Pain management nursing : official journal of the American Society of Pain Management Nurses
-
Randomized Controlled Trial
Tapering Opioid Prescription Program for High-Risk Trauma Patients: A Pilot Randomized Controlled Trial.
Chronic opioid use has been documented in up to 20% of patients with traumatic injuries. Hence, we developed the Tapering Opioids Prescription Program for high-risk Trauma (TOPP-Trauma) patients. ⋯ Some challenges need to be addressed before testing TOPP-Trauma. These include creating strategies to decrease attrition, offering the program throughout the care continuum to higher risk patients, and evaluating the impacts of reduced opioid use.
-
Heart rate variability biofeedback (HRVB) is a self-management strategy that guides individuals to breathe at a designated resonance frequency of the cardiovascular system. Resonant breathing may reduce FM-related symptoms as well as improve physical functioning and quality of life. Although prior research recommends HRVB for chronic pain, we found no studies testing the feasibility for individuals with FM regarding protocol adherence or acceptability of the treatment. ⋯ Results of this study suggest difficulties operating the emWave2 and scheduling challenges interfered with HRVB implementation. However, veterans reported self-awareness of the benefits of HRVB, positive physiological effects, and improved psychological effects. Future studies require a larger sample size to provide a deeper insight.
-
Chronic pain management is a major challenge for primary care providers (PCPs). PCPs manage many patients with chronic pain and other comorbidities including mental health problems like post-traumatic stress disorder (PTSD) and depression. Chronic pain and opioid problems are a national crisis, particularly among veterans (U.S. Department of Veterans Affairs, 2019). There are many veterans with chronic non-cancer pain who are being treated with opioids. Chronic opioid use has contributed to an epidemic of opioid-related adverse events (VA, 2017). Opioids not only result in poor pain control, but have associated risks such as misuse, overdose, and diversion which may be fatal (Frieden & Houry, 2016). ⋯ APRNs are in a key position to assess and treat patients based on current evidence while facilitating opioid titration. This initiative highlights that safe tapering of opioids is possible when utilizing a multidisciplinary approach for chronic pain management. Findings support the use of non-pharmacologic and non-opioid therapy for chronic pain management which can result in reduced patient-reported pain. Further research is warranted to examine both pharmacologic (non-opioid) and non-pharmacologic strategies that promote pain management while tapering opioids.
-
To explore how health care providers in the United States are adapting clinical recommendations and prescriptive practices in response to patient use of medical cannabis (MC) for chronic pain symptoms. ⋯ MC use for chronic pain is increasing with cannabis legalization. Provider practices are heterogenous, demonstrating a balance of treating chronic pain using available evidence, while being aware of potential harms associated with MC and opioids.
-
Misuse of prescription opioids is a public health crisis in the United States. In 2016, it was estimated that 3.3 million Americans were misusing prescription opioids (SAMHSA, 2017) and nearly 63,632 deaths were due to prescription opioid misuse. From 1999 to 2010, the number of prescription opioid drugs sold to health care facilities from pharmaceutical companies, nearly quadrupled. Cesarean delivery is the most common surgical procedure performed in the United States and opioids are most often chosen to manage post-operative pain. Research has shown that women, who deliver via cesarean section, are prescribed an excess of opioid tablets upon discharge and often store them in unsecure locations. Furthermore, the vast majority, are not disposed of properly. ⋯ Engaging post-operative patients in decisions regarding pain management, educating women on multi-modal methods to manage pain, and providing women with a means to properly dispose of excess tablets, can reduce opioid tablets available for misuse and diversion in the community.