INTERVENTION PLAN DESIGN
Intervention Plan Design
Student’s Name
Institution of Affiliation
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 consequences may incorporate compromised physical functioning and immobility, sleep disturbance, fatigue, alteration in mood, depression, anxiety, anger, and irritability. In the veteran population, chronic pain management has become a challenge with the ever-rising prevalence rates of mental health and substance abuse disorders compared to the general population. 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 guided by the following PICOT question:
PICOT Question (Major Components of the Intervention Plan)
In the Veteran population, does nonpharmacological treatment show more effectiveness in treating chronic pain versus opioid therapy in three months?
Population/Patient/Problem (P): Veterans experiencing chronic pain.
Intervention (I): Nonpharmacological Interventions Like CAM therapy.
Comparison (C): Opioid therapy.
Outcome (O): Reduction in the intensity and the frequency of chronic pain
Time (T): 3 months.
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 as well as pain catastrophizing. These factors can play a significant role in the onset and maintenance of chronic pain states in the veteran population. For example, veterans of Asia origin often tend to refrain from talking about their pain. Again, when they communicate their pain, they are often less direct when communicating with a non-Asian clinician than when they communicate with an individual from the same ethnicity as them. 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.
Further, culture also influences pain beliefs. For instance, educated veterans with access to healthcare information on the internet may believe that their low back pain results from a “disc bulge.” However, research indicates that disc budges often resolve on their own (Sharma, Abbott, & Jensen, 2018). The veterans with such beliefs may restrict their activities when they experience pain so that they do not make the “disc bulge” worse. On the other hand, those in rural areas often do not report back pain because they believe low back pain is associated with the normal ageing process. As a result, they often proceed with their normal activities of daily living without complaint or request for medical examination. Again, culture plays a significant role in coping with chronic pain. For instance, passive coping responses like rest and utilization of appliances are mostly not recommended. They may result in further harm, while 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 main theories are considered to result in high comorbidity between PTSD and chronic pain. The first theory is the “shared vulnerability” hypothesis, which states that underlying trait-like anxiety sensitivity, that is, the fear of anxiety symptoms are dangerous, predisposes the veterans to both chronic pain and PTSD (Lewis et al., 2018). The second theory, known as the “mutual maintenance” hypothesis, 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 hypothesis 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. However, this hypothesis was tested and confirmed by the American military (Lewis et al., 2018). Moreover, the US military pain management guidelines have been shown to enhance chronic pain monitoring, education, and relief. The US military also instituted the establishment of programs and guidelines to ensure proper utilization and discourage aberrant behaviors with respect to 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
The main aim of this project is 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, the chronic pain management strategies by providers 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 the use of opioid therapy and an increase in patients diagnosed with chronic pain. Other studies show that veterans prescribed long-term opioid therapy are at increased risk of overdose and accidental deaths while receiving very insignificant pain relief and little enhancement in 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
Chronic pain is a public health challenge that has attracted the attention of 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 take part in evaluation and continuous 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) (National Academies of Sciences, Engineering, and Medicine,2017). 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 that they can within their limits to assist their patients to 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 do no harm to the patient, while the beneficence principle means that the provider must help to prevent or remove harm. Therefore, not ensuring that the veteran’s pain and symptoms are managed violates the healthcare professionals’ Code of Ethics.
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, when it comes to veteran pain management, two key hypotheses, such as the “shared vulnerability” and the “mutual maintenance,” can be considered. Moreover, the literature has shown that nonpharmacological chronic pain management interventions in veterans are more effective than opioid therapy. Opioid therapy is associated with deaths from overdose and misuse of opioids, as well as little pain management as 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 non-pharmacological 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.
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.
