered chronic pain medication. Unfortunately, it is associated with high risks of overdose and addiction. 

The different studies associated with the use of opioid as a pain reliever identified that it is associated with severe risks in veterans. According to Nielsen et al. (2016), opioid therapy has high connections to substance abuse and disorders. Studies focused on the veterans was determined to explore the physical histories and the aspects following the retrieval of opioid pharmacy for veteran affair database to note the individuals on opioid therapy (Herman et al., 2019). The study identified that the veterans under the long-tern use of opioid were those with high pain diagnosis and functioning interferences compared to those on short-term opioid prescription. 

 Complementary and alternative medicine (CAM) has been cited as a substitute to opioid treatment for offering safe chronic pain management. Some researchers, including (Bennett, Golub & Elliott (2017), completed RCTs comprising of the VA healthcare outpatient clinics to assess the efficiency of the CAM treatments in managing the CNCP to assess the variance in pain relief elements of different CAM methods (Belitskaya, Clark, Shih & Bair, 2021). These methods included massage therapy, manipulation, and herbal agents, among others. The researchers note that the participants who have used CAM methods in the past and those who had not compared their levels of satisfaction in the treatments received (Kip et al., 2014). Most of these studies note that the use of opioid therapy is not as effective as implied by how veterans are using the option. Most of the evidence point that there is a need to find an alternative to opioid therapy, including establishing rules and policies that limit the prescription of opioids. 

References

Bennett, A. S., Golub, A., & Elliott, L. (2017). A behavioral typology of opioid overdose risk behaviors among recent veterans in new york city. PLoS One, 12(6) doi:http://dx.doi.org/10.1371/journal.pone.0179054

Belitskaya-Levy, I., Clark, J. D., Shih, M., & Bair, M. J. (2021). Treatment preferences for chronic low back pain: Views of veterans and their providers. Journal of Pain Research, 14, 161-171. doi:http://dx.doi.org/10.2147/JPR.S290400

Finley, E. P., Schneegans, S., Curtis, M. E., Bebarta, V. S., Maddry, J. K., Penney, L., . . . Jennifer, S. P. (2020). Confronting challenges to opioid risk mitigation in the U.S. health system: Recommendations from a panel of national experts. PLoS One, 15(6) doi:http://dx.doi.org/10.1371/journal.pone.0234425

Gudin, J., Kaufman, A. G., & Datta, S. (2020). Are opioids needed to treat chronic low back pain? A review of treatment options and analgesics in development. Journal of Pain Research, 13, 1007-1022. doi:http://dx.doi.org/10.2147/JPR.S226483

Godsi, S. M., Saadatniaki, A., Aghdashi, M. M., Firoozabadi, N. K., & Dadkhah, P. (2011). Outcome of continuous intrathecal opioid therapy for management of chronic pain in iranian veterans of the imposed iraq- iran war. Acta Medica Iranica, 49(7), 456-9.

Hagedorn, H., Kenny, M., Gordon, A. J., Ackland, P. E., Noorbaloochi, S., Yu, W., & Harris, A. H. S. (2018). Advancing pharmacological treatments for opioid use disorder (ADaPT-OUD): Protocol for testing a novel strategy to improve implementation of medication-assisted treatment for veterans with opioid use disorders in low-performing facilities. Addiction Science & Clinical Practice, 13 doi:http://dx.doi.org/10.1186/s13722-018-0127-z

Hadlandsmyth, K., Mosher, H. J., Vander Weg, M.,W., Amy M. O’Shea, McCoy, K. D., & Lund, B. C. (2020). Utility of accumulated opioid supply days and individual patient factors in predicting probability of transitioning to long‐term opioid use: An observational study in the veterans health administration. Pharmacology Research & Perspectives, 8(2) doi:http://dx.doi.org/10.1002/prp2.571

Herman, P. M., Yuan, A. H., Cefalu, M. S., Chu, K., Zeng, Q., Marshall, N., . . . Taylor, S. L. (2019). The use of complementary and integrative health approaches for chronic musculoskeletal pain in younger US veterans: An economic evaluation. PLoS One, 14(6) doi:http://dx.doi.org/10.1371/journal.pone.0217831

Kip, K. E., Rosenzweig, L., Hernandez, D. F., Shuman, A., Diamond, D. M., Girling, S. A., . . . Mcmillan, S. C. (2014). Accelerated resolution therapy for treatment of pain secondary to symptoms of combat-related posttraumatic stress disorder. European Journal of Psychotraumatology, 5 doi:http://dx.doi.org/10.3402/ejpt.v5.24066

Minegishi, T., Garrido, M. M., Pizer, S. D., & Frakt, A. B. (2018). Effectiveness of policy and risk targeting for opioid-related risk mitigation: A randomised programme evaluation with stepped-wedge design. BMJ Open, 8(6) doi:http://dx.doi.org/10.1136/bmjopen-2017-020097

Nielsen, Suzanne,B.Pharm, PhD., Campbell, G., M.Crim, Peacock, Amy,B.A.Hons, PhD., Smith, K., M.Sc, Bruno, R., PhD.(Clin), Hall, W., PhD., . . . Degenhardt, Louisa,B.A.(Hons - Psychology), M.Psycho. (2016). Health service utilisation by people living with chronic non-cancer pain: Findings from the pain and opioids IN treatment (POINT) study. Australian Health Review, 40(5), 490-499. doi:http://dx.doi.org/10.1071/AH15047

Pergolizzi, J. V., Varrassi, G., Paladini, A., & LeQuang, J. (2019). Stopping or decreasing opioid therapy in patients on chronic opioid therapy. Pain and Therapy, , 1-14. doi:http://dx.doi.org/10.1007/s40122-019-00135-6

Rice, D., Corace, K., Wolfe, D., Esmaeilisaraji, L., Michaud, A., Grima, A., . . . Hutton, B. (2020). Evaluating comparative effectiveness of psychosocial interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analyses. PLoS One, 15(12) doi:http://dx.doi.org/10.1371/journal.pone.0244401

Wandner, L. D., Fenton, B. T., Goulet, J. L., Carroll, C. M., Heapy, A., Higgins, D. M., . . . Kerns, R. D. (2020). Treatment of a large cohort of veterans experiencing musculoskeletal disorders with spinal cord stimulation in the veterans health administration: Veteran characteristics and outcomes. Journal of Pain Research, 13, 1687-1697. http://dx.doi.org/10.2147/JPR.S241567

White, P. F., Elvir Lazo, O. L., Lidia, G., & Xuezhao, C. (2017). Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management. F1000Research, 6 http://dx.doi.org/10.12688/f1000research.12324.1